CommercialAdministrativeMedium impact
Enhanced Clinical Editing Processes
EmblemHealth·Provider News
Effective date
Sep 1, 2021
We identified it
Jun 20, 2026
Summary
EmblemHealth is expanding their partnership with Cotiviti, Inc. starting September 1, 2021, to conduct post-payment reviews of paid medical claims. These reviews will include Retrospective Accuracy datamining (RA) and Clinical Claim Validation DRG review (CCV), similar to current Optum reviews.
Action Required
By September 1, 2021: Billing team should review current documentation practices and ensure all claims submitted to EmblemHealth have proper supporting documentation and accurate coding. Prepare for potential post-payment review requests from Cotiviti and maintain organized claim files for easy retrieval during audits.