Health plans have an obligation to protect their funding from inappropriate expenditures, whether that funding comes from member premiums or taxpayer dollars. But payers of all sizes can be vulnerable to significant amounts of claim errors, waste, and abuse every year. This challenge is particularly significant for Medicaid plans, which serve low-income members who often face challenges related to health equity and social determinants of health. With the latest reported Medicaid improper payment rate exceeding 8.5% according to the Centers for Medicare & Medicaid Services (CMS), these plans must protect their already-thin margins from inappropriately coded claims—on top of bad actors looking to exploit their members and their payment policies. That’s why one Cotiviti client, a large Medicaid payer, partners with Cotiviti for both second-pass prepay claim editing and prepay review of complex coding errors—with more than 80% of Cotiviti’s overall savings delivered before claims are paid.

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