Risk Adjustment solutions

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.


From the Cotiviti blog

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.

Read the blog


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

Chart Risk Adjustment


risk_adjustment_suspect_analyticsSuspect Analytics

Risk adjustment suspect analytics to identify members with potentially undocumented conditions for prospective and retrospective targeting


risk_adjustment_medical_record_retrievalMedical Record Retrieval

Achieve >90% medical record retrieval success with a streamlined solution



Achieve >95% coding accuracy for optimized compliance


Download the Risk Adjustment brochure