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.

Cotiviti is the designated CMS RAC for Regions 2, 3, and 4. Whether you’re new to the RAC program or working with Cotiviti, we have resources to help you.

CMS RAC Region 2 and 3

CMS RAC Region 4

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.