Quality Intelligence

Measure and report HEDIS and HEDIS-related metrics your way


The facts

As quality becomes tied increasingly tightly to their financial well-being, health plans are broadening and deepening the complexity and impact of their quality improvement programs. HEDIS® measures and reporting requirements continue to evolve and expand each year, joined by a long and growing list of other reporting needs that often have HEDIS at their core, such as state-specific, pay-for-performance (P4P), Star Ratings, and custom programs.

As plans look to successfully implement value-based reimbursement models across their provider networks, the ability to collect and analyze accurate, timely information about the care that their members receive has never been more important. A true strategic partner can help plans measure and report quality metrics confidently, efficiently, proactively, and repeatedly, transforming quality management into the core competency required for newly integrated, multifaceted quality measurement and reporting initiatives.

Quality Intelligence, our 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. Maybe that’s why 68 percent of health plan members for whom HEDIS scores are reported run through our software.


Drill down to member-level claim detail for optimal insight and analysis

Take advantage of intuitive medical record review templates for data entry

Create HEDIS submission files simply and efficiently

Customize views to display the most meaningful data and facilitate smooth workflows

Create and customize reports easily for deeper insights into how to improve provider-related and other key metrics

Set goals and benchmarks to monitor progress in real time

Depend on the best

Quality Intelligence reduces quality measurement and reporting workflow to its most efficient and effective point. With a smarter, smoother process in place, plans can both ease the burden of seasonal HEDIS reporting and implement a year-round measurement and reporting program that significantly improves health plan rankings. Using Quality Intelligence, health plans can also determine what drives changes in HEDIS and other quality metrics with the greatest transparency and flexibility. 

Highlights of our analytic capabilities include:

Chase logic
Using multiple and customizable data points, we can fine-tune our chase logic to the most accurate degree, so you target the right providers, locations, and records; optimize resources; and minimize expense.

Transparent data model
With visibility and insight at every level—from the initial claim to intermediate tables for measure processing to the final results—you know exactly where to find your best improvement opportunities.

A single resource to analyze and report HEDIS-related metrics
Quality Intelligence helps you keep a vigilant eye on complex and rapidly evolving healthcare quality metrics. Timely insights boost your quality improvement initiatives and help optimize performance under value-based reimbursement models.

Design a program that best meets your needs
Cotiviti has a well-deserved reputation for flexibility. Here are three examples:

Choose your deployment option
You can select either of the following:

  • Full service, in which designated Cotiviti data operations personnel support your runs throughout the year
  • Self service, where you have the flexibility to set your own processing schedule and number of data runs and otherwise own the entire process

Pick your measures
We have nearly 275 quality measures and we're adding more all the time. Supported measure sets include:

  • AHCA (Florida Medicaid)
  • California P4P
  • California Medi-Cal MCAS
  • CMS Adult and Children Core Sets
  • CMS Star Ratings Part D and Survey
  • Covered California
  • Custom HEDIS-like Rolling Measures
  • Georgia Medicaid
  • Hawaii Medicaid Quest Integration
  • Illinois Medicare/Medicaid Plans
  • Kentucky Medicaid
  • Louisiana Medicaid
  • Maryland
  • Mass. Group Insurance Commission
  • MN Community Measurement
  • New Jersey
  • New York QARR
  • Pennsylvania Medicaid CHIP and PAPM
  • Pharmacy Quality Alliance (PQA)
  • Vermont ACO
  • West Virginia Medicaid

Get a deeper level of support

Cotiviti is there for you at every step of the process.


Need a deeper level of support to optimize Star Ratings?

Add Star Navigator, 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.

Is medical record retrieval a problem area?

Cotiviti’s Medical Record Retrieval services will help you fulfill high-volume record requests with minimal disruption to providers and their staff.

Are medical record abstraction woes keeping you from achieving top scores?

Cotiviti’s Medical Record Abstraction services can help you achieve the highest number of compliant components possible within any reporting timeframe.

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

Get your fact sheet today