Risk Adjustment solutions

Help ensure compliant, accurate compensation
for your members' risk burden

Download solution overview

Find opportunity in the complexity of risk adjustment

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 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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Cotiviti's risk adjustment value

Our comprehensive Risk Adjustment solution suite allows you to optimize your programs.

Metrics that
matter

>$2B

average appropriate incremental risk adjustment revenue delivered to clients annually

Delivering better
results

>4M

records retrieved annually

A commitment
to quality

>97%

chart coding accuracy

Cotiviti's Risk Adjustment solutions

Complete risk adjustment solutions to help ensure optimal and appropriate reimbursement. Click on each icon below to learn more.

 
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Suspect Analytics

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

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.

  • Identify charts with higher potential value
  • Leverage the latest developments in machine learning and advanced algorithms to effectively create your chase list

Learn more about Suspect Analytics

 
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Medical Record Retrieval

Achieve medical record retrieval success with a streamlined solution

Cotiviti's Medical Record Retrieval services provide optimized medical record retrieval, aggregation, indexing, and storage to fulfill even high-volume record requests with minimal disruption to providers and their office staff.

  • Avoid unnecessary medical record retrieval effort and reduce abrasion with provider weighting algorithms
  • Eliminate medical record image transfer downtime
  • Gain transparency into retrieval status at request, project, and provider levels

Learn more about Medical Record Retrieval

 
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Medical Record Coding

Achieve >95% coding accuracy for optimized compliance

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).

  • Improve coding project turnaround times
  • Facilitate provider education on appropriate medical chart coding
  • Reduce risk adjustment data validation (RADV) audit risk

Learn more about Medical Record Coding


Suspect
Analytics

Medical Record
Retrieval

Medical Record
Coding
 
 

 

 

Download the Risk Adjustment brochure