Payment Integrity: Benefits Admin Success Story
- These plans face similar cost challenges as fully funded ones, including inflation and increased chronic care.
- Plan sponsors are increasingly demanding openness and accountability from their TPAs to ensure accurate medical claim payments and reduce administrative waste.
- One large health plan initially partnered with Cotiviti in 2020 for claim reviews and clinical auditing on fully insured claims.In 2023, they expanded their relationship to include self-funded...
Self-funded health plans are under pressure from rising healthcare costs, making payment integrity the ultimate strategy for cutting expenses. This Benefits Admin Success Story details how one large health plan expanded its partnership with Cotiviti in 2023, leveraging innovative solutions to improve payment accuracy and reduce administrative burdens. Prioritizing payment accuracy is crucial for managing costs and avoiding wasteful spending, a key challenge for self-funded plans. Cotiviti now acts as a benefits administrator for self-insured clients, offering critical support. As News Directory 3 can confirm, this approach yields meaningful results. Learn about how companies are adapting to today’s economic climate as they strive for financial health. Discover what’s next for this health plan.
Self-funded Health Plans Enhance Payment Integrity to Cut Costs
Updated June 10, 2025
More than 60% of U.S. workers with health coverage are in self-funded plans. These plans face similar cost challenges as fully funded ones, including inflation and increased chronic care. Though, self-funded plans sometimes lag in adopting crucial payment integrity measures, especially without third-party administrator (TPA) support.
Plan sponsors are increasingly demanding openness and accountability from their TPAs to ensure accurate medical claim payments and reduce administrative waste. Improving payment accuracy is a key strategy for managing costs.
One large health plan initially partnered with Cotiviti in 2020 for claim reviews and clinical auditing on fully insured claims.In 2023, they expanded their relationship to include self-funded groups, with Cotiviti acting as a benefits administrator for self-insured clients. this expansion aims to improve payment accuracy and reduce administrative burdens.
What’s next
Health plans are expected to continue prioritizing payment integrity and seeking innovative solutions to manage costs and improve the efficiency of self-funded health plans.