Cotiviti Unifies Inpatient Claim Review on a Single Platform

SALT LAKE CITY--(BUSINESS WIRE)--Cotiviti, The Healthcare Infrastructure Company™, today announced two additions to its Payment Accuracy suite that allow health plans to review all inpatient claims through a single platform — reducing administrative complexity and eliminating the need to piece together multiple vendors and point solutions. The expansion brings together capabilities that health plans have traditionally managed through separate programs, creating a more unified approach to payment accuracy.

"These new capabilities give our clinical team a more complete picture of each claim, helping us catch errors more accurately and ensure payments reflect the care that was actually provided."

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Medicare Fee-for-Service claims had a 6.5% improper payment rate in fiscal year 2025, according to the Centers for Medicare & Medicaid Services — reflecting billions of dollars in payments affected by documentation, coding and billing errors.

“Health plans want a simpler, more effective way to ensure claims are paid correctly,” said Cheri Moehring, Executive Vice President of Clinical Chart Validation at Cotiviti. “By bringing itemized bill review, coding validation and clinical expertise together through a single connection, we help health plans review every inpatient claim more accurately and pay claims correctly the first time.”

The new offerings, Itemized Bill Review and Inpatient Coding Validation, expand Cotiviti's Payment Accuracy suite, which combines claim editing, advanced analytics and clinical review across the payment lifecycle. Together, these capabilities allow health plans to review 100% of inpatient claims through a single platform. Instead of relying on separate vendors to address coding, clinical and billing errors, health plans can manage the full spectrum of inpatient claim review through a unified solution, improving efficiency and payment accuracy.

Itemized Bill Review analyzes high-cost facility claims to spot billing errors such as miscoding, unbundling, upcoding and duplicate charges. Inpatient Coding Validation strengthens Diagnosis-Related Group (DRG) review through deeper coding and clinical analysis before payment. Together, they help health plans address both DRG and non-DRG inpatient spending through a single program, delivering an additional 9 to 12% in identified errors on inpatient claims.

“Inpatient claims are among the most complex to review, and even small documentation or coding gaps can have a significant financial impact,” said Dr. James Lee, Senior Medical Director at Cotiviti. “These new capabilities give our clinical team a more complete picture of each claim, helping us catch errors more accurately and ensure payments reflect the care that was actually provided."

These additions build on Cotiviti's existing inpatient payment accuracy capabilities, expanding the company’s ability to help health plans catch payment issues earlier and manage the full spectrum of inpatient claim review through a single partner.

By bringing automated policy enforcement, coding validation and clinical expertise together on a single platform, Cotiviti helps health plans move from fragmented review processes to a more connected approach to payment integrity, reducing complexity, improving accuracy and preventing errors before payment.

About Cotiviti

Cotiviti’s infrastructure platform enables healthcare organizations to deliver better care at lower cost through advanced technology and data analytics that improve the quality and sustainability of healthcare in the United States. Cotiviti’s solutions increase transparency and collaboration between payers and providers while empowering them to reduce medical and administrative costs, enable better health, improve claims payment efficiency, streamline operations, drive interoperability and advance value-based care. Its customers serve the majority of U.S. healthcare consumers, providing coverage and care for over 300 million members and patients. For more information, visit www.cotiviti.com.