Cotiviti Blog

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

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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Perform Beyond Expectations: Delivering a true solution

In a disruptive healthcare environment, simply meeting expectations is no longer enough. Between shifting regulations, evolving quality benchmarks, and growing member needs, health plans...

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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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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.

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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.

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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...

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FWA Insights: Excessive dental restorations

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

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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.

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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.

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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.

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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.

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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.

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