Enhanced Clinical Editing Processes

Starting on Sept. 1, 2021, EmblemHealth will be expanding our partnership with Cotiviti, Inc. for periodic post-payment reviews of paid medical claims. The post-payment reviews to be conducted are: Retrospective Accuracy datamining (RA) and Clinical Claim Validation DRG review (CCV). These are the same/similar reviews that are currently being conducted by Optum on behalf of EmblemHealth. Click here for more information.