Medical Record Abstraction

Abstract medical record data and improve quality scores with thorough documentation of compliant care


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For health plans and other healthcare organizations, the quality measurement and reporting process grows more complex—and more important—every year. Yet measuring and reporting quickly, efficiently, accurately, and thoroughly is essential.

nurse abstractor accuracy rate over the past three HEDIS seasons


Cotiviti’s Medical Record Abstraction services deliver rapid, accurate abstraction of clinical data components that document the provision of compliant care for HEDIS® reporting, and other quality measurement needs.

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. Abstraction is performed by registered nurses with clinical and chart review experience and coders certified through AAPC or AHIMA. As a result of handling such large record volumes, including for state-specific measures, Cotiviti is able to focus its abstraction teams on smaller numbers of measures, allowing them to go deeper, perform better, and improve quality.

With this solution, our clients benefit from working with a partner with a track record that includes:


accuracy rates maintained throughout the season


of Medical Record Abstraction services clients passed MRRV1 in the first round


years of clinical experience, on average, for our registered nurses2

1 Medical Record Review Validation.

2 Six years’ average experience for medical coders.

Medical Record Abstraction solution benefits and features

Medical Record Abstraction is a collaborative solution that relies on a combination of seasoned experts running abstraction and data collection tools to ensure the most accurate quality measuring and reporting. Take a look at some of the features that set Medical Record Abstraction apart:

  • Scalable staff. To handle volume adjustments, we use a combination of internal staff, direct contract staff, and vendor staffing partners to form a bank of expert registered nurses and certified coders. Our staff can extract information directly from electronic medical record (EMR) systems, which saves time and increases the number of compliant hits. We can also highlight the record, helping clients and auditors to quickly find the same information.
  • Expert abstractors. We conduct thorough NCQA technical specification training for our teams, focusing on measures that match their areas of clinical expertise. Each team member is tested by abstracting a set of mock records and must achieve 97% accuracy to pass in no more than three tries. We also perform inter-rater reliability (IRR) testing, which must be passed with 100% accuracy in no more than three tries.
  • Data collection. At the core of abstraction is data collection. After images are retrieved, abstractors access images and collect data per NCQA technical specifications. Abstractors then perform data entry into the data collection tool. This process repeats until all chases are exhausted or the sample is made complete. As an additional benefit, our team can abstract directly from EMRs, and we’re able to highlight where compliant information appears in the medical record, saving time for clients, auditors, and others.
  • Two-way client communication. Health plans can directly communicate with the Cotiviti abstraction team and send records for re-evaluation in the event that verification needs to be made.
  • Real-time compliance. Abstraction takes place in a single environment, allowing clients to see compliance and reports in real time rather than a communication chain that could result in long processing times.
  • Direct access to annotated records. Annocoder streamlines the audit process. Cotiviti Medical Record Retrieval and Abstraction clients and Medical Record Attach and Annotate licensees may launch Annocoder directly from Quality Reporter to annotate medical records and search those annotations during quality checks and audits.

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

Industry-leading communication and transparency

We understand that you will have questions, and we go out of our way to help. We reach out to NCQA for clarification on your behalf, so you are always getting firm, fast, and direct answers.

Our regular reports include:

  • Project status with retrieval, abstraction, and quality reporting
  • Weekly and cumulative quality scores, including identified errors and how errors can be corrected
  • A dashboard of non-compliant chase reason codes illustrating what’s missing in the record or where records need to be pursued elsewhere

We also develop a road map and client handbook—tools that help our staff and our clients understand our approach.


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