Cotiviti Blog

Cotiviti is empowering a sustainable value-based healthcare delivery and payment system for health plans, employers, and providers.

Webinar: Decoding the 2026 Star Ratings

The recently published 2026 Star Ratings results confirm that even for large national payers, achieving and maintaining a rating of four stars or higher is no simple feat as measure...

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FWA Insights: Appropriate billing of intensive outpatient programs

Learn how to spot red flags in billing for intensive outpatient programs (IOPs) with these insights from Cotiviti's FWA team.

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Preparing for 2026: Adapting to new risk adjustment regulations

Learn the impact of the latest changes in risk adjustment for 2026 and beyond.

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MY 2026: Breaking down the latest HEDIS Technical Specifications

Read a structured breakdown of confirmed changes to the MY 2026 HEDIS Technical Specifications and strategies to enable health plans to prepare.

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Case study: Regional plan exceeds expectations with second-pass COB

Coordination of benefits (COB) is an intricate, time-consuming process for all health plans—sifting through data assets, checking validity, establishing primacy, and more. But having a...

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Star Ratings Plan Preview: 4 key recommendations

As we await publication of the final 2026 Star Ratings, learn why scores are dropping and strategies for MA plans to close out the calendar year with stronger performance.

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Busted: The top fraud schemes of Q2 2025

Read our breakdown of 10 major healthcare FWA schemes from April through June 2025—and what they reveal about the evolving tactics of bad actors.

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Payment Policy Insights: The evolution of physical therapy

Learn three key trends across physical therapy in outpatient and professional settings—and the implications for health plans.

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Webinar: Deploying AI effectively and responsibly in payment integrity

Artificial intelligence (AI) is unlocking numerous possibilities for payers to make costs more sustainable without a negative impact on care quality. According to McKinsey estimates,...

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FWA Insights: Q&A with the SIU

Cotiviti's FWA investigators break down complex questions related to skin grafts and substitutes, a growing area of concern in healthcare.

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The journey to four stars: How one plan transformed its Star Ratings strategy

Learn how Star Intelligence powers data-driven decision-making for one regional health plan as it seeks to improve Star Ratings outcomes.

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Blue Plan expands Cotiviti DRG review program amid early success

Learn how one Blue Plan adopted Cotiviti's DRG review solution and achieved triple its original projected findings with Clinical Chart Validation.

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FWA Insights: Identifying a DME dropshipping scheme

Learn how Cotiviti identified a DME provider that ordered items from a large online retailer, then billed the health plan at heavily marked up rates.

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Regional plan exceeds expectations with second-pass COB

Learn how a regional health plan enlisted the help of Cotiviti’s retrospective COB Validation solution and started seeing results fast.

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Decoding HEDIS® MY 2024 for success in MY 2025

Learn key takeaways from the HEDIS MY 2024 season along with measure and timeline changes that will impact health plans for MY 2025.

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7 key steps to build a valuable COB program

Learn how to build a comprehensive, member-centric COB program with prompt monitoring, accurate data, and auditing expertise.

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FWA Insights: Uncovering improper billing in urine drug screens

Learn how Cotiviti's SIU identified a recent scheme in this common area of healthcare fraud, waste, and abuse (FWA).

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Unlocking business value through interoperability: 3 key strategies

Learn three essential strategies to help payers maximize the value of their interoperability investments as key industry deadlines draw closer.

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Large Medicaid payer protects taxpayer dollars, financial integrity with prepay review

Learn why one large Medicaid plan realizes value from Cotiviti's prepay solutions and differentiated service model.

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The shift to outpatient care

As procedures that were once strictly performed in hospitals move to outpatient facilities, patients and providers alike are witnessing a shift that promises both opportunity and challenges.

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