Self-funded health plans, which include 63% of covered workers in the United States, grapple with cost pressures similar to fully funded plans, such as inflation, increased chronic care incidence, and higher utilization rates. However, these plans can lag in adopting payment integrity measures, especially when they lack the support of a third-party administrator (TPA) that offers these services. Ensuring accurate payment of medical claims and reducing administrative waste has become crucial, with plan sponsors seeking greater transparency and accountability from their TPAs. After initially partnering with Cotiviti in 2020 for prepay claim review and clinical auditing on fully insured claims, one large health plan expanded the scope of its relationship with Cotiviti in 2023 to include self-funded groups, acting as a benefits administrator to self-insured clients.

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