Cotiviti Saves Dental Plan Clients an Average 1.5% on Claim Spend with Market-Leading Dental Claim Accuracy Solution

Cotiviti, a leader in data-driven healthcare solutions, saved its dental payer customers an average of 1.5% of their total claim spend over 2020 with its Dental Claim Accuracy solution. For one client, this solution has delivered millions of dollars in annual dental claim savings. This offering is part of Cotiviti’s complete payment integrity solution suite, which leverages the company’s access to vast clinical and financial healthcare data to unlock previously unrealized medical and administrative cost savings along the entire payment lifecycle across dental carriers and health plans.

According to the National Health Care Anti-Fraud Association (NHCAA), an estimated $12.5 billion of the $250 billion spent on dental care nationwide is lost to dental waste and abuse every year. Cotiviti’s Dental Claim Accuracy solution zeroes in on this longstanding issue to detect improperly coded claims early and render payment recommendations to dental clients within hours after being reviewed by dental coding analysts and dentists on staff. The company’s prepay accuracy offering allows dental plans to prevent incorrect payments from being made and focus pay-and-chase efforts on larger abuse schemes.

“Financial losses due to waste and abuse have long been a significant challenge for dental payers, and these organizations are looking for ways to improve their payment integrity strategies in order to remain financially stable – especially in the midst of the COVID-19 pandemic,” said Emad Rizk, M.D., chairman, president, and CEO of Cotiviti. “Cotiviti is one of the few vendor organizations that solely focuses on health and dental plans, and has become a trusted partner and leader in the space because we analyze hundreds of billions of claims every year to curb inappropriate payments. By applying our deep dental analytics expertise to our extensive set of dental and medical data, Cotiviti has been able to uncover critical payment accuracy insights to decrease inappropriate payments before they are made, delivering significant savings to our dental plan clients for over fifteen years.”

By sharing product and process quality controls across both medical and dental platforms, and leveraging lessons learned from both platforms to inform broader fraud, waste, and abuse initiatives, Cotiviti enables greater payment integrity insights and associated results for payer clients. Cotiviti’s leading prepay dental payment integrity services combine automated claim editing, quick clinical claim review, and integrated prior authorization and appeals support to catch instances of over-coding that would otherwise be missed. For example, Cotiviti has been able to detect abuse issues by identifying suspicious claims for unnecessary bone removals that could have resulted in tens of thousands of dollars lost per year.

“In addition to historic challenges with waste and abuse in the dental space, the ever-changing landscape of CDT codes creates complexity for plans, providers, and members, often resulting in incorrect coding of procedures and inappropriate payments,” said Steven Canfield, D.D.S., medical director at Cotiviti. “There is a significant market need for a proven payment integrity solution in the dental space, and very few organizations are able to offer robust payment integrity analytics that are informed by massive amounts of dental and medical data. By optimizing the ability to detect and report suspicious claims, Cotiviti has been able to help dental payers avoid inappropriate payments without disrupting their current workflow, saving many of them millions in unnecessary costs every year.”

To learn more about Cotiviti’s Dental Claim Accuracy solution, visit Cotiviti’s website and view Cotiviti’s recent webinar hosted by the National Association of Dental Plans.

About Cotiviti

Cotiviti is a leading solutions and analytics company that is reshaping the economics of healthcare, helping its clients uncover new opportunities to unlock value. Cotiviti’s solutions are a critical foundation for healthcare payers in their mission to lower healthcare costs and improve quality through higher performing payment accuracy, quality improvement, risk adjustment, and network performance management programs. Cotiviti’s healthcare solutions are powered by Caspian Clarity, a proprietary data and analytics platform spanning thousands of unique member and provider data types across financial and clinical domains, representing the most comprehensive longitudinal data set in healthcare. The company also supports the retail industry with data management and recovery audit services that improve business outcomes. For more information, visit www.cotiviti.com.

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