Our latest healthcare insights and perspectives
PAYMENT INTEGRITY
Two key claim trends and their impact on payment integrityJonathan Edwards
Jul 30, 2025
FRAUD, WASTE, