Cotiviti radically evolves healthcare fraud prevention with its groundbreaking 360 Pattern Review solution, swiftly tackling fraud, waste, and abuse (FWA) across the entire payment cycle. this AI-powered innovation pinpoints suspect claim patterns, empowering payers to prevent and recover losses more effectively. Dental FWA, including costly overtreatment, is a major target. The new solution streamlines complex reviews with detailed provider scoring models. Stay informed about the latest industry advancements with News Directory 3. Learn from experts like Dr. Steven M. Canfield, who address methods to detect and counteract FWA in dental payments, emphasizing the risks of upcoding and more. Discover what’s next in the fight against healthcare fraud.
Cotiviti Launches 360 Pattern Review to Combat Healthcare FWA
New Orleans — As healthcare fraud, waste, and abuse (FWA) schemes become increasingly sophisticated, Cotiviti is introducing a new approach to combatting these issues in both dental and healthcare payments. The company unveiled its 360 Pattern Review solution at the National Health Care Anti-Fraud Association (NHCAA) Annual Training Conference.
The 360 Pattern Review solution combines advanced prepay fraud detection with postpay insights. This extensive tool is designed to help healthcare payers prevent and recover more FWA, while also streamlining the frequently enough-complex claims review process. The system is powered by an AI-driven analytics engine that identifies suspect claim patterns throughout the entire payment cycle.
With healthcare costs and medical loss ratios continuing to rise, this solution aims to transform how payers manage FWA. It leverages robust provider scoring models and lead vetting by subject matter experts, ultimately benefiting members, providers, and the healthcare industry as a whole. The goal is to reduce inappropriate payments and increase efficiency without disrupting existing systems.
Dental FWA contributes a significant portion to the hundreds of billions of dollars lost annually in the U.S.healthcare system. Overtreatment, such as unnecessary crowns or root canals, leads to significant financial losses for dental payers. The administrative burden of audits and investigations further increases premiums for policyholders.
Steven M. Canfield, DDS, senior dental director at Cotiviti, participated in a discussion on “Counteracting FWA in Dental payments” at the NHCAA conference. Canfield, along with Thomas Redd, DDS, MS of Delta dental of Arkansas, highlighted real-world examples and innovative methods to detect these practices before they impact patient costs. The discussion covered how issues like overtreatment and upcoding can drive up premiums and erode patient trust.
What’s next
Cotiviti continues to develop and refine its 360 Pattern Review solution, aiming to further enhance payment integrity and reduce the impact of FWA on healthcare organizations.
