Rising telehealth: Catching FWA in behavioral health claims
Discover how the pandemic has affected behavioral health claims and learn different tactics for avoiding fraud, waste, and abuse.
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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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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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Transitioning from postpayment 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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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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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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