Cotiviti Completes Acquisition of Edifecs.
Read the press release.
A strong analytics foundation is key to improving risk adjustment efficiency and results. However, identifying the right priorities can be a challenge.
Cotiviti's Suspect Analytics solution helps plans:
Health plans need to acquire, exchange, and share large volumes of clinical data to support appropriate reimbursement and high-quality member care. A successful retrieval solution is designed to operate efficiently at scale and allows health plans to conduct outreach in a coordinated, minimally intrusive manner using a range of options from EMR integration to traditional mail and fax.
Cotiviti's Medical Record Retrieval solution features:
Medical record coding is complex, with guidelines and requirements that are constantly changing and evolving. Health plans need a partner to reduce complexity and manage coding compliantly, efficiently, and effectively at scale.
Our Medical Record Coding services support healthcare organizations to accurately capture their population risk while delivering high quality results. It leverages natural language processing (NLP) technologies to augment coding efficiency, combining them with expert oversight, an in-depth understanding of the healthcare industry, and proven best practices and quality processes to help optimize results and compliance.
We also offer Second Level Review for charts previously coded, enabling health plans to add a layer of protection and to optimize results with our coding and quality assurance expertise. This solution focuses on:
Coding oversights are a risk for healthcare organization. Over time, errors add up, making it much harder for health plans and providers to identify risk-adjustable opportunities, intervene early, and deliver the best possible care quality and outcomes. Our Retrospective Review coding platform helps health plans and providers to:
Identifying clinical indicators and flagging risk-adjustable opportunities are essential for complete and accurate risk adjustment coding. Being aware of these opportunities is key—but the ability to quickly act on them is even more important.
Our Member Suspecting solution leverages industry-leading NLP to:
Our Engagement solutions empower health plans with multi-channel communications to help target the right member with the right message at the right time—an increasingly difficult task amid an oversaturated communications landscape. These solutions help to:
Opportunities for effective risk adjustment can arise long before the patient encounter begins. Unfortunately, the density of information in a patient’s chart can make it difficult for providers to cut through the noise and identify where they should focus. And identifying patient condition insights is only the beginning—delivering insights to clinicians during the patient encounter is critical in converting insights to actions.
Our Pre-Visit Prep solution leverages AI and NLP to help care teams reduce chart review workload, identify the right clinical information, and capitalize on opportunities to close care and diagnosis gaps upstream. It helps to:
Shift risk adjustment closer to the encounter to reduce gaps and facilitate the accurate, complete capture of population needs.
Our Post-Visit Review solution leverages AI and NLP to analyze encounter clinical data and quickly reconcile it with hierarchal condition category (HCC) codes on the claim. Available as a SaaS or service solution, Post-Visit Review helps to:
Our Concurrent Risk Adjustment solution helps managed care organizations (MCOs) and payers serving other at-risk markets to address risk adjustment gaps early. Respecting state regulatory constraints, Concurrent Risk Adjustment helps to close gaps and support accurate capture of chronic conditions before the claim transaction is adjudicated. This solution allows plans to:
Encounter Management
Ensuring the accuracy of risk-adjusted revenue data and staying compliant with submissions guidelines are common challenges for managed care plans. And if that’s not enough, managed care plans also must navigate frequent changes to regulatory requirements, state-specific nuances, and the complexities of using multiple submission systems.
Our Encounter Management solution helps health plans overcome these challenges. This solution features dedicated AI-enabled analytics and workflows that help to:
DxCG Intelligence
Our DxCG Intelligence solution analyzes and helps manage the clinical and financial risks associated with caring for populations. The solution features:
