Q&A: Improving value-based care through data and collaboration
To successfully transition from paying for volume to paying for value, Medicare Advantage plans must take a more innovative approach to provider engagement.
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Cotiviti Blog
Cotiviti is empowering a sustainable value-based healthcare delivery and payment system for health plans, employers, and providers.
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Podcast: The role of AI during COVID-19 and in a post-pandemic world
While COVID-19 has shifted many healthcare payers' priorities in the past year, organizations are also looking at where they will make their long-term technology investments once the...
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How to turn in-home assessments into “close encounters of the right kind”
Health plans complete in-home health assessments (often called health risk assessments) for their members for several reasons: accurately documenting members’ risk burden, supporting...
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Keeping members in mind: Optimizing coordination of benefits
Coordination of benefits (COB) requires health plans to navigate significant complexities. The order of benefit determination rules rely on an ever-changing member landscape that is as...
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NCQA publishes proposed changes to HEDIS measures for MY 2022
The National Committee for Quality Assurance (NCQA) is accepting comments through March 11 on proposed changes for HEDIS® Measurement Year 2022 (MY 2022), which will be published in...
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Case study: Identifying potential fraud, waste, and abuse during the COVID-19 pandemic
While the COVID-19 pandemic has challenged providers in significant ways, it unfortunately has also created new opportunities for a small handful of bad actors to take advantage of the...
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CMS Star Ratings: Navigating changes in 2021 and the coming years
As many health plans know, achieving a higher Star Rating will soon be more challenging. The Centers for Medicare & Medicaid Services (CMS) is changing the makeup of the rating system,...
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COVID-19 health risk by underlying condition and age: what the latest data says
In the summer of 2020, Cotiviti released a new health risk map to help determine which states might see serious, medically attended novel coronavirus (COVID-19) cases. At the time, we...
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Cotiviti achieves 20 years of HEDIS® certification amid expanding quality landscape
To build a successful quality improvement program, health plans not only must stay ahead of annual changes to HEDIS® reporting requirements, but also a continually expanding list of...
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Busted: The top healthcare fraud schemes of Q4 2020
Numerous bad actors in healthcare continued to be at large in 2020, exploiting the COVID-19 health crisis and taking advantage of health plans and their members. In Q4, healthcare fraud...
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Podcast: How to step up claim overpayment recovery results
Payment accuracy programs are critical to delivering value to health plan members. Some plans excel at recovery management while others struggle—and the difference in financial results is significant.
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Podcast: The keys to successful claim overpayment recovery
Managing payment recovery is very hard to accomplish without increasing provider abrasion. And this proves especially difficult when using collection agencies that aren't experts in healthcare claims.
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Video: Forecasting COVID-19 outbreaks in Massachusetts and beyond
As numerous regions around the country see surges of COVID-19 outbreak, Cotiviti's Outbreak Tracker continues to accurately predict which counties are at risk within the next seven to...
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CMS 2022 Advance Notice: 4 key takeaways for MA plans
The public comment period has just closed for the calendar year (CY) 2022 Medicare Advantage (MA) and Part D Advance Notice recently released by the Centers for Medicare & Medicaid...
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Podcast: Excellus BlueCross BlueShield's data lake journey
As they look to tame their data and turn it into actionable insights, many payers are significantly ramping up their data analytics strategy by building a data lake.
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Podcast: A better approach to clinical appropriateness in claims payment
Listen to our podcast and learn how to ensure that claims are clinically appropriate through a combination of coordinated technology and human review.
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Podcast: Dr. Emad Rizk on managing telehealth concerns amid COVID-19
The extraordinary increase in telehealth usage during the COVID-19 pandemic has opened the door for potential healthcare fraud, waste, and abuse (FWA), particularly around upcoding....
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Precision medicine’s value to complex disease management
Understanding how individuals vary on disease susceptibility is becoming increasingly important for clinicians to deliver effective treatment to their patients. For example, some...
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Podcast: How to sharpen your inpatient auditing program with better chart selection
Listen to our podcast as we discuss how health plans can be more selective and focus on pursuing medical records that will actually return value back to the plan.
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Cotiviti clients outperform the field in 2021 Star Ratings
With Medicare open enrollment set to begin this week, the Centers for Medicare & Medicaid Services (CMS) has released the 2021 Star Ratings for Medicare Advantage plans with...
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