Articles from Cotiviti

Cotiviti, a leader in data-driven healthcare solutions, has launched Engagement Hub to empower health plans to identify care gaps and gain a holistic view of members across quality measures, enabling them to deploy targeted outreach to improve member care and achieve performance benchmarks. This new solution brings together the quality measure logic and reporting of Cotiviti’s Best in KLAS® Quality Intelligence solution with the activation and outreach capabilities of the Eliza® member engagement engine to set the standard for efficiency, ease-of-use, and customer satisfaction.

Cotiviti, a leader in data-driven healthcare solutions, has welcomed seasoned technology leader Suvajit Gupta as its new Chief Technology Officer as the organization drives innovation across its portfolio of solutions that serve healthcare payers and retailers. Bringing more than 30 years of experience in technology leadership to Cotiviti, Gupta will be tasked with shaping the organization’s technology strategy, leading research and development, and aligning technology initiatives with business objectives.

Cotiviti, a leader in data-driven healthcare solutions, is launching 360 Pattern Review, a powerful, fully managed service that combines prepay fraud, waste, and abuse (FWA) prevention with postpay review for true FWA prevention and management across the entire claim payment cycle. Cotiviti will introduce 360 Pattern Review at the 2024 National Health Care Anti-Fraud Association (NHCAA) Annual Training Conference in New Orleans, Louisiana, taking place November 19-22, 2024.

Quality Engine, the administrative measure logic and systematic sample processing component of Cotiviti’s Quality Intelligence solution, has earned Certified Measures status for the Healthcare Effectiveness Data and Information Set (HEDIS®) 2024 Measurement Year (MY 2024) from the National Committee for Quality Assurance (NCQA). This certification, which follows Quality Intelligence being named the 2024 Best in KLAS® solution for Payer Quality Measurement and Reporting, validates that measures have passed the thorough testing required to effectively support health plans with the MY 2024 reporting season.

Cotiviti, a leader in data-driven healthcare solutions, will host the 2024 Cotiviti Client Conference (CCC24) May 15–17 in Austin, Texas, bringing together more than 140 health plan leaders to share solutions for enabling a high-quality and viable healthcare system. Themed “Navigating New Frontiers,” the conference will highlight leading strategies to create successful outcomes for members and address challenges in payment integrity, quality improvement, risk adjustment, and member engagement amid the shifting healthcare climate.

Cotiviti, a leading healthcare data analytics and technology business, announced today the close of its business recapitalization with two premier firms, affiliates of its long-standing partner Veritas Capital (Veritas) and investment funds managed by KKR. KKR and Veritas are now co-sponsors with equal ownership stakes in Cotiviti.

Cotiviti, a leader in data-driven healthcare solutions, has been named the winner of the bronze Stevie® Award for Best Use of Technology in Customer Service. The award focuses on the company’s technological expertise and prioritization of customer service outcomes through its MyCotiviti client portal, a comprehensive customer service portal providing multi-level support and a library of information for Cotiviti’s payer-focused solutions.

Cotiviti, a leader in data-driven healthcare solutions, has been named 2024 Best in KLAS® in Payer Quality Measurement and Reporting for its Quality Intelligence solution. This recognition stems from insights sourced from healthcare executives as well as directly from Quality Intelligence end-users, continuing Cotiviti’s long-running status as a top performer. Cotiviti earned the highest ratings in five of KLAS's customer experience pillars, including culture, loyalty, product, relationship, and value.

Cotiviti, a leader in data-driven healthcare solutions, will present on preventing healthcare fraud, waste, and abuse (FWA) at the 2023 National Health Care Anti-Fraud Association (NHCAA) Annual Training Conference in Dallas, Texas, taking place November 6–9. Cotiviti’s experts will share insights into the role of advanced analytics in FWA, how to execute prepay investigations with meaningful financial impact, and how combined prepay and postpay investigation creates better collaboration with payment integrity counterparts.

Cotiviti, a leader in data-driven healthcare solutions, will showcase its industry-leading Quality and Stars solutions at the National Committee for Quality Assurance (NCQA) Health Innovation Summit taking place October 23–25 in Orlando, Florida. These solutions include Star Intelligence, a powerful tool that gives Medicare Advantage and MA-PD plans the ability to track, predict, and model their Star Ratings.

