Cotiviti Completes Acquisition of Edifecs.
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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.
Expertise and technology combine to improve coding results
Health plans can drive a higher level of coding accuracy with Cotiviti's Second Level Review, helping to strengthen compliance. Our solution integrates NLP automation and quality assurance led by senior industry experts to review first-pass coding results. We focus on improving the capture of relevant diagnoses by identifying overlooked or underreported diagnoses, as well as on correcting unsupported conditions from the first-pass review. Plans can:
Part of healthcare's DNA for nearly 30 years, DxCG Intelligence analyzes and helps manage the clinical and financial risks associated with caring for populations, using proprietary predictive models to turn healthcare data into individual risk scores. Aggregating the scores of individuals with key attributes generates group-level predictive results that can help answer critical questions about healthcare efficiency.
The latest release of DxCG Intelligence pairs our easy-to-use health risk assessment and enhanced clinical and pharmaceutical classification systems with the rapid calculation of the geographic vulnerabilities (environmental factors) impacting members. Using this new SDoH functionality in conjunction with our industry-standard Relative Risk Scores and the SDoH Hierarchical Condition Categories allows clients to identify members at highest risk before designing, deploying, and evaluating a closed-loop strategy for improving health equity.
