Cotiviti enables healthcare organizations to deliver better care at lower cost through advanced technology and data analytics that improve the quality and sustainability of healthcare in the United States. Cotiviti’s solutions increase transparency and collaboration between payers and providers while empowering them to reduce medical and administrative costs, enable better health, improve claims payment efficiency, streamline operations, drive interoperability, and advance value-based care. Its customers serve the majority of U.S. healthcare consumers, providing coverage and care for over 300 million members and patients. Additionally, Cotiviti offers data management and recovery audit services to the retail sector to improve business outcomes. For more information, visit www.cotiviti.com.
Healthcare Data Interoperability
The Edifecs Healthcare Interoperability Cloud combines our EDI, FHIR, and Smart Trading platforms to seamlessly connect systems, processes, organizations, and people across the entire healthcare ecosystem.
· EDI Gateway
Optimize data processing, reduce interoperability workloads, and support all X12 HIPAA-compliant transactions with a single EDI solution.
· FHIR Gateway
Comply with CMS Interoperability mandates 9115 and 0057. Reduce provider abrasion and improve ALR by orchestrating FHIR-based electronic prior authorization submissions.
· Smart Trading Platform
Automate business processes, modernize your technical infrastructure, and reduce costs.
Workflow & Data Enrichment
The Edifecs Healthcare Operations Cloud enables users to holistically apply their data across the major facets of their business to support the entire member journey—from contracting and enrollment through encounter submissions and prior authorizations.
· Member Enrollment
Simplify and streamline enrollment management processes to capture a greater market share across all lines of business.
· Encounter Submissions
Break down encounter operations silos, support submission accuracy, and ensure compliance
· Member Consent Management
Effectively manage member consent by capturing and enforcing federal, state, CMS, and enterprise data-sharing policies according to member preferences.
· Risk Adjustment
Maximize your resources to find more risk-adjustable opportunities faster and ensure ongoing compliance.
· Value-Based Payments
Design, automate, and administer value-based contracts for more accurate payments and faster scaling of value-based programs.