Cotiviti, a leader in data-driven healthcare solutions, is expanding its end-to-end Coordination of Benefits (COB) Validation solution by adding prospective COB validation capabilities. This comprehensive offering allows health plans to reduce overpayments by reviewing claims and determining payment responsibility after adjudication but before payment, making it the only full-service, “pause-and-pay” COB offering in the market.

Quality Engine, the administrative measure logic and systematic sample processing component of Cotiviti’s Quality Intelligence solution, has earned Certified Measures status for the Healthcare Effectiveness Data and Information Set (HEDIS®) 2023 Measurement Year (MY 2023) from the National Committee for Quality Assurance (NCQA). This certification, which follows Cotiviti’s recognition as a top performer in the 2023 Best in KLAS ratings for payer quality analytics, validates that measures have been put through the thorough testing required to effectively support health plans with the HEDIS 2023 reporting season, marking the 23rd consecutive year Cotiviti has earned this recognition.

Cotiviti, a leader in data-driven healthcare solutions, will host the 2023 Cotiviti Client Conference (CCC23) May 10–12 in San Diego, California, bringing together leading payer organizations and healthcare stakeholders from across the country to discuss new ways to improve the sustainability of the healthcare ecosystem. The three-day conference will focus on themes such as taking a holistic approach to payment integrity, delivering a better member experience, and improving quality outcomes and Star Ratings through integration.

Cotiviti, a leader in data-driven healthcare solutions, will present on preventing healthcare fraud, waste, and abuse (FWA) at the 2022 National Health Care Anti-Fraud Association (NHCAA) Annual Training Conference in Orlando, Florida, taking place November 15–18, 2022. Cotiviti will be joined by Highmark Wholecare, a health plan serving more than 350,000 members in Pennsylvania, to discuss how to prevent wasteful and abusive claims from being paid while remaining within strict fraud compliance guidelines.

Cotiviti, a leader in data-driven healthcare solutions, has launched Star Intelligence for Medicare Advantage payers, marking the latest addition to its industry-leading Quality and Stars solution suite. This new solution gives plans the ability to track, predict, and model their Star Ratings to better understand and prioritize actions needed to offer high-quality care to a growing Medicare Advantage population as well as optimize bonus payments. An increase of half a star improves a plan’s quality bonus by an average of $400 per member per year, according to one recent analysis1.

Cotiviti, a leader in data-driven healthcare solutions, will present on optimizing health plan risk adjustment programs at the RISE West conference in Los Angeles, taking place August 31–September 2, 2022. Cotiviti’s RaeAnn Grossman, executive vice president of population health management, risk adjustment, and quality operations, and Andres Aguirre, MPH, director of quality improvement at Sharp Health Plan, will look at proven strategies for shifting from reactive decision-making to prescriptive, dynamic interventions to improve clinical and financial outcomes, as well as close gaps across risk adjustment and quality programs such as HEDIS® and Star Ratings.

Quality Engine, the administrative measure logic and systematic sample processing component of Cotiviti’s Quality Intelligence solution, has earned Certified Measures status for the Healthcare Effectiveness Data and Information Set (HEDIS®) 2022 Measurement Year (MY 2022) from the National Committee for Quality Assurance (NCQA). This marks the 22nd consecutive year that Cotiviti, a leader in data-driven healthcare solutions, has earned this certification, validating that Cotiviti’s HEDIS measure logic has passed the rigorous testing required to support health plans for HEDIS MY 2022.

Cotiviti, a leader in data-driven healthcare solutions, will present at the RISE Qualipalooza conference in Las Vegas, June 28–29, 2022. The presentation will focus on the value of integrating quality improvement throughout payer organizations, enabling them to improve the member experience and quality program results. Rachael Jones, senior vice president of performance analytics and quality at Cotiviti, will open the conference as co-chair of the RISE event.

Cotiviti, a leader in data-driven healthcare solutions, will host the 2022 Cotiviti Client Conference (CCC22) May 11–13 in Charleston, South Carolina. Leading payer organizations and healthcare stakeholders from across the country will come together to teach, learn, and discuss new ways to achieve value and optimize outcomes. The first Cotiviti event held in-person since 2019, the three-day conference will focus on navigating post-pandemic challenges related to healthcare payments, risk, quality, and consumer engagement.

