11 August 2026

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Cotiviti Improves AI-Powered Dental Payment Integrity

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Modernized solution unifies claim workflows, expands transparency, and delivers scalability.

Cotiviti, The Healthcare Infrastructure Company™, has launched an enhanced version of its prepay dental payment integrity solution to support real-time claim processing, expanded content and policy development through AI-assisted rule authoring, improved policy transparency, and streamlined fraud, waste, and abuse detection for both healthcare and standalone dental payers.

Delivered as a fully integrated offering on Cotiviti’s market-leading prepay claim editing platform, Payment Policy Management , the new Dental Claim Accuracy solution brings dental and medical payment accuracy workflows onto a single, scalable foundation, enabling plans to improve claim accuracy, increase transparency, and support future growth across lines of business. Accredited by URAC, Dental Claim Accuracy combines configurable, policy-driven code editing, professional clinical validation by licensed dentists, analytics, and review workflows within the same platform that payers already trust for medical claim editing, supporting both batch and real-time processing while providing clients with greater visibility into claim decisions.

“With dental spending reaching an estimated $198 billion per year, dental payers face increasing challenges from fraud, waste, and abuse, overtreatment, miscoding, inappropriate billing practices, and rising coding complexity. These issues contribute to improper payments, increased administrative burden, unnecessary utilization, and pressure on plan resources,” said Matthew Hawley, Executive Vice President of Payment Integrity for Cotiviti. “Dental Claim Accuracy brings the same proven platform, policy management capabilities, and transparency that payers rely on for medical claims into the dental space. By integrating dental claims onto our Payment Policy Management platform, both health and dental-only plans can simplify operations and strengthen payment accuracy as claim volumes grow.”

Dental Claim Accuracy also expands transparency for clients through integration with Cotiviti’s Payment Clarity® platform, which provides clear explanations of why claims were flagged, the policies applied, and recommended next steps. It also delivers executive-ready reporting and analytics to measure savings, monitor trends, and demonstrate program effectiveness. Together, these capabilities provide payers with a more transparent, defensible, and operationally efficient dental payment integrity program.

The enhanced solution reflects Cotiviti’s broader strategy of helping health and dental plans move from fragmented point solutions toward a connected infrastructure that improves the accuracy and efficiency of healthcare transactions. By leveraging a common platform architecture, clients can extend established workflows, integrations, and policy management practices across both medical and dental claims while reducing operational friction and improving consistency.

“Dental plans need solutions that can keep pace with evolving billing practices, increasing claim complexity, and emerging fraud, waste, and abuse patterns,” said Steven Canfield, DDS, Senior Dental Director at Cotiviti. “By combining advanced claim editing with professional clinical validation, documentation review, and decades of dental expertise, Dental Claim Accuracy helps plans identify suspect claims before payment, improve the precision of payment decisions, and better protect both plan resources and member benefits.”

Dental Claim Accuracy is the latest example of Cotiviti’s ongoing evolution beyond traditional point solutions toward becoming the structural utility layer connecting healthcare. By bringing more workflows, intelligence, policy management, and decision support onto a unified platform, Cotiviti helps payers govern financial accuracy more effectively, reduce information gaps, and create a more connected healthcare ecosystem.

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 more than 300 million members and patients. For more information, visit www.cotiviti.com .

Source: http://www.cotiviti.com/