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, 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, in particular the Centers for Medicare & Medicaid Services (CMS), face unique challenges measuring and managing healthcare quality; optimizing risk adjustment programs; and preventing fraud, waste, and abuse. The United States wastes nearly $1 trillion annually on healthcare spending—an estimated $600 billion of which can be attributed to unnecessary care and other inappropriate payments.

Cotiviti Government Solutions provides multiplatform solutions that drive effective and efficient management and stewardship of mission-critical programs. As a CMS Recovery Audit Contractor (RAC), Cotiviti has made more than $3.9 billion in corrections for the Medicare Trust Fund since its inception. We use the latest technology and processes designed to protect and engage by optimizing data insights and designing smarter solutions.

CMS RAC
Cotiviti is the designated CMS RAC for Regions 2 and 3. Whether you’re new to the RAC program or working with Cotiviti, we have resources to help you.

Log in to our CMS RAC provider portal

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 solutions help self-insured employers, insurance brokers, and third-party administrators set the right strategy for health and productivity improvement and objectively measure results, ensuring program ROI. We support employers with:

• 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.

Life insurance companies

The life insurance industry relies heavily on the approval and underwriting of strong policies that are both profitable and long term. The ability to quickly gather accurate attending physician statements (APS) is crucial in closing policies. 

Cotiviti has a patented medical record retrieval process that is flexible enough for anyone to quickly order, track, retrieve, and view digitized APS files through a secure online account. We service all players in the life insurance industry, including carriers, broker general agents (BGAs), and independent agents.

Law firms

Whether plaintiff or defense, law firms must continually balance aggressive litigation with the massive work behind discovery and case management. The amount of work with medical record retrieval alone can be costly and daunting, yet these records can be the most important documents needed for strong cases.

Cotiviti has a patented medical retrieval system designed to simplify the retrieval of records and eliminate the burden from law firms. Our solution allows an otherwise non-billable expense to become billable and is flexible enough for any legal professional to quickly order, track, retrieve, and view digitized medical records.