Discovery

Are there leaks in the system that we can’t see?

ost health plans contract with recovery vendors to help identify and recoup claims overpayments, but even with this expensive outside help, payers are never certain that they’ve plugged every leak in their pipes.

To help one client solve this challenge, Cogitativo developed machine-learning models that identified over $40 million in yearly overpaid claims not previously found by their incumbent recovery vendors.

Even better, our client validated our algorithms as 100% accurate (compared to incumbent vendor accuracy of 10%).

With this new found capability to identify overpayments earlier in the process, our client will be able to fix their systems and stop overpaying claims once and for all.

Other Discoveries