Our Solutions

Build better healthcare with our structural utility layer

Cotiviti's clients face increasingly complex clinical and financial risk. Our insights unlock unique opportunities to avoid wasteful spending that inflates healthcare costs, protect member benefits, reduce inefficiency, improve value, and engage consumers to drive meaningful action.

solutions_hero

Stop improper payments and recover hidden savings

Our Payment Accuracy suite can unlock previously unrealized medical and administrative cost savings for healthcare payers by providing solutions for every critical dimension along the claim payment lifecycle-from early payment policy management and clinical claim review to pre and postpay chart review and fraud pattern investigation. We help clients work more effectively across their payment accuracy silos by deploying the right approach at the right time, driven by a full-service model and the deepest industry expertise.

Learn more
Payment Accuracy Icon Payment Accuracy

Use one pathway for all your healthcare data

Our Interoperability solutions give payers, providers and connected stakeholders across the ecosystem the ability to control how healthcare data is defined, validated and governed – not just exchanged. We provide clients with a single front door to unify intake of all administrative and clinical transactions and apply consistent standards to create a shared operational truth that improves workflow predictability for critical business functions like Payment Accuracy, Risk Adjustment and Quality.

Layer_1 (1)-1 Interoperability

  • EDI Gateway

  • FHIR Gateway

  • Smart Trading

  • Transaction Management

  • Enrollment Management

  • Prior Authorization

  • Electronic Claims Attachments

  • Member Consent

Support appropriate reimbursement for every member

Our Risk Adjustment suite includes complete retrospective risk adjustment solutions supported by technology, analytics, artificial intelligence, and deep subject-matter expertise. We are committed to ensuring that plans are appropriately reimbursed to manage and coordinate care for their members.

Learn more
Layer_1 (2) Risk Adjustment

Expand from reporting quality to actively driving it

Our Quality and Stars suite allows health plans to move from simply reporting quality measures to driving the purchase, delivery, and utilization of higher value healthcare. Our solutions enable health plans to collaborate more effectively with their provider networks, with members, and with other functional teams within the plan itself to successfully manage members' clinical and financial risks.

Learn more
Layer_1 (3) Quality & Stars

Move members to action through empathy-driven outreach

Our Engagement solutions move members to take meaningful action using a highly tailored, multi-channel approach rooted in empathy. Combining technology with the proper data and analytics as well as a clear user experience, our solutions are built to augment and improve, making it easy to implement and to scale.

Learn more
Layer_1 (4) Engagement

Help retailers recover substantial savings year over year

Cotiviti Retail solutions provide audit and recovery services for all retail verticals, including mass merchandisers, grocery and discount chains, department stores, and specialty retailers. Every year across our client base, we help the largest and most influential retailers in the industry save hundreds of millions of dollars.

Learn more
Untitled Image 1 Cotiviti Retail

Connect with our experts