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