Cotiviti

Smarter healthcare.

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Overview

Cotiviti is a leading solutions and analytics company that leverages a combination of proprietary data, analytics, and expertise to serve the healthcare industry. For population health, Cotiviti's Quality and Performance solutions help health plans to close care gaps, meet quality standards (like HEDIS), and manage risk adjustment. They focus on ensuring payment accuracy and improving outcomes through data-driven insights.

✨ Key Features

  • Quality Improvement
  • Risk Adjustment
  • Payment Integrity
  • Payer-Provider Data Exchange
  • HEDIS Reporting and Management
  • Care Gap Analysis

🎯 Key Differentiators

  • Deep expertise in payment accuracy and financial aspects of healthcare.
  • Comprehensive approach to risk adjustment through advanced analytics.
  • Strong focus on serving the needs of healthcare payers.

Unique Value: Provides a comprehensive solution for health plans to manage financial risk and ensure payment accuracy through advanced data analytics.

🎯 Use Cases (4)

HEDIS and Star Ratings improvement for health plans. Risk adjustment optimization (HCC coding). Closing clinical care gaps. Ensuring payment integrity and accuracy.

✅ Best For

  • Helping Medicare Advantage plans improve their Star Ratings.
  • Identifying and validating chronic conditions for accurate risk adjustment.
  • Facilitating the closure of gaps in care through provider and member engagement.

💡 Check With Vendor

Verify these considerations match your specific requirements:

  • Provider organizations looking for a real-time care management workflow tool.
  • Small practices not involved with health plan quality programs.

🏆 Alternatives

Optum Change Healthcare Edifecs

Offers a deeper focus on the financial and payment integrity side of risk adjustment compared to more clinically-focused population health platforms.

💻 Platforms

Web API

🔌 Integrations

Health Plan Systems Provider EHRs (via data exchange) Claims Data

🛟 Support Options

  • ✓ Email Support
  • ✓ Phone Support
  • ✓ Dedicated Support (Enterprise tier)

🔒 Compliance & Security

✓ SOC 2 ✓ HIPAA ✓ BAA Available ✓ ISO 27001 ✓ SSO ✓ HITRUST ✓ SOC 1 & 2 ✓ ISO 27001 ✓ NCQA Certified

💰 Pricing

Contact for pricing
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