Case Study: a regional Blue Plan achieves nearly $100M in savings with Cotiviti’s payment integrity solutions

How a strategic focus on prepayment claim accuracy led to nearly $100M in savings for one Blue Plan

A large regional Blue Plan serving over 4 million members was facing significant financial losses due to improper claims passing through its internal systems. To address this challenge and improve prepayment claim accuracy, the health plan partnered with Cotiviti for a solution.

Cotiviti implemented its Payment Policy Management solution as a secondary editing filter, followed by its Coding Validation service for complex claims. This two-pronged approach resulted in nearly $100 million in client savings for the Blue Plan in 2020, including $62 million from professional claims and $36 million from outpatient claims. The Cotiviti solution also improved payment accuracy and reduced provider abrasion.