We are proud to announce Eliza® Member Engagement is now part of Cotiviti!
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Suspect Analytics is part of Cotiviti's
Risk Adjustment solution suite.
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.
years of industry experience
Our advanced analytical models provide a nuanced data examination that can predict which members have the highest probability of missing or incomplete conditions. We leverage multiple sources of data to identify gaps in documentation and help identify the opportunities to focus on.
Suspect Analytics is powered by proprietary clinical rules and statistical models to aggregate, quickly assess, and integrate large volumes of data and devise recommendations that are tailored to client needs.
We mine data from a range of sources including prior risk adjustment history, diagnoses from past medical and drug claims, durable medical equipment usage, and medical procedures for evidence of missing conditions. With our expert analysis of complex patterns across multiple data sources, clients gain key insights to prioritize their members risk and optimize their risk-adjustment programs.
Based on potential impact, we identify and rank members with the highest probability of having missing or incomplete diagnosis codes. This approach considers different levels of investment for each member based on a proprietary value scoring model, providing a recommended path to reducing gaps.
With more than 25 years of industry experience, Cotiviti’s solutions enable health plans to identify the best opportunities and approaches to optimize accuracy, compliance, and appropriate reimbursement for clients. Analytics helps our clients to:
