Experienced people with deep industry expertise

Our people are at the core of our processes. Our domain expertise includes clinical and technical knowledge in machine learning, pattern recognition, and NLP, allowing us to deploy AI purposefully to drive value throughout our risk adjustment workflow. For medical record coding, AI-enabled processes complement the talents of our approximately 1,000 certified coding professionals to benefit our customers through:

• Improved accuracy: Our commitment to quality ensures that relevant codes and clinical context are not missed as part of our extensive certified coder chart review.
• Enhanced compliance: Through our advanced technology, we capture complex combinations of conditions and severity levels that may be missed by manual coding alone.
• Greater consistency: We ensure that complex coding guidelines, incorporating national and customer-specific nuances, are applied in the same manner across different patient populations, coders, and risk adjustment seasons.

An extra layer of confidence

For additional Medicare and commercial risk adjustment compliance confidence, Cotiviti can compare claims and encounter data with medical chart coding data through our optional Coding Compliance Review (CCR) process. CCR highlights discrepancies between the medical claim data submitted and the first-pass coding of associated medical charts.  If the coder cannot validate the HCC, it will be marked for deletion and sent to the client for final determination.

This extra layer of review not only increases a plan’s confidence that the HCCs submitted to CMS have validated diagnoses, but also helps strengthen payer-provider relationships. Plans receive reports from Cotiviti indicating which providers are consistently submitting incorrect claims, allowing them to proactively reach out with educational support.