How payers can execute high-performing interoperability programs to enable clinical data
Learn the key steps, options available, and recommendations for payers to optimize their interoperability programs.
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White Papers
Take advantage of these in-depth insights into improving payment integrity, risk adjustment, and quality and analytics performance.
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Close member care gaps across 12 critical areas in 2024
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Finding new opportunities to improve payment integrity with inpatient claim review
Learn how to reduce the burden of research and recovery for inpatient claims with a tailored pre and postpay approach.
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FWA Insights%%6 areas of healthcare and how to defend them against FWA
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Implementing a digital quality strategy
Learn how to navigate digital quality measurement changes with success and improve quality of care.
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Payment integrity: Getting self-insured employer groups on board
Discover best practices for reaching your self-insured employer groups with better payment integrity.
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The "smart prepay" approach to payment integrity
Learn how a managed service model addresses the five critical dimensions of payment integrity versus a software-only approach.
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Developing trust with Medicare Advantage members through better engagement
Learn the critical elements of creating a positive member experience from the outset for Medicare Advantage plans, beginning with building trust with the power of multi-channel communications.
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The payment integrity playbook for success in 2023 and beyond
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Rising telehealth: Catching FWA in behavioral health claims
Discover how the pandemic affected behavioral health claims and learn different tactics for avoiding fraud, waste, and abuse.
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Engaging Medicaid members to take action
Learn how Medicaid plans can support whole-person, culturally competent, and equitable care—from enrollment to renewal.
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Specialty Drugs: Ensuring payment accuracy beyond prior authorizations
While many plans lean on prior authorizations to ease the processing of specialty drug claims, our experts explore more comprehensive options for getting claims paid more accurately—and more quickly.
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The evolution of DxCG, the gold standard in risk adjustment and predictive modeling
Updated in 2022 for DxCG's 25th anniversary, this is the story of the birth and evolution of one of the earliest and most accurate risk assessment and predictive modeling solutions in the industry.
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A proven approach to preventing E&M over-coding
Cotiviti Chief Medical Officer Richard Pozen, M.D., explains how payers can tackle challenging Level 4 and 5 E&M claims while still paying claims promptly and minimizing abrasion.
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Research: Optimizing payment integrity with enterprise pre and postpayment solutions
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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