Reminder: Enhanced Clinical Editing Processes – Post-Payment Reviews Have Begun


Starting on Sept. 1, 2021, Cotiviti, Inc. began periodic post-payment reviews of EmblemHealth’s 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.