Cotiviti Completes Acquisition of Edifecs.
Read the press release.
Concurrent Risk Adjustment is part of Cotiviti’s
Risk Adjustment solution suite.
Health plans are under increasing pressure to capture risk accurately while reducing administrative burden and provider abrasion.
Close up to
more gaps over baseline*
With near real‑time automation and minimal disruption to provider workflows, we deliver a smarter, faster, and more scalable approach to risk capture.
Concurrent Risk Adjustment directly addresses the challenges of retrospective chart retrieval by shifting gap detection and review to the moment a claim is submitted, enabling plans to identify missing diagnosis codes based on prior claims history before adjudication. Our solution analyzes the full digital footprint of each claim, including submitted, returned, and edited transactions, to ensure no relevant information is overlooked. By returning automated messages of acknowledgement with clear, gap-specific notifications prompting review, the solution empowers providers to correct claims quickly without manual outreach or operational disruption. This proactive approach not only reduces administrative burden but also improves accuracy, strengthens revenue integrity, and ensures plans can accurately reflect member risk even when downstream data access is constrained.
Concurrent Risk Adjustment operates directly inside the claims pipeline; earlier in the workflow than traditional risk-adjustment solutions. With a design that is both clearinghouse‑agnostic and EMR‑agnostic, plans can deploy at scale with minimal integrations, limited workflow disruption, and configurable controls to reduce provider abrasion. Unlike retrospective tools that rely on incomplete data or manual processes, Concurrent Risk Adjustment leverages the entire digital lifecycle of a claim—submitted, returned, and edited—to deliver unmatched visibility and precision.
By combining real‑time interception, automation, and comprehensive data intelligence, Concurrent Risk Adjustment delivers a level of speed, accuracy, and scalability that traditional gap‑closure methods are not designed to match.
Cotiviti's Concurrent Risk Adjustment solution creates opportunities to drive earlier value. Its unique features include:
