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 and encounter submissions. 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.
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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
acceptance for encounter submissions in 2019
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
Risk adjustment member assessments in a home or alternative provider setting including remotely via telehealth
Achieve >95% coding accuracy for optimized compliance
Risk adjustment submissions solutions with >98% acceptance