Cotiviti Blog

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

7 key steps to build a valuable COB program

Explore the 7 steps to build a successful COB program.

Read Blog
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).

Read Blog
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.

Read Blog
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.

Read Case Study
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.

Read Blog
CCC25: 3 key pillars required to perform beyond healthcare challenges

Learn about the three key values that guide Cotiviti's relationship with our clients: transparency, authenticity, and accountability.

Read Blog
Navigating dental claim FWA: The impact of abused codes and claim splitting

Learn the top dental procedures that are frequently misused as we examine their causes, consequences, and the steps necessary to mitigate the effects of fraudulent and abusive billing.

Read eBook
Webinar: Reflecting on HEDIS MY 2024 and preparing for what’s next

The conclusion of another HEDIS® season offers health plans an important opportunity to evaluate their performance, uncover key takeaways from the past year, and realign priorities for...

Read Blog
FWA Insights: Excessive dental restorations

Learn how Cotiviti's SIU identified excessive billing for dental restorations to safeguard payment integrity and appropriate member care.

Read Blog
Optimizing payment integrity for emergency department E/M claims

Learn three key trends shaping emergency department (ED) E/M claims as we examine their impact on payers and payment integrity programs.

Read White Paper
Risk adjustment: 4 strategies as CMS increases RADV audits

Learn how to prepare for CMS's new risk adjustment audit methodology for Medicare Advantage plans in 2025 and beyond.

Read Blog
Medical pharmacy data mining innovation uncovers significant findings for large national plan

Learn how a multi-state managed care organization identifies complex pharmacy errors and more with Cotiviti’s solutions.

Read Case Study
Star Ratings: 4 recommendations for the 2026 CMS Final Rule

Learn about key updates from the CMS Final Rule and how to prepare for Star Ratings success in 2026 and beyond.

Read Blog
FWA Insights: Solving durable medical equipment (DME) challenges

Learn how Cotiviti's investigators took action when one provider stood out for excessive durable medical equipment (DME) billing of Medicare.

Read Blog
Payment integrity: Unlocking the value of complex outpatient reviews

Learn about one of the most impactful and often underutilized tools in a high-performing payment integrity program: the complex outpatient review.

Read Blog
Key commercial risk adjustment updates as 2026 approaches

Learn about key changes to the commercial risk adjustment program from the 2026 Payment Notice as we offer key strategies for health plans to prepare and strengthen their efforts.

Read White Paper
Busted: The top fraud schemes of Q1 2025

Read our summary of how bad actors allegedly deployed kickbacks, false claims, and exploitation of vulnerable patients to defraud health plans in Q1 of 2025.

Read Blog
Prepay coordination of benefits (COB) boosts payment integrity results for large national payer

Learn how health plans can prevent overpayments, reduce future erroneous payments, and confirm that primary payment responsibility is correctly assigned—all while lowering provider abrasion.

Read Case Study
3 updates from the 2026 CMS Final Rate Announcement

CMS has finalized a >5% payment increase in the Medicare Advantage and Part D Rate Announcement for calendar year 2026.

Read Blog
FWA Insights: Skin grafts and substitutes

Learn how prepay FWA review identified over half a million dollars in skin substitute overpayments for one client.

Read Blog
Loading More...