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.
Our comprehensive Risk Adjustment solution suite allows you to optimize your programs.
average appropriate incremental risk adjustment revenue delivered to clients annually
records retrieved annually
chart coding accuracy
Complete risk adjustment solutions to help ensure optimal and appropriate reimbursement. Click on each icon below to learn more.
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.
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.
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).