Cotiviti, Inc.

White Paper: How payers can execute high-performing interoperability programs to enable clinical data
Read our white paper as we define the key steps for payers to build and execute a high-performing interoperability programâ??offering best practices to consider when working with both internal and external partners.

National health plan deploys Eliza for secure digital engagement with members
Read our case study and learn how one national health plan deployed Eliza to launch an innovative campaign with secure digital-linked text messages, interactive voice response (IVR) outreach, and email to improve quality compliance and reach members with diverse care needs.

Fact Sheet: Star Intelligence
Cotiviti's Star Intelligence gives health plans the ability to track, predict, and model their Star Ratings. This empowers plans with the capability to understand and prioritize actions needed to offer better care to a growing MA population and to optimize bonus payments. Many plans may struggle to predict their Star Ratings for the current year and beyond, using homegrown solutions or Stars-specific offerings. But with Star Intelligence, plans can choose to integrate with our Quality Intelligence solution for a more holistic view of members in regards to quality, Star Rating improvement, member engagement, and more.

Fact Sheet: Quality Intelligence Solution
Cotiviti's Quality Intelligence measurement and reporting solution sets the standard for efficiency, integration, ease of use, and customer satisfaction. With our fully NCQA-certified quality measure logic, health plans are in good hands. Quality Intelligence enables health plans to: track, monitor, and improve quality compliance; develop and measure proprietary quality metrics; facilitate HEDIS®, Star Ratings, state-specific, and other quality measure submissions.

Prepay coordination of benefits (COB) boosts payment integrity results for large national plan
Learn how a Cotiviti client achieved a >99% conversion rate with prospective and retrospective COB Validation.

Discover the impact of prospective DRG validation
Learn how Clinical Chart Validation enabled one plan to streamline and optimize DRG review while improving quality and the provider experience.

eBook: Close care gaps in 12 critical areas
From HEDIS®, to Star Ratings, to member outreach and more, health plans have many priorities to tackle and limited resources to accomplish their goals. And when members receive an overwhelming amount of communications, itâ??s easy to get lost in the noise. Thatâ??s why plans need new strategies to reach their members with the right message at the right time and close care gaps when it matters most. In this new and comprehensive eBook, we explore 12 key focus areas for improving member care and quality scores with better messaging, collaboration, and prevention.

eBook: Six areas of healthcare and how to defend them against FWA
Fraud, waste, and abuse (FWA) is an area of constant concern for health plans. Whether inappropriate billing is happening purely by accident, due to lack of correct coding education, or with malicious intent from bad actors, flagging and fixing billing errors is a continual process. A strong FWA strategy is the only way to safeguard plans against inappropriate billing and ensure payment integrity. In our new eBook, we dive into several specific areas susceptible to FWA, including DME, mental health services, genetic testing, dental services, and more.

White Paper: The smart prepay approach to payment integrity
Adjudicating claims appropriately while minimizing the need to pursue overpayment recovery remains one of the greatest challenges faced by all payers. While many players in the payment integrity space offer software that enables health plans to manage their prepay claim editing of professional and outpatient facility claims, this approach only tackles one aspect of the payers entire claim stream and the payment integrity continuum. Read the new white paper from Cotiviti, a payment integrity partner to more than 100 health plans, as we break down the five critical dimensions of any payment integrity program.

Case Study: Medicaid plans leverage Eliza to reach members during redetermination
The resumption of the Medicaid redetermination process brought uncertainty for tens of millions of Americans and their health plans, many of which struggled to successfully reach their members to update contact information or assist them in finding alternative coverage. Learn how health plans of all sizes worked with Cotiviti to conduct redetermination campaigns leveraging Eliza+, Cotivitiâ??s multi-channel consumer engagement platform.