Cotiviti surveyed health plan leaders to investigate the challenges their organizations are facing with balancing prospective and retrospective payment integrity programs.
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Read our Savings Spotlight and learn how one regional Blue Plan serving more than 4 million members achieved nearly $100 million in savings with Cotiviti's prospective payment integrity solutions.
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A house united: Integrating pre and postpay programs for optimal FWA results
Watch WebinarPayers and providers are both highly motivated to keep their members and patients healthy, but amid numerous challenges—not the least of which was the major disruption to primary care...
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One solution for proactively re-engaging members with the healthcare delivery system and accurately documenting disease burden is In-Home Assessments (IHAs). Learn how to optimize them in our webinar.
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Take a look at this calendar as a reminder of proposed and confirmed upcoming changes to the CMS Star Ratings system.
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Break out of hyper-focusing on the claim payment lifecycle and analyze claims within the context of the human experience to optimize your coordination of benefits processes.
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What results could you be achieving with Cotiviti for your Medicare risk adjustment programs? Use this calculator and find out!
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Avoid payment errors and increase prospective savings
Learn howWhile 2021 has brought renewed optimism over the COVID-19 pandemic, it has also delivered numerous new fraud, waste, and abuse (FWA) cases in healthcare.
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With the June 15 submission deadline just over a month away, health plan quality departments are in the thick of the HEDIS® Measurement Year (MY) 2020 audits and submissions. But soon,...
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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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Calculate your risk adjustment opportunity with Cotiviti
See the calculatorBy working in unison, risk adjustment and quality teams can better understand where care gaps exist and the most effective ways to deliver high-value care to disengaged or disenfranchised members.
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DxCG co-founder Dr. Arlene Ash explains how analytics can be used to combat inequities that impact caregiving, costs, and wellness to effectively and efficiently close gaps in care.
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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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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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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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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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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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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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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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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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