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Our latest healthcare insights and perspectives

FRAUD, WASTE, AND ABUSE

Case study: Highmark Wholecare prevents FWA with Claim Pattern Review

Erin Rutzler

Nov 6, 2024

Latest Content

QUALITY AND STARS

3 takeaways for Medicare Advantage plans from the 2025 Star Ratings

Marge Ciancetta

Oct 28, 2024

PAYMENT INTEGRITY

Webinar: What TPAs need to know about payment integrity

Michael Jablon

Oct 24, 2024

RISK ADJUSTMENT

Webinar: Key updates to improve coding accuracy in 2025

Katie Sender, MSN, RN, PHN, CRC

Oct 11, 2024

QUALITY AND STARS

Webinar: Decoding the 2025 Star Ratings

Marge Ciancetta

Oct 8, 2024

RISK ADJUSTMENT

Partnering for success in 3 critical areas of risk adjustment

Chad Kinkead

Sep 30, 2024

QUALITY AND STARS

Decoding the HEDIS MY 2025 Technical Specifications

Samantha Davis

Sep 25, 2024

FRAUD, WASTE, AND ABUSE

Webinar: Lessons learned from a successful prepay FWA program

Nikki Brody

Sep 23, 2024

PAYMENT INTEGRITY

Recovering improper costs in SNF and IRF claims

Amy Carleton, RN, BSN

Sep 16, 2024

PAYMENT INTEGRITY

eBook: How AI can drive health plan success

Brett Arnold

Sep 11, 2024

PAYMENT INTEGRITY

4 attributes of a successful specialty drug payment integrity program

Jonathan Starr, PharmD

Sep 3, 2024

CONSUMER ENGAGEMENT

Webinar: Engaging with members at the end of the year

Leah Dewey

Aug 28, 2024

PAYMENT INTEGRITY

eBook: The three pillars of coordination of benefits (COB) success

Evan Okulanis

Aug 26, 2024

QUALITY AND STARS

Podcast: Star Ratings strategies for smaller MA plans

Marge Ciancetta

Aug 22, 2024

QUALITY AND STARS

Webinar: Decoding the HEDIS MY 2025 Technical Specifications

Samantha Davis

Aug 20, 2024

FRAUD, WASTE, AND ABUSE

Busted: The top fraud schemes of Q2 2024

Erin Rutzler

Aug 15, 2024

FRAUD, WASTE, AND ABUSE

FWA Insights: Catching outlier behaviors in physical therapy claims

Melanie Poole

Aug 8, 2024

RISK ADJUSTMENT

Webinar: Integrating internal and external risk adjustment innovations

Tracey Bradberry

Aug 6, 2024

PAYMENT INTEGRITY

Checklist: How to build a valuable coordination of benefits program

Evan Okulanis

Aug 1, 2024

RISK ADJUSTMENT

Navigating new frontiers in interoperability

Katie Devlin, DHSc, MS, CPHIMS

Jul 30, 2024

PAYMENT INTEGRITY

Podcast: Deploying AI in payment integrity responsibly

Beth Waibel

Jul 29, 2024

RISK ADJUSTMENT

10 tips for a successful commercial risk adjustment program

Katie Sender, MSN, RN, PHN, CRC

Jul 23, 2024

CONSUMER ENGAGEMENT

Navigating new frontiers in member engagement

Leah Dewey

Jul 23, 2024

PAYMENT INTEGRITY

Podcast: Artificial intelligence in payment integrity

Beth Waibel

Jul 22, 2024

PAYMENT INTEGRITY

FRAUD, WASTE, AND ABUSE

Video: Navigating new frontiers in FWA and payment integrity

Erin Rutzler

Jul 16, 2024

RISK ADJUSTMENT

Video: Navigating new frontiers in risk adjustment

Katie Sender, MSN, RN, PHN, CRC

Jul 9, 2024

QUALITY AND STARS

Quality Decoded webinar: Preparing for HEDIS MY 2024

Jamison Gillitzer

Jul 3, 2024

QUALITY AND STARS

Video: Navigating new frontiers in quality improvement

Branka Sustic

Jul 2, 2024

QUALITY AND STARS

What to expect from CMS recalculating Star Ratings

Marge Ciancetta

Jun 24, 2024

PAYMENT INTEGRITY

Webinar: Provider billing accuracy and payment trends

Jon Edwards

Jun 19, 2024

PAYMENT INTEGRITY

3 strategies for payers to curb increasing medical loss ratios

Michael Jablon

Jun 17, 2024

FRAUD, WASTE, AND ABUSE

FWA Insights: Analysis confirms >$1 million in improper claims

Erin Rutzler

Jun 10, 2024

PAYMENT INTEGRITY

Case study: Protecting financial integrity with prepay review solutions

Warren Lesnefsky

Jun 5, 2024

PAYMENT INTEGRITY

Podcast: How to build a valuable coordination of benefits program

Beth Waibel

Jun 3, 2024

ENTERPRISE DATA ANALYTICS

Navigating new frontiers in healthcare: 3 takeaways from CCC24

Brett Arnold

May 29, 2024

QUALITY AND STARS

Podcast: New Star Ratings strategies for success in 2025 and beyond

Marge Ciancetta

May 20, 2024

FRAUD, WASTE, AND ABUSE

Busted: The top fraud schemes of Q1 2024

Erin Rutzler

May 14, 2024

PAYMENT INTEGRITY

eBook: How to achieve “total value” in payment integrity

Matthew Hawley

May 8, 2024

QUALITY AND STARS

RISK ADJUSTMENT

White Paper: Executing high-performing interoperability programs to enable clinical data

