Cotiviti Consolidates Inpatient Claim Review with New Payment Accuracy Tools
Event summary
- Cotiviti added Itemized Bill Review and Inpatient Coding Validation to its Payment Accuracy suite, enabling health plans to review all inpatient claims through a single platform.
- The new capabilities aim to reduce administrative complexity and improve payment accuracy by addressing coding, clinical, and billing errors in one system.
- Cotiviti claims the tools can identify an additional 9 to 12% in errors on inpatient claims.
- Medicare Fee-for-Service claims had a 6.5% improper payment rate in fiscal year 2025, highlighting the need for better payment accuracy.
The big picture
Cotiviti's move to unify inpatient claim review aligns with broader industry trends toward reducing administrative complexity and improving payment accuracy in healthcare. The consolidation of claim review capabilities into a single platform addresses the fragmented review processes that have historically plagued health plans. With Medicare's improper payment rate at 6.5% in 2025, the need for more accurate and efficient claim review systems is critical for cost management and operational efficiency.
What we're watching
- Adoption Pace
- How quickly health plans will integrate Cotiviti's unified platform into their existing systems.
- Error Reduction
- Whether the additional 9 to 12% error identification will translate into meaningful cost savings for health plans.
- Competitive Response
- How competitors in the healthcare payment accuracy space will react to Cotiviti's consolidated offering.
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