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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Our latest healthcare payer resources
The newest resources from Cotiviti to help power your payment integrity, risk adjustment, quality reporting, and performance analytics programs.
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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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Advanced analysis and collaboration drives $1M+ overpayment recovery success for Health Partners Plans
Learn how Health Partners Plans of Pennsylvania successfully recovered more than $1 million in overpayments related to upcoding from a provider group in partnership with Cotiviti.
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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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Transitioning from post-payment recovery to prospective validation
Payers continue to invest in innovative techniques to prevent improper payments, rather than “pay and chase." Learn how health plans can successfully navigate the challenges of prospective validation.
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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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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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Avoid payment errors and increase prospective savings
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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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The three fundamentals of risk adjustment success
Risk adjustment—and the complex nature of the processes involved—is often misunderstood. Learn the fundamentals health plans must master to be successful.
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Q&A: Highmark's payment integrity director on new COVID-19 claim trends
Cotiviti's Signature Series features interviews with senior health plan leaders on how to improve clinical and financial outcomes in healthcare.
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Calculate your risk adjustment opportunity with Cotiviti
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How Medicaid plans can overcome the inevitable strain of COVID-19
The COVID-19 pandemic has led to unprecedented challenges for Medicaid plans. Here are five areas that Medicaid plans should evaluate to protect their business in this environment.
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Beyond claims: how to design a more member-centric COB process
Cotiviti payment leaders explain how to optimize your coordination of benefits (COB) process to account for variable member life events to help ensure proper COB determinations.
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Accelerating value-driven care: A comprehensive approach to provider specialty tiering
Learn how a major North Carolina health plan uses Cotiviti's Network Intelligence solution to support a provider specialty tiering program centered on value-based care.
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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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Reduce FWA in 2021 with a proactive approach
Cotiviti's senior leaders explain how to guard against healthcare fraud in 2021 amid recent CPT code updates coupled with permanent regulatory changes to telehealth.
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Cotiviti Solutions Flipbook
Choose Certainty with a proven leader in payment integrity, risk adjustment, quality, and analytics.
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Rolling back the surge: new Cotiviti map helps forecast COVID-19 health risk severity
As COVID-19 cases and deaths surge in several hot spots across the United States, many individuals and organizations continue to ask, “What else can we do to help protect ourselves, our...
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New York health plan cracks massive diagnostic testing scheme for pre-pay FWA savings
Learn how a major New York health plan worked with Cotiviti to realize more than $10.5 million in savings from one major investigation.
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Q&A: How Arkansas Blue Cross created a value-based payment model
Cotiviti's Signature Series features interviews with senior health plan leaders on how to improve clinical and financial outcomes in healthcare. To address rising healthcare costs and...
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Busted: the top COVID-19 healthcare fraud schemes
The COVID-19 pandemic has created opportunity for bad actors to exploit vulnerabilities in the healthcare system—as well as capitalize on fear. From offering phony testing to peddling...
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