Cotiviti Expands Its Risk Adjustment Solution Suite with New Prospective Capabilities
Health plans can now turn to Cotiviti for both retrospective and prospective risk adjustment support via the new In-Home Assessments offering

ATLANTA & WALTHAM, MASS., October 10, 2018— Cotiviti, a leader in data-driven healthcare solutions, has added to its Risk Adjustment solution suite with a new offering for prospective risk adjustment. In-Home Assessments provide a complementary approach to retrospective methodologies, allowing health plans to capture and substantiate health information about their members who do not regularly visit their doctors. These assessments not only ensure appropriate documentation of health conditions but also facilitate care planning and help close care gaps, all in the convenience of the members’ own homes.

Risk adjustment programs for health plans were put in place to ensure that members receive the care they need, when they need it. The higher a member’s illness burden, the greater cost he or she generates, which means health plans must be appropriately compensated for that illness burden. In addition, costs can quickly spiral out of control if diagnoses are not carefully captured and members’ conditions are not carefully managed.

“Clinicians are responsible for the documentation process, but health plans also provide a vital safety net for their members,” explained Emad Rizk, M.D., president and CEO of Cotiviti. “Cotiviti offers its clients compliant, efficient, end-to-end retrospective and now prospective risk adjustment services to ensure member risk burden is appropriately captured and compensated. Cotiviti is committed to continuing our active investments in risk adjustment solutions as a key growth area for the company.”

Cotiviti (formerly known as Verscend Technologies, Inc.) provides expert risk adjustment services for national and regional health plans across the country. Where health plans have medical charts and associated claims, professional coders can review this information looking for evidence of missing or incorrect diagnoses for previous years of service, a process known as retrospective risk adjustment.

When members do not generate claims, however, plans may not be aware of their health risk or potential need for additional healthcare reinforcement. Cotiviti’s sophisticated analytics can identify members from the entire population who are likely to have conditions requiring clinician contact, even when they have not regularly engaged with the healthcare system. Nurse practitioners or physician assistants visit members in their own homes and provide a thorough health screening. This information is then reviewed for the identification of supplemental chronic conditions that can be submitted on behalf of clients to the Centers for Medicaid & Medicare Services (CMS) as incremental risk adjustment revenue. Members’ physicians also receive a copy of the assessment to facilitate ongoing care.

About Cotiviti
Cotiviti is a leading information technology and analytics company that is reshaping the economics of healthcare, helping its clients uncover new opportunities to unlock value. Cotiviti’s solutions are a critical foundation for healthcare payers in their mission to lower healthcare costs and improve quality through higher performing payment accuracy, quality improvement, risk adjustment, and network performance management programs. The company also supports retail and life/legal industries with data management and audit services that improve business outcomes. For more information, visit


Media Contact
Jeffrey Robinson, Cotiviti
(781) 693-3717