Cotiviti Completes Acquisition of Edifecs.
Read the press release.
Encounter Management is part of Cotiviti’s
Risk Adjustment solution suite.
Managed care plans are often challenged to ensure the accuracy of risk-adjusted revenue data as well as compliance with submissions-related encounter guidelines. Furthermore, they need to manage frequent changes to regulatory requirements, state-specific nuances, and the complexities of using multiple submission systems.
encounters submitted annually across all Managed Care lines of business
Encounter Management deploys AI-enabled workflows and analytics to enhance data quality and accuracy through robust validation and normalization tools. In doing so, it is able to break down encounter operations silos, improve encounter data quality, and support submission accuracy and compliance across managed care lines of business.
Its flexible framework is designed to adapt to changing state and federal regulations, reducing complexity for users and supporting timely responses to new reporting standards. Encounter Management supports interoperability by aggregating encounter data from multiple sources and formats, seamlessly integrating with existing provider and vendor systems.
The solution automates key processes, such as data correction and error resolution, which decreases manual processes, improves efficiency, and helps accelerate the timeline for submissions. With advanced tracking and AI-enabled analytics, the solution helps health plans to capture payments, quickly identify and correct errors, manage resubmissions, and monitor performance metrics in real time. Overall, Encounter Management helps health plans support compliance efforts, improve reimbursement accuracy, and navigate the evolving regulatory landscape.
Encounter Management stands out from other solutions due to its advanced automation, real-time analytics, and adaptability to regulatory changes. The solution is uniquely designed to integrate seamlessly with a wide variety of data sources and formats, aiding interoperability across diverse provider and partner systems. Unlike traditional manual processes, Encounter Management leverages intelligent tools for data validation, normalization, and error remediation that help reduce rejections and streamline resubmissions. Its real-time tracking and analytics empower health plans with actionable insights on submission performance, quickly pinpointing data issues and optimizing operational efficiency.
Additionally, Cotiviti offers flexible configuration to accommodate evolving state and federal requirements, enabling health plans to more easily respond to compliance changes without disruptive system overhauls. With these capabilities, Encounter Management delivers a scalable, end-to-end solution that not only streamlines encounter submissions but also enhances data-driven decision-making and supports sustained regulatory compliance.
