As health plans increasingly adopt formal prepay fraud, waste, and abuse (FWA) programs, many still face challenges such as limited resources, unsatisfactory results, or uncertainty about where to begin. For Highmark Wholecare, finding a solution that would complement the health plan’s existing special investigations unit (SIU) without increasing the team’s workload was critical. We invite you to join Cotiviti and Highmark Wholecare for our next payment integrity webinar this Thursday, September 26 at 1 pm ET focusing on lessons learned from a successful prepay FWA program. You’ll learn more about Highmark Wholecare’s implementation of Cotiviti’s Claim Pattern Review solution, which led to success in identifying and preventing improper claims across critical areas such as durable medical equipment (DME) and more. The collaboration also allowed the health plan to proactively flag and address potentially fraudulent billing behaviors, all while maintaining high accuracy and low appeal rates from providers.  

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