Quality and Performance solutions

Analyze, communicate, and improve your clinical
and financial performance with industry-leading
HEDIS® reporting and more

How Cotiviti enables higher value healthcare

As value-based reimbursement becomes the standard, Cotiviti’s Quality and Performance solutions allow 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. The result? Plans can successfully manage members’ clinical and financial risks, make the most of limited internal resources, and stay compliant with industry requirements and regulations.

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Measure what matters—then take action

Cotiviti's Quality and Performance solutions enable transformative quality measurement and reporting, population health management, network management, and underwriting initiatives with a "single source of truth"—and a collaborative approach to analysis and action. Our Quality and Stars solutions enable payers to meet evolving requirements for HEDIS®, Star Ratings, state measures, and more. Our Network and Clinical Analytics solutions simplify the aggregation and organization of healthcare data to uncover member-, population-, and provider-level opportunities to mitigate clinical and financial risk. Integration between our quality improvement solutions and the Eliza® member engagement platform offers a clear path from identifying care gaps to closing them.

Greater breadth
and depth


members reported to NCQA are processed by Quality Intelligence

better results


HEDIS® medical record retrieval rate

A commitment
to quality


medical record abstraction accuracy

Cotiviti's Quality and Stars solutions

Take your HEDIS and Star Ratings results to the next level. Click on each icon below to learn more.


Quality Intelligence

Measure and report HEDIS and quality-related metrics your way

Quality Intelligence, Cotiviti's measurement and reporting software with fully NCQA-certified quality measure logic, sets the standard for efficiency, ease of use, and customer satisfaction. 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 health plan rankings.

  • Drill down to member-level claim detail for optimal insight and analysis
  • Configure and track top priority measures, goals, and measure trends
  • Create ad-hoc SQL queries using the backend datamart and save as custom reports

Learn more about Quality Intelligence

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).


Star Intelligence

Optimize Medicare Advantage Star Ratings

Introduced in October 2022, Star Intelligence gives health plans the ability to track, predict, and model their Star Ratings. This empowers plans with the capability to understand and prioritize actions needed to offer better care to a growing MA population and to optimize bonus payments. Plans can choose to integrate with Quality Intelligence for a more holistic view of members in regards to quality, Star Rating improvement, member engagement, and more.

  • Access a one-stop shop for HEDIS quality and Stars management
  • Get a clear view of progress with trending and benchmarking dashboards
  • Leverage analytics that offer measure prediction, predictive cut points, EOY contract ratings, trends, and opportunities for growth
  • Gain strategic support for identifying gaps and understanding best practices

Learn more about Star Intelligence

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).


Medical Record Retrieval

Achieve >90% medical record retrieval success with a streamlined solution

Cotiviti's Medical Record Retrieval services provide optimize medical record retrieval, aggregation, indexing, and storage to fulfill even high-volume record requests with minimal disruption to providers and their office staff.

  • Avoid unnecessary medical record retrieval effort and reduce abrasion with provider weighting algorithms
  • Eliminate medical record image transfer downtime
  • Gain transparency into retrieval status at request, project, and provider levels

Learn more about Medical Record Retrieval


Medical Record Abstraction

Achieve >97% abstraction accuracy without hiring and training new staff

Cotiviti's Medical Record Abstraction services deliver rapid, accurate abstraction of clinical data components that document the provision of compliant care. Our goal is to achieve the highest number of compliant components possible within any reporting time frame, optimizing health plan quality scores and revenue while helping to close care gaps.

  • Gain flexibility from a partner that can readily staff to meet your needs, no matter how great the volume
  • View annotated medical records and real-time compliance for retrieval and abstraction
  • Extract information directly from electronic medical record (EMR) systems

Learn more about Medical Record Abstraction



Medical Record

Medical Record

Cotiviti's Performance Analytics solutions

Tame your data and optimize your clinical and financial performance with one partner. Click on each icon below to learn more.


Medical Intelligence

Gain insights into every facet of healthcare utilization

Medical Intelligence combines Cotiviti's industry-leading DxCG science, evidence-based clinical quality rules, healthcare utilization metrics, and claims-based HEDIS measures to enable payers to manage risk and target opportunities for improving healthcare results. Users can easily stratify and segment populations (by risk, costs, utilization, predicted future cost, or location), access member-level detail (e.g., conditions, comorbidities, clinical events, gaps in care, prescription compliance), and evaluate efficiency and performance by program, provider, and more.

  • Identify high-risk members in need of immediate or long-term clinical intervention
  • Analyze population and member-level conditions, gaps in care, quality, and compliance metrics
  • Identify new intervention programs needed to address conditions driving cost and utilization
  • Inform pay-for-performance, accountable care, and other alternative quality contracts

Learn more about Medical Intelligence

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).


DxCG Intelligence

Clearly understand and predict individual and population risk

Part of healthcare's DNA for more than 20 years and used by hundreds of organizations, DxCG Intelligence is at the core of Cotiviti's performance analytics solutions. The gold standard in risk adjustment and predictive modeling, DxCG Intelligence analyzes and helps manage the clinical and financial risks associated with caring for populations, with specificity at the individual level. DxCG Intelligence uses Cotiviti's proprietary predictive models, validated in depth by the Society of Actuaries for their breadth and utility, to turn healthcare data into risk scores for individual members.

  • Leverage data on 190 million lives
  • Assess the disease burden of individuals, subgroups, and populations
  • Predict the future cost of care for a population

Learn more about DxCG Intelligence



Download the Quality and Performance brochure