We are proud to announce Eliza® Member Engagement is now part of Cotiviti!
Learn More
Help ensure compliant, accurate compensation for your members’ risk burden
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.
5 takeaways from the 2023 medicare advantage and part D final rate announcement
Learn the key highlights from the latest CMS announcement including a major payment increase for MA plans and integration of social determinants of health into risk adjustment.
Claim Editing
Clinical Validation
Billing Accuracy
Contract Compliance
Payment Responsibility
Clinical Chart Validation
Fraud, Waste, and Abuse (FWA) Solutions
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
>$2B
in appropriate incremental risk adjustment revenue delivered to clients in 2019
Delivering better results
>90%
medical record retrieval rate since 2017
A commitment to quality
>95%
chart coding accuracy since 2017
Complete prospective and retrospective risk adjustment solutions to help ensure optimal and appropriate reimbursement
Suspect AnalyticsRisk adjustment suspect analytics to identify members with potentially undocumented conditions for prospective and retrospective targeting
More
Cotiviti’s Suspect Analytics solution leverages advanced analytical models and machine learning to provide our clients with a nuanced examination of their data, predicting which members have the highest probability of missing or incomplete conditions.
Medical Record RetrievalAchieve >90% medical record retrieval success with a streamlined solution
More
Cotiviti’s Medical Record Retrieval services provide optimize 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 CodingAchieve >95% coding accuracy for optimized compliance
More
Cotiviti’s Medical Record Coding services provide chart review by AAPC- or AHIMA-certified clinician coders to capture risk-adjusted medical conditions not previously reported for the measurement year (Medicare and commercial).
Designed by credentialed investigators in collaboration with clinical, claims, and regulatory specialists, Cotiviti’s end-to-end FWA Management solutions adapt to emerging fraud schemes and compliance requirements.
‡ Based on actual client results. Individual organization results may vary.
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
