We are proud to announce Eliza® Member Engagement is now part of Cotiviti!
Learn More
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.
HEDIS STRATEGIES: 4 WAYS TO PREPARE FOR THE ECDS TRANSITION
The HEDIS ECDS reporting standard provides payers with a method to collect and then report structured electronic clinical data for HEDIS quality measures, but health plans have struggled with implementation. Here are four strategies for payers to adopt to optimize their HEDIS scores and efficiency.
Claim Editing
Clinical Validation
Billing Accuracy
Contract Compliance
Payment Responsibility
Clinical Chart Validation
Fraud, Waste, and Abuse (FWA) Solutions
Serving upstate New York, one large nonprofit health plan uses Cotiviti’s Quality Intelligence solution to support year-round quality improvement and improved performance in HEDIS, Star Ratings, and other quality initiatives. The results speak for themselves: in 2021, 76% of all measures related to a regulatory program—including HEDIS, Star Ratings, quality incentives, and accreditation—either improved to the next threshold or maintained their current rating, up from 68% in 2020.
Read moreCotiviti'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
61%
of all members reported to NCQA in 2021 were processed by Quality Intelligence
Delivering better results
>90%
medical record retrieval rate since 2017
A commitment to quality
>97%
abstraction accuracy since 2015
Take your HEDIS and Star Ratings results to the next level
Quality IntelligenceMeasure and report HEDIS and quality-related metrics your way
More
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 IntelligenceOptimize Medicare Advantage Star Ratings
More
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.
Medical Record RetrievalAchieve >90% medical record retrieval success with a streamlined solution
More
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
More
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
More
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
More
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.
Network IntelligenceObtain the solid foundation you need to shift from volume to value
More
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).
