Case Study: Layered (mid-sized health plan) achieves $19.5M in pre- and postpay savings with Cotiviti

Layered approach delivers pre and postpay savings for mid-sized health plan

Layered, a mid-sized health plan with nearly 1 million members across primarily commercial and ASO lines, needed to strengthen pre- and postpayment integrity while minimizing provider abrasion. Layered partnered with Cotiviti and deployed solutions including COB Validation, Payment Data Validation, Payment Policy Management, Clinical Chart Validation, and later Coding Validation to address correct-coding and payment integrity gaps.

Cotiviti implemented a layered prepay and postpay approach—combining prepay editors and final filter logic with postpay COB, data mining, and clinical chart review—which yielded $19.5M in savings in 2020 (about $14 PMPY prepay and $6 PMPY postpay) and produced a 1.1% prepay net savings rate and 0.2% postpay net savings rate. Cotiviti’s work increased incremental prepay savings beyond the plan’s primary editor, boosted postpay recoveries, preserved positive provider relationships, and delivered measurable cost savings and time-to-value.