Our capabilities

Unique approach to unlocking value

Our clients know that to achieve administrative, operational and financial goals, they need to take into account their pay-for-value and payment accuracy objectives. That’s why Cotiviti Healthcare offers a uniquely comprehensive set of capabilities that reflects our view of payment accuracy and network value as a wide-ranging strategic activity.

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Cotiviti Healthcare solutions achieve accuracy both prospectively and retrospectively to ensure that coding is correct, and our clients are billed in accordance with their payment and medical policies. Continual monitoring enables up-to-date policy compliance, supported by a robust policy library, deep research and clinical expertise so that policy determinations across plans are consistently accurate and comprehensive.

Cotiviti’s constantly updated content library spans government, industry and medical board recommendations and guidance – thousands of policy changes that Cotiviti researches, manages and applies for our payer clients. Cotiviti Healthcare combines this content with leading research, expertise and guidance in policy decisions from medical and coding experts.

We drill into the details of each payment, cross-checking claims against the specifics of differing provider contracts to avoid inappropriate payments. This helps achieve greater accuracy in an environment of increasingly complex contractual arrangements, enabling our clients to better manage changes in the healthcare system.

Cotiviti Healthcare solutions draw on multiple data sources to increase payment accuracy. We thoroughly review and analyze contracts, eligibility files, third-party benefits agreements, and other data sources to determine payment responsibility and coordination of benefits.

Using a combination of technology-enabled analytic filtering, automated processes and the expertise of highly qualified clinicians, Cotiviti Healthcare reviews medical charts for correct coding and proper documentation to determine whether claims are supported, and whether care was delivered in accordance with industry standards and payer guidelines.

When you engage with Cotiviti, our partnership begins with a comprehensive discovery process and takes you through the development of a Network Value strategy and multi-year plan to implement your pay-for-value programs. The result is far more than just another consulting report – with Cotiviti, you’ll receive unique data-driven insights and tactical support services to make changes that deliver results.

Using Cotiviti’s Network Value benchmarks, we can explore your markets or networks to develop detailed comparisons of cost and quality by geography, specialty, and provider. Working together, we can develop strategies and tactics designed to drive high-value care delivery. These tactics can include a range of projects tailored to your organization’s needs and preferences, including developing high-value networks that outperform benchmarks, creating new payment models, supporting provider behavior change, influencing provider referral relationships, and ensuring members seek and receive high-value care.