eBook: How AI can drive health plan success

Payment integrity is an integral part of healthcare delivery, maximizing the value patients receive for their healthcare dollar by helping ensure claims are paid accurately and reducing fraud, waste, and abuse. However, this requires specialized processes and teams to review large amounts of data in a short time, often putting strain on health plan resources.

With the introduction of artificial intelligence (AI), payment integrity is evolving rapidly. As payers seek to incorporate AI into their payment integrity solutions, finding the balance between human expertise and machine learning is critical. There is significant opportunity for improvement, but there is also real risk.

Read our new eBook as we discuss how payers can responsibly deploy AI to reduce administrative burden, enhance data accuracy, and ease provider abrasion. Join us as we explore the future of artificial intelligence in payment integrity and learn how Cotiviti responsibly deploys AI in our solutions, focusing on:

• Common barriers that prevent payers from implementing AI into their payment integrity programs
• Best practices to deploy AI responsibly and effectively
• Questions to ask potential payment integrity partners about AI

As payers seek to incorporate AI into their payment integrity solutions, finding the balance between human expertise and machine learning is critical.

One area where AI is driving improved results ?is deciding which medical records to retrieve for review. With the targeted application of AI, health plans can focus on the records most likely to yield a finding of incorrect coding or payment. Using AI to improve medical records selection can increase savings, reduce resources wasted on unnecessary chart retrieval, and decrease provider abrasion.

For one large regional health plan, Cotiviti experts deployed AI-enabled chart selection to improve their clinical review program. After previously experiencing medical record retrieval issues and poor clinical review results, the plan grew its savings by six times in one year. Read our case study and learn more about how effective, targeted use of AI can drive additional value while also helping to maintain positive provider relationships.

By focusing on the capabilities of AI as a tool deployed in addition to human expertise, plans can achieve more value from their payment integrity programs without sacrificing accuracy. Don’t miss this opportunity to learn more about AI’s potential in delivering better healthcare outcomes.

About the author

As senior vice president of product development, Brett’s role is to understand client needs and lead the process of enhancing Cotiviti’s product portfolio to meet them. This involves engaging with clients, understanding market needs, leading product discovery,?developing market strategies, building business cases, managing a product roadmap, defining solutions,?and leading market launches.