Katie Devlin, DHSc, MS, CPHIMS

May 2, 2024

RISK ADJUSTMENT

3 key risk adjustment strategies to drive success in 2024

Katie Sender, MSN, RN, PHN, CRC

Apr 18, 2024

PAYMENT INTEGRITY

Webinar: Unlock the “Total Value” of your payment integrity program

Michael Jablon

Apr 16, 2024

PAYMENT INTEGRITY

Podcast: The "Total Value" approach to payment integrity

Jeff Robinson

Mar 26, 2024

RISK ADJUSTMENT

New approaches to enhance risk adjustment at RISE National 2024

Katie Sender, MSN, RN, PHN, CRC

Mar 5, 2024

QUALITY AND STARS

NCQA releases proposed HEDIS MY 2025 updates

Samantha Davis

Feb 28, 2024

RISK ADJUSTMENT

RISE Webinar: Key risk adjustment trends to watch in 2024

Branka Sustic

Feb 26, 2024

QUALITY AND STARS

Quality Decoded webinar series: 2025 CMS Advance Notice

Marge Ciancetta

Feb 20, 2024

QUALITY AND STARS

RISK ADJUSTMENT

3 interoperability updates for payers in 2024

Katie Devlin, DHSc, MS, CPHIMS

Feb 14, 2024

QUALITY AND STARS

RISK ADJUSTMENT

3 takeaways from the 2025 Advance Notice

Branka Sustic

Feb 8, 2024

FRAUD, WASTE, AND ABUSE

Busted: The top fraud schemes of Q4 2023

Erin Rutzler

Feb 6, 2024

FRAUD, WASTE, AND ABUSE

FWA Insights: Examining a suspicious volume of HCPCS codes

Melanie Poole

Jan 31, 2024

PAYMENT INTEGRITY

White Paper: Improving payment integrity with inpatient claim review

Cheri Moehring

Jan 29, 2024

FRAUD, WASTE, AND ABUSE

Case study: Integrated prepay and FWA solutions deliver improved claim accuracy

Vince Smith, AHFI, CFE

Jan 24, 2024

FRAUD, WASTE, AND ABUSE

Preparing for 2024 trends in healthcare FWA: CPT code updates and beyond

Mary Cate Anderson, HCAFA

Jan 17, 2024

QUALITY AND STARS

eBook: Closing care gaps in 12 critical areas in 2024

Chad Kinkead

Jan 11, 2024

ENTERPRISE DATA ANALYTICS

Best of 2023: Explore Cotiviti’s top content from last year

Jeff Robinson

Jan 9, 2024

PAYMENT INTEGRITY

Case study: The impact of prospective DRG validation

Cheri Moehring

Dec 12, 2023

FRAUD, WASTE, AND ABUSE

Webinar: Preparing for investigative strategies in 2024

Mary Cate Anderson, HCAFA

Dec 5, 2023

CONSUMER ENGAGEMENT

Case study: Reaching Medicaid members amid redetermination

Leah Dewey

Nov 30, 2023

QUALITY AND STARS

Closing the Gap: Improving chronic disease screening and care

Jamison Gillitzer

Nov 28, 2023

PAYMENT INTEGRITY

Case study: Data mining for errors yields more accurate pharmacy payments

Matthew Herbein

Nov 16, 2023

FRAUD, WASTE, AND ABUSE

Busted: The top healthcare fraud schemes of Q3 2023

Erin Rutzler

Nov 14, 2023

FRAUD, WASTE, AND ABUSE

FWA Insights: Flagging suspicious activity related to COVID-19 testing

Erin Rutzler

Nov 8, 2023

CONSUMER ENGAGEMENT

Webinar: A progress report on Medicaid redetermination

Leah Dewey

Nov 6, 2023

QUALITY AND STARS

