Payers

Commercial, Medicare, and Medicaid lines of business all face unique challenges in a rapidly changing market. The key to success, however, remains constant: smart decisions based on sound data. Whether you want to improve payment accuracy, risk adjustment, care quality, consumer engagement, or network performance, Cotiviti has the most complete set of solutions to meet your needs, backed by decades of experience and our passionate commitment to your success.

Government

Government agencies, especially those responsible for providing health benefits for the most vulnerable populations, face unique challenges measuring and managing healthcare quality, optimizing risk adjustment programs, and preventing inappropriate payments.

Cotiviti GOV Services provides multiplatform solutions that drive effective and efficient management and stewardship of mission-critical programs. Our 20 years of federal experience spans multiple agencies including the Centers for Medicare & Medicaid Services (CMS), the Veterans Health Administration (VHA), the Defense Health Agency (DHA), and the Centers for Disease Control and Prevention (CDC).

Notably, we have supported the CMS Recovery Audit Contractor (RAC) program since its inception, returning the highest dollar amount to the Medicare Trust Fund—more than $6.8 billion to date—while maintaining a combined 97.5% accuracy rate.

Cotiviti is the designated RAC for Regions 3 and 4. We also continue to support Region 2 audits performed prior to September 16, 2022, until the end of our administration period on April 30, 2024.

Whether you’re new to the RAC program or working with Cotiviti, we have resources to help you.

CMS RAC Region 3

CMS RAC Region 4

Department of Veterans' Affairs

Cotiviti GOV Services has an 18 year history working with the Department of Veterans’ Affairs (VA) as an Identification and Verification contractor and subcontractor, returning more than $9 billion to VA’s Medical Collection Fund. Cotiviti provides a robust solution, has a long and successful record completing seamless startups for the VA.

Cotiviti is the designated VA RAC for the VHA Office of Community Care (OCC) to conduct audits of payments to community care providers. We are committed to helping the VHA maximize its collected funds and ensure that Veterans’ claims are paid properly.

Cotiviti VA RAC

Healthcare providers

Provider organizations have moved steadily into value-based healthcare delivery and payment programs. However, successful risk management is as challenging as it is essential. 

Cotiviti’s performance analytics solutions help provider organizations understand and mitigate clinical and financial risks, delivering the insights needed to design and refine high-impact population health strategies. Our track record of success in managing multi-payer claim sets and other clinical data allows accountable care organizations and other risk-bearing providers to create a true longitudinal record across many settings of care to make better, data-driven decisions.

Self-insured employers, insurance brokers, and third-party administrators

To do what’s right to reinforce employee health, you need to have insights into healthcare cost, quality, and utilization. Cotiviti's performance analytics and payment accuracy solutions help self-insured employers and third-party administrators set the right strategy for cost management, health and productivity improvement, and objectively measure results, ensuring program ROI. We support employers and TPAs with:

• Payment integrity
• Health and productivity data integration and warehousing
• Data-driven benefit design and program measurement
• Cost-driver reporting and analysis
• Plan modeling and budgeting
• Employee risk profiling and care-gap identification
• Vendor selection and management
• Benchmarking

Retailers

For retailers, financial leakage can occur from a range of channels, including but not limited to overpayments, under-collection of trade funding and vendor income, routing compliance violations, and breakdowns in the returns process. Even if retailers optimize payments and collections with 99.9 percent accuracy, the remaining space can translate to millions of dollars.

Cotiviti Retail solutions provide audit and recovery services for all retail verticals, including mass merchandisers, grocery and discount chains, department stores, and specialty retailers.