Cotiviti
Cotiviti offers comprehensive solutions in payment accuracy, risk adjustment, quality and performance, consumer engagement, and retail, aiming to enhance healthcare efficiency and profitability.
Payment Accuracy Solutions
Cotiviti's payment accuracy solutions are designed to improve reimbursement accuracy and reduce inefficiencies in healthcare claims. The suite of services includes payment policy management, coding validation, dental claim accuracy, claim pattern review, clinical chart validation, COB validation, data mining, contract compliance, and fraud, waste, and abuse management. These solutions help healthcare payers save over $8 billion annually and ensure claims are appropriately reimbursed.
Risk Adjustment Solutions
Cotiviti offers comprehensive risk adjustment solutions to help Medicare Advantage clients and other healthcare organizations optimize their financial performance. These solutions include suspect analytics, medical record retrieval, and medical record coding. Annually, these efforts generate over $2 billion in appropriate incremental risk adjustment revenue. The goal is to accurately reflect the health status of enrolled members, ensuring proper compensation and improved care.
Quality and Performance Solutions
Cotiviti's quality and performance solutions aim to close care gaps and drive better healthcare outcomes. Services include quality intelligence, star intelligence, medical record retrieval, medical record abstraction, medical intelligence, and DxCG intelligence. Reporting over 127 million HEDIS® lives, these solutions help healthcare organizations monitor and improve their quality ratings, which are crucial for both regulatory compliance and competitive performance.
Retail Solutions
Cotiviti supports the retail industry with targeted audit and recovery services designed to increase efficiency and maximize profitability. Retail solutions cater to all retail verticals, including mass merchandisers, grocery and discount chains, department stores, and specialty retailers. By identifying and recovering lost revenues, Cotiviti helps retailers optimize their operations and financial performance.
Corporate Social Responsibility: Cotiviti Cares
The corporate social responsibility program, Cotiviti Cares, focuses on community engagement, environmental challenges, educational development, and health. By supporting various initiatives in these areas, Cotiviti aims to make a positive impact beyond its business operations. This commitment underscores Cotiviti’s dedication to fostering a better society through responsible and ethical practices.