Risk adjustment programs are complex. Their successful management requires ensuring your health plan’s risk is appropriately captured, documented, and compliant—all without sacrificing efficiency. The regulatory environment changes frequently, and government audits are becoming more common. You need a partner with in-depth risk adjustment experience, one that you can depend on and trust.
Cotiviti provides comprehensive risk adjustment services, combining unique subject matter expertise with natural language processing (NLP) and other advanced technologies to optimize risk revenue capture as well as compliance. We provide full transparency at every stage, so that you can always track the status and performance of your risk adjustment programs.
Our Risk Adjustment solutions help drive compliant, accurate results with in-depth expertise, advanced technology, and complete quality assurance processes. Our solutions drive impact across key areas:
Metrics that
matter
>$2B
average appropriate incremental risk adjustment revenue delivered to clients annually
Ensuring scale
and capacity
>10M
charts coded annually
A commitment
to quality
>97%
average coding accuracy
Deploy expert risk adjustment solutions to help ensure optimal and appropriate reimbursement. Click on each icon below to learn more.
Effectively identify members with suspected but potentially undocumented conditions
Starting your risk adjustment program with a strong analytics foundation is key to improving efficiency and results. However, identifying the right priorities can be a challenge. Cotiviti's Suspect Analytics solution helps identify members with potentially undocumented conditions, as well as risk and probability of success, to optimize your efforts. Our advanced analytical models provide our clients with a nuanced examination of their data, predicting which members have the highest probability of missing or incomplete conditions. Our solution enables plans to:
Improve risk adjustment results while minimizing provider abrasion
Health plans need to acquire, exchange, and share large volumes of clinical data to support appropriate reimbursement and drive quality member care. A successful retrieval solution operates efficiently at scale and allows health plans to conduct outreach in a coordinated, minimally intrusive manner using a range of options from EMR integration to traditional mail and fax.
Cotiviti's Medical Record Retrieval solution offers comprehensive, web-based medical record retrieval, aggregation, indexing, and storage. It features strong digital data exchange capabilities and interoperability strategies, which combine with Cotiviti's expertise in leveraging traditional channels such as fax, email, and phone to help address gaps or barriers and optimize results. Medical Record Retrieval allows plans to:
Accurately capture and document risk-adjustable conditions
Medical record coding is complex, with guidelines and requirements that are constantly changing and evolving. Health plans need a partner to reduce complexity and manage coding compliantly, efficiently, and effectively at scale.
Cotiviti’s Medical Record Coding solution enables health plans to accurately capture their population risk while delivering high quality results. Leverage natural language processing (NLP) technologies, integrating them with our teams' expert leadership, an in-depth understanding of the healthcare industry, and our proven best practices to:
We also offer Second Level Review for charts previously coded, enabling health plans to add a layer of protection and optimize results by integrating our coding and quality assurance expertise.