Cotiviti is celebrating the 25th anniversary of DxCG Intelligence, the healthcare industry standard in risk assessment and predictive modeling, by introducing major enhancements to enable healthcare organizations to more accurately measure risk and improve care for their populations. Containing enhanced clinical and pharmaceutical classification systems including an expanded set of Hierarchical Condition Categories (HCCs), DxCG Intelligence v6.0 expands social determinants of health (SDoH) classifications to identify health plan members experiencing socioeconomic and psychosocial difficulties such as homelessness, poverty, and abuse. The latest release also features newly recalibrated models based on the latest benchmark data for commercial, Medicare, and Medicaid populations.

RaeAnn Grossman, executive vice president of population health management, risk adjustment, and quality operations at Cotiviti, will co-chair and participate as a speaker in The RISE Women in Health Care Leadership Summit taking place December 14–15 in San Diego, California. Grossman will take part in a panel discussion on how women can effectively negotiate beyond salary; how to better align, collaborate, and execute no matter what size of organization; and best practices for exceeding expectations and succession planning.

Quality Engine, the administrative measure logic and systematic sample processing component of Cotiviti’s Quality Intelligence solution, has earned Certified Measures™ status for the Healthcare Effectiveness Data and Information Set (HEDIS®) 2021 Measurement Year (MY 2021) from the National Committee for Quality Assurance (NCQA). This marks the 21st consecutive year that Cotiviti, a leader in data-driven healthcare solutions, has earned this certification, validating that measures have passed the rigorous testing required to support health plans with this year’s HEDIS reporting.

Cotiviti, a leader in data-driven healthcare solutions, has published new research capturing the healthcare payer industry’s challenges in optimizing pre and postpay claim payment integrity programs. The report, “Optimizing Payment Integrity with Enterprise Pre and Postpayment Solutions,” is based on a survey of 104 health plan stakeholders from more than 70 different payer organizations, conducted in partnership with HealthPayerIntelligence.

Cotiviti, a leader in data-driven healthcare solutions, has received recognition from two premier business award programs for its COVID-19 Outbreak Tracker, which identifies potentially hidden infection “hot spots” across the U.S. to help the country respond to the pandemic. Cotiviti received a Stevie® Award in the 2021 American Business Awards® and a Fast Company 2021 World Changing Ideas Award in the AI and Data category.

The IT Infrastructure Service Delivery and Transformation team at Cotiviti, a leader in data-driven healthcare solutions, has been rated at level 3 of the CMMI Institute's Capability Maturity Model Integration (CMMI)® (CMMI Services V2.0). The appraisal was performed by ATKOTT, Inc. Achievement of this maturity level places Cotiviti in an elite group of organizations that have been found to have met the CMMI model’s standards of efficient and effective delivery of quality service offerings that meet market and customer needs.

Cotiviti, a leader in data-driven healthcare solutions, will share insights on how organizations can use AI technologies to reduce healthcare fraud, waste, and abuse (FWA) at the Ai4 2021 Healthcare Summit. Cotiviti executive vice president of development and innovation Nicole Neumarker will discuss how fraudulent activity within healthcare represents $100 billion+ lost each year and what organizations can do to solve this ongoing issue in the panel discussion, “Reducing Fraud, Waste & Abuse with AI.”

Cotiviti, a leader in data-driven healthcare solutions, has earned Certified status for information security by HITRUST® for its Quality and Performance as well as Risk Adjustment solutions for the third consecutive year. Earning HITRUST certification for the first time are Network Intelligence, which enables payers and providers to collaborate to manage value-based healthcare delivery and payment, and Quality Reporter Web, Cotiviti’s new streamlined, web-based quality reporting solution.

Cotiviti, a leader in data-driven healthcare solutions, bolstered its executive team with the appointment of one of the nation’s premier health plan experts to the role of executive vice president, risk adjustment and quality. RaeAnn L. Grossman brings more than two decades of deep industry experience to the role to support the ongoing success of these key lines of business. The addition of this new senior leader marks a new phase of growth and expansion for Cotiviti, as well as a renewed focus on further optimizing its quality and risk offerings to meet rising market demand.