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Healthcare Payer Resources Medicare Advantage, Medicaid, and

WEBOur latest healthcare payer resources. Improve your payment, risk, quality, and member engagement outcomes with the latest healthcare insights from Cotiviti's leading experts …

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URL: https://resources.cotiviti.com/

The payment integrity guide for health plans Cotiviti

WEBA national health plan supporting commercial, Medicaid, and Medicare Advantage lines of business works with Cotiviti’s prospective solutions including Payment Policy …

Category: Health Go Health

CMS 2023 Advance Notice: Health equity takes center stage

WEBIn a statement on the 2023 Advance Notice, America’s Health Insurance Plans (AHIP) president and CEO Matt Eyles expressed support: Over 28 million Americans—44% of …

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Preparing for a “Universal Foundation” of quality measures

WEBCMS says the Universal Foundation quality measures are crucial to promoting health equity. The measures selected are meant to address many of the health problems …

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NCQA publishes proposed changes to HEDIS measures for MY …

WEBThe National Committee for Quality Assurance (NCQA) has released proposed updates and changes to HEDIS ® measures for Measurement Year 2023 (MY 2023) for public …

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3 areas of investment for payers to improve health equity in 2022

WEBThe State of Massachusetts also invested $2.5 million in community partnerships focused on SDoH, specifically targeting food security and economic mobility. Amid this increased …

Category: Food Go Health

Closing the Gap: Improving chronic disease screening and care

WEBHealth plan members engaged with Eliza ®, Cotiviti’s multi-channel member engagement solution, saw a 4.3% higher rate of HEDIS colorectal cancer screening gap closure. In a …

Category: Cancer Go Health

4 strategies to curb medical cost increases as healthcare

WEBWhen the COVID-19 pandemic accelerated rapidly in early 2020, the impact on healthcare utilization was sharp, dropping nearly 32% in April 2020 as both providers and …

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Healthcare Analytics Webinars Cotiviti

WEBPreparing for the unwinding of the Public Health Emergency (PHE) Learn how to prevent disenrollment when the COVID-19 public health emergency (PHE) expires. Cotiviti's …

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Rounding up Star Ratings changes in the 2024 Advance Notice

WEBProposed 2026 Star Ratings (CY 2024) changes. In the Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program document released in …

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NCQA releases proposed HEDIS MY 2025 updates

WEBEach year, the National Committee for Quality Assurance (NCQA) publishes a list of measure updates, additions, and deletions for future HEDIS ® measure years for public …

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NCQA confirms HEDIS updates for Measurement Year (MY) 2024

WEBWith the August publication of the HEDIS Measurement Year 2024 Volume 2: Technical Specifications for Health Plans, the National Committee for Quality Assurance (NCQA) …

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How to sequence FWA investigations for greater impact

WEBSequence investigations efficiently to increase positive behavior change. Reviewing an allegation begins with data analysis to determine if the billing behavior in question …

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Preparing for 2024 trends in healthcare FWA: CPT code updates …

WEBEvaluation and management (E&M) codes. Another CPT code update in 2024 affects E&M codes, involving the removal of time ranges from certain outpatient codes, such as …

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Moving to in-year HEDIS: 5 best practices to boost scores

WEBThe annual HEDIS ® data gathering, reporting, and submission process is typically a retrospective activity: health plans retrieve and abstract medical charts to demonstrate …

Category: Medical Go Health

Busted: The top fraud schemes of Q2 2023

WEBThe second quarter of 2023 saw a new batch of fraud, waste, and abuse cases targeting both public and private payers. Many of these schemes employed tactics such as …

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Busted: The top healthcare fraud schemes of Q3 2023

WEBFraud, 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 …

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Busted: The top fraud schemes of Q1 2023

WEBBusted: The top fraud schemes of Q1 2023. The start of 2023 saw an influx of fraud, waste, and abuse (FWA) cases. Bad actors sought to gain from both public and private payers …

Category: Health Go Health