Submitting timely and accurate risk adjustment data to the Centers for Medicare and Medicaid Services (CMS) for Medicare and commercial risk adjustment can be complicated and difficult. Payers have navigated numerous challenges and setbacks in the ongoing transition from the Risk Adjustment Processing System (RAPS) to the Encounter Data Processing System (EDPS). And setting up and running the dedicated EDGE server required for commercial risk adjustment requires expensive and difficult-to-maintain IT resources. Cotiviti’s Submissions solution alleviates these burdens, combining technology with subject-matter expertise to reduce the time and cost involved in the submission of risk adjustment data while optimizing revenue opportunities for health plans.

• Achieve proven match rates of hierarchical condition category (HCC) edits properly submitted to CMS
• Consolidate activities with a single data storage solution accessible by Medicare and commercial risk adjustment systems
• Gain transparency and visibility into risk adjustment programs at all stages with simplified reconciliations
• Validate the return on investment (ROI) associated with Cotiviti solutions and improve revenue forecasts
• Fine-tune ongoing suspect analytics with encounter data