Beyond prior authorization: Ensuring accuracy of specialty drug claims

Learn and solve common challenges in processing specialty drug claims

Register for the webinar

Specialty drugs are in a complex area of claims processing. Almost half of specialty drug claims occur under a plan’s medical benefit rather than the pharmacy benefit. They’re also typically drugs that are administered by the provider—often intravenously—and are used for treating chronic and complex diseases. And they can be notoriously expensive.

This complexity and expense make specialty drug claims especially prone to inaccurate billing, or worse, fraud and abuse. While many plans use prior authorization to handle these claims, relying solely on this process can result in limited details that can leave plans open to inappropriate claims.

Join our Cotiviti experts as we walk through solving the complex challenges of specialty drug claims in our webinar, Beyond prior authorization: Ensuring accuracy of specialty drug claims.

In this webinar, our specialty claim experts will discuss:

  • The latest trends in specialty drug spending
  • Common areas of claim errors, waste, abuse, and fraud
  • Concepts to improve claim accuracy and reduce patterns of fraud and abuse


Cotiviti presenters:



Jonathan Starr, PharmD, Senior Consultant, Cotiviti

Jonathan supports Cotiviti’s vast library of Drugs and Biologicals payment policies and aids in presenting these policies to clients. He has also managed and operated Cotiviti’s pharmacy fraud, waste, and abuse solutions since 2016.




Matthew Herbein, Director, Audit Operations, Cotiviti

Matthew is a seasoned auditor, specializing in data science, analytics, and payment integrity, with a demonstrated history of working in information technology and healthcare services. He is responsible for overseeing pharmaceutical audit activities to maximize valid claim identification and overpayment recoveries, while meeting contractual commitments and delivering customer satisfaction.


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