Cotiviti’s HEDIS® Measures Earn NCQA Certified MeasuresSM Status for the 2020 Season

Achievement marks 19th consecutive year that Cotiviti’s quality measures have passed rigorous validation process

HEDIS 2020 seal_Cotiviti

ATLANTA, March 9, 2020 – Quality Engine, the administrative measure logic and systematic sample processing component of Cotiviti’s Quality Intelligence solution, has earned Healthcare Effectiveness Data and Information Set (HEDIS®) Certified MeasuresSM status from the National Committee for Quality Assurance (NCQA). This marks the 19th consecutive year that Cotiviti, a leader in data-driven healthcare solutions, has earned this certification. NCQA certification validates that measures have been put through the thorough testing required to effectively support health plans with the HEDIS 2020 (measurement year 2019) reporting season.

“Improving member health outcomes is the highest priority of any health plan, with NCQA’s HEDIS measures setting the standard for quality in the industry,” said Emad Rizk, M.D., Cotiviti chairman, president, and chief executive officer. “Cotiviti not only recognizes that improving the quality of care delivery is vital to achieving true value-based care, but that it must be linked with improving payment integrity and risk assessment as well. By focusing deeply on all three and their connections to one another, we are helping payers steadily improve their clinical and financial performance to the ultimate benefit of their members.”

HEDIS is the measurement tool used by the nation’s health plans to evaluate their performance in terms of clinical quality and customer service, offering a standardized set of performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare the healthcare quality of various health plans. Processing data for 68 percent of all health plan members for whom HEDIS scores are reported, Quality Intelligence combines NCQA-certified measure logic and easy-to-use reporting software with high-volume, expert medical record retrieval and abstraction services to drive the best results with the least amount of health plan effort at every step. Cotiviti has required only three measure recertifications for Quality Intelligence in the past three years, minimizing the potential for any client inconvenience.

Enabling payers to measure and report HEDIS and HEDIS-related metrics with flexibility and insight, Quality Intelligence forms the solid foundation of an effective quality improvement program. Health plans can track, monitor, and improve quality compliance; develop and measure proprietary quality metrics; facilitate HEDIS, Star Ratings, and other quality measure submissions; and implement a year-round measurement and reporting program that significantly improves their rankings.

“HEDIS is the leading quality measurement set for health plans, and Cotiviti achieves compliance with the highest NCQA software measurement standards early in the HEDIS season every year without exception,” said Rachael Jones, Cotiviti senior vice president of Quality and Performance. “Cotiviti enables our clients to succeed through our industry-leading Quality Intelligence software and our end-to-end approach to quality measurement, reporting, and improvement. This solution complements our record retrieval rate consistently exceeding 90 percent as well as our abstraction accuracy surpassing 97 percent year after year. With our focus not only on the HEDIS reporting season but empowering health plans to continually improve their program during the off-season, we help our clients achieve their quality goals year-round.”

Medicare Advantage plans can further benefit from Cotiviti’s Quality Complete solution, a market-leading, comprehensive quality management system. Quality Complete builds on the proven Quality Intelligence platform, adding Star Navigator to help payers determine the most direct path to higher Star Ratings as well as relevant custom and state measures. Tight integration between the two solutions enables easy population of provider and member dashboards and reduces health plan IT support needs.

HEDIS® is a registered trademark of NCQA.
HEDIS Certified MeasuresSM is a service mark of NCQA.
NCQA Measure CertificationSM is a service mark of NCQA.

About Cotiviti
Cotiviti is a leading solutions 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 accuracyquality improvementrisk adjustment, and network performance management programs. These solutions are powered by Caspian Insights, a proprietary data and analytics platform spanning thousands of unique member and provider data types across financial and clinical domains, representing the most comprehensive longitudinal data set in healthcare. The company also supports the retail industry with data management and recovery audit services that improve business outcomes. For more information, visit

About NCQA
NCQA is a private, non-profit organization dedicated to improving healthcare quality. NCQA accredits and certifies a wide range of healthcare organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s website contains information to help consumers, employers and others make more informed healthcare choices.

Media Contact:

Ashley Owen
Aria Marketing for Cotiviti
(617) 332-9999 x 216