Retrospective Review platform

Enhance team productivity and precision

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Retrospective Review is part of our
Risk Adjustment solution suite.

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Coding oversights are a risk for any healthcare organization. Over time, errors add up, making it harder for health plans and providers to identify risk-adjustable opportunities, intervene early, and deliver the best possible care quality and outcomes.


Read the fact sheet

Up to

4x

Increase in coder productivity*

With the Retrospective Review platform, health plans and providers can improve coding productivity and accuracy, support compliance with regulatory requirements, strengthen risk-adjusted revenue integrity, and maximize value-based program performance.

Retrospective Review is an AI-poweredcoding platform that helps healthcare organizations maximize their coding productivity and more effectively identify missed or potentially mis-coded conditions.

Our platform further drives accuracy by analyzing structured and unstructured clinical data and combining it with claims information to deliver a more accurate and comprehensive picture of population disease burdens.

Charts with conditions not represented on claims or coded outside of standard CMS guidelines are isolated, evidence is prioritized to help ensure coders only review relevant documentation, and confidence scoring ensures only the most likely suggestions are surfaced.

Dedicated compliance enhancements such as the Audit Risk Members (ARM) module supports defensible coding and proactively manages RADV audit risk by embedding CMS audit logic into day-to-day review processes. With ARM, health plans can identify members most likely to be selected for audit and validate or delete diagnoses in a structured, audit-defensible manner. This approach enables plans to shift from a state of reactive audit response to continuous audit readiness.

By improving coding precision, supporting compliant risk capture, and directing resources to the highest‑value opportunities, Cotiviti’s Retrospective Review helps improve efficiency, enhance compliance, and strengthen financial performance across your organization.

Retrospective Review impact

Improve workflow efficiency to help your team handle more reviews:

  • Focus coder review efforts
  • Effectively scale to accommodate larger volumes of data
  • Enable real-time tracking of coder productivity and accuracy

Better identify and correct coding and documentation discrepancies:

  • Reduce audit risk with two-way review that highlights additions and deletions
  • Streamline quality assurance and strengthen compliance
  • Spot frequently missed or miscoded conditions for effective provider education

Gain confidence in coding and documentation accuracy:

  • Identify records coded outside of standard guidelines
  • Isolate and prioritize coding gaps with AI and NLP
  • Improve revenue integrity and support accurate reimbursement

What makes Retrospective Review different?

Retrospective Review combines AI-powered efficiency, an intuitive experience, and deep clinical expertise to help you:

  • Increase your team productivity
  • Scale effectively to meet changes in volume
  • Support correct documentation and improve RAF scores

Proactively manage RADV audit risk

Audit Risk Members (ARM) is a module within Retrospective Review designed to assist health plans in proactively managing RADV audit risk.

ARM supports defensible coding programs by embedding CMS audit logic into daily coding workflows, promoting defensible coding practices and ensuring documentation integrity and traceability. By applying CMS RADV audit criteria to the plan population, health plans can identify members most likely to be selected for audit and strengthen audit-readiness.

ARM surfaces high-risk members across the population and provides structured workflows for plans to validate or delete diagnoses in a structured, auditable way. Focused review of conditions identified through retrospective chart review enables plans to optimize their RADV risk profile and take action to ensure that every ICD code submitted is clinically supported and compliant with CMS documentation requirements.

This approach empowers plans to move from reactive audit response to continuous audit readiness. Rather than focusing only on post-audit response, ARM helps plans build defensible coding programs that can withstand increasing audit scrutiny while reducing operational burden.

Read the fact sheet

*This is based on the average productivity increase for client coding teams using the coding platform, results may vary per client.

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