Closing the Gap: American Diabetes Month

Marge Ciancetta

Nov 2, 2023

CONSUMER ENGAGEMENT

Video: Reducing disparities in care during Global Health Equity Week

Kassi Yozzo

Oct 26, 2023

QUALITY AND STARS

3 takeaways from the 2024 Star Ratings

Marge Ciancetta

Oct 23, 2023

QUALITY AND STARS

RISE Webinar: Star Ratings Reflections

Ashley McNairy

Oct 12, 2023

PAYMENT INTEGRITY

Podcast: Optimizing inpatient claim review

Jeff Robinson

Oct 10, 2023

QUALITY AND STARS

Closing the Gap: Better preventative measures for breast cancer

Ashley McNairy

Sep 28, 2023

QUALITY AND STARS

White paper: Implementing a digital quality strategy

Katie Devlin, DHSc, MS, CPHIMS

Sep 20, 2023

QUALITY AND STARS

NCQA confirms HEDIS® updates for Measurement Year (MY) 2024

Samantha Davis

Sep 18, 2023

PAYMENT INTEGRITY

Savings spotlight: Dental claim review expertise nets significant savings

Steve Canfield, DDS

Sep 13, 2023

FRAUD, WASTE, AND ABUSE

Webinar: Finding new schemes with AI and investigative techniques

Erin Rutzler

Sep 11, 2023

FRAUD, WASTE, AND ABUSE

Busted: The top fraud schemes of Q2 2023

Erin Rutzler

Aug 29, 2023

PAYMENT INTEGRITY

Podcast: Payment integrity for self-insured (ASO) employer groups

Jeff Robinson

Aug 16, 2023

FRAUD, WASTE, AND ABUSE

FWA Insights: Catching schemes related to Ozempic, Wegovy, and semaglutides

Melanie Poole

Aug 2, 2023

QUALITY AND STARS

Closing the Gap: National Immunization Awareness Month

Jamison Gillitzer

Jul 31, 2023

QUALITY AND STARS

eBook: Improving care gap closure in 2023 and beyond

Chad Kinkead

Jul 26, 2023

PAYMENT INTEGRITY

Webinar: Making payment integrity work for your self-insured groups

Allyn Sullivan

Jul 19, 2023

QUALITY AND STARS

Webinar: Making the most of HEDIS downtime

Branka Sustic

Jul 12, 2023

QUALITY AND STARS

Closing the Gap: Minority Mental Health Awareness

Katie Devlin, DHSc, MS, CPHIMS

Jun 29, 2023

PAYMENT INTEGRITY

Webinar: A Claim Pattern Review case study

Ed McCormick

Jun 19, 2023

CONSUMER ENGAGEMENT

Podcast: Preventing coverage loss during redetermination

Jeff Robinson

Jun 14, 2023

QUALITY AND STARS

Preparing for a “Universal Foundation” of quality measures

Branka Sustic

Jun 12, 2023

FRAUD, WASTE, AND ABUSE

How to sequence FWA investigations for greater impact

Erin Rutzler

Jun 7, 2023

FRAUD, WASTE, AND ABUSE

FWA Insights: Flagging high-frequency telehealth claims

Erin Rutzler

Jun 1, 2023

QUALITY AND STARS

Closing the Gap: Men’s Health Month

Marge Ciancetta

May 30, 2023

PAYMENT INTEGRITY

3 takeaways from CCC23 to improve payment integrity

Matthew Hawley

May 24, 2023

QUALITY AND STARS

Webinar: Optimizing MA Star Ratings with Star Intelligence

Ashley McNairy

May 23, 2023

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