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Cotiviti Quality and Performance

Better data. Better decisions. Better healthcare.

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Overview

Cotiviti offers a range of solutions for healthcare payers that focus on improving financial performance and quality of care. Their Quality and Performance solutions help health plans manage and improve HEDIS, Stars, and other quality measures. By integrating clinical and claims data, Cotiviti provides analytics to identify and close care gaps, manage member outreach, and submit accurate quality data.

✨ Key Features

  • HEDIS and Quality Improvement
  • Risk Adjustment
  • Payment Integrity
  • Network and Clinical Analytics
  • Consumer Engagement
  • NCQA-Certified HEDIS Engine

🎯 Key Differentiators

  • Deep focus on the payer market
  • Integrated suite covering quality, risk, and payment integrity
  • Advanced analytics and AI to identify hidden patterns in data

Unique Value: Provides an integrated solution for health plans to optimize revenue, ensure payment integrity, and improve quality scores.

🎯 Use Cases (5)

End-to-end HEDIS reporting and submission Improving Medicare Star Ratings Risk adjustment factor (RAF) score optimization Fraud, waste, and abuse detection Provider performance measurement

✅ Best For

  • Helping health plans achieve high HEDIS scores and Star Ratings
  • Identifying and recovering improper payments
  • Improving the accuracy of risk adjustment submissions

💡 Check With Vendor

Verify these considerations match your specific requirements:

  • Provider organizations (hospitals, clinics)
  • Organizations not focused on payer-centric quality measures like HEDIS

🏆 Alternatives

Optum MedeAnalytics Inovalon Change Healthcare

Offers a more comprehensive suite of financial and quality solutions specifically for payers compared to vendors that serve both provider and payer markets.

💻 Platforms

Web API

🔌 Integrations

Claims Systems EHR/EMR data feeds Lab data Provider Portals

🛟 Support Options

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

🔒 Compliance & Security

✓ SOC 2 ✓ HIPAA ✓ BAA Available ✓ ISO 27001 ✓ SSO ✓ HITRUST CSF Certified ✓ SOC 1 Type II ✓ SOC 2 Type II ✓ ISO 27001 ✓ NCQA Certified

💰 Pricing

Contact for pricing
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