Analyze, communicate, and improve your clinical and financial performance with industry-leading HEDIS® reporting and more
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.
collecting COVID-19 analytic insights
Healthcare organizations are struggling to understand how to pivot from containment to recovery amid the COVID-19 crisis. Here are three key concerns payers will need to address as they work through these steps.
Claim Editing
Clinical Validation
Billing Accuracy
Contract Compliance
Payment Responsibility
Clinical Chart Validation
Fraud, Waste, and Abuse (FWA) Solutions
Interas is a division of The Partners Group, a financial services firm that works primarily with larger employers that self-fund healthcare for their employees. For Interas managing director Case Escher and his team, selecting the right tool, from the right partner, enabled a differentiated approach to the market. “Every time I show clients what we can do through Medical Intelligence, the comments are always the same: ‘We don’t have anything like this.”
Read moreCotiviti can help you turn quality measurement and reporting into the rock-solid foundation you need to support such mission-critical initiatives as population health, quality improvement, compliance, network management and contracting, and value-based reimbursement. Our 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.
Greater breadth and depth
>250
quality measures in our solutions and growing
Delivering better results
>90%
medical record retrieval rate since 2017
A commitment to quality
>97%
abstraction accuracy since 2015
Take your HEDIS measurement and reporting to the next level
Quality IntelligenceMeasure and report HEDIS® and Quality-related metrics your way with >250 measures and growing
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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.
Star NavigatorBenefit from a deeper level of support to optimize Star Ratings
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Star Navigator is a quality improvement solution that helps Medicare Advantage plans determine the most direct path to higher Star Ratings, then track and communicate their progress toward goals. With Star Navigator, health plans gain the insights necessary to efficiently close care gaps, enlisting providers as partners in quality improvement while providing a better member experience.
Medical Record RetrievalAchieve >90% medical record retrieval success with a streamlined solution
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Cotiviti’s Medical Record Retrieval services provide optimized medical record retrieval, aggregation, indexing, and storage to fulfill even high-volume record requests with minimal disruption to providers and their office staff.
Medical Record AbstractionAchieve >97% abstraction accuracy without hiring and training new staff
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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.
Tame your data and optimize your clinical and financial performance with one partner
Medical IntelligenceGain insights into every facet of healthcare utilization
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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.
DxCG IntelligenceClearly understand and predict individual and population risk
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Part of healthcare’s DNA for more than 20 years and used by 450 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.
Network IntelligenceObtain the solid foundation you need to shift from volume to value
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Cotiviti’s Network Intelligence solution helps payers collaborate with providers to optimize value-based healthcare delivery and payment. We enable an innovative new approach to medical economics that helps clients recognize and reward high-value care while eliminating low-value care and other unnecessary payments from the healthcare system. We take payers through the high-value journey, socializing and educating providers about value. Then, we put data into action and incentivize change.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
