INSURANCE SOLUTIONS

Protecting enterprise value.

Our investigative solutions are accurate, robust and highly effective. As a trusted partner, we work diligently to protect against every type of fraudulent activity, with a level of service built upon vast amounts of experience in the field. Our worldwide network of expert investigators provides comprehensive, case-specific fraud and loss protection. Anywhere. Plus, the implementation of best practices is a distinct advantage we offer our partners. From claim referral to resolution, we provide one convenient place for comprehensive and full-service fraud investigations. We are the insurance industry’s premier full-service provider and we’re ready to help.

GOVERNMENT SOLUTIONS

Verify and validate.

From enrollment compliance to adherence with program requirements, we deliver verification and validation services to key stakeholders and regulators in their administration. Our professionally licensed investigative staff work with fraud SMEs and data analysts to provide accurate, reliable and actionable information to use in the fight against fraud. All the while continuing to provide oversight of benefits and entitlement programs. We empower program decisionmakers to make better payment decisions and ensure receipt of public services by those who are genuinely entitled to them. We also help confirm that providers who render and bill for services are authorized and perform those services according to program rules and regulations. As both an organization and a strategic partner with government vendors, we stand on the front line in the fight against fraud, waste and abuse.

INTERNATIONAL SOLUTIONS

Solutions without borders.

The distinct advantage the comes from working with us is our deep, global reach that ensures that no matter where the case may lead, we’re able to follow it. We are backed by an international team of 500 foreign investigators, serving more than 700 company clients in over 100 countries world-wide. Our foreign investigation team works strategically in high-claim areas like the Pacific Rim, mainland China, Mexico, and Puerto Rico. These fully licensed specialists adhere to stringent investigative standards that are easily monitored through our SmartPartner™ site.

HEALTH PLAN FWA SOLUTIONS

Powerfully effective.

CoventBridge Group’s industry leading expertise in revenue recovery and compliance, combined with our deep understanding of the need to maintain and improve provider relationships, enables us to successfully balance these competing priorities while delivering a valuable return to our health plan clients.

For over 20 years, the CoventBridge team has served as an FWA contractor for CMS investigating Medical Provider Fraud, Waste, & Abuse in Medicare, Medicaid, and commercial lines of business.

Strong roster of data analysts for prospective & retrospective reviews, Certified Coder Registered Nurses for clinical review and a national network of licensed investigators, along with in-house legal and clinical resources.

Experienced, flexible, and sensitive approach to preventing provider abrasion, while still achieving client objectives.