Risk adjustment programs are complex, and their successful management requires maintaining complete compliance while ensuring your health plan’s risk burden is appropriately documented in medical records. Knowing which risk adjustment tools to use—and when to use them—is critical to ensuring timely and consistent revenue payments. In addition, the regulatory environment changes frequently, and government audits are becoming more common. The stakes are high. You need a partner with extensive risk adjustment experience, one that you can depend on and trust.
Cotiviti provides comprehensive, end-to-end prospective and retrospective risk adjustment services and support for health plans, combining technology, artificial intelligence (AI), analytics, and deep subject-matter expertise to ensure risk-associated revenue is optimized while maintaining appropriate compliance. We provide full transparency at every stage, so you always know the status of your risk adjustment program.
Our comprehensive Risk Adjustment solution suite allows you to use one partner and leverage your data across the workflow to optimize both retrospective and prospective programs.
Metrics that matter
in appropriate incremental risk adjustment revenue delivered to clients in 2019
Delivering better results
medical record retrieval rate since 2017
A commitment to quality
chart coding accuracy since 2017
Complete prospective and retrospective risk adjustment solutions to help ensure optimal and appropriate reimbursement
Risk adjustment suspect analytics to identify members with potentially undocumented conditions for prospective and retrospective targeting
Achieve >90% medical record retrieval success with a streamlined solution
Achieve >95% coding accuracy for optimized compliance
With the average Medicare Advantage (MA) having 39 plans to choose from in 2022, the competition is getting even tougher—and plans that haven’t taken advantage of every opportunity to drive risk adjustment excellence will fall behind. Our eBook explains three key strategies to help ensure premium accuracy and improve your results.Download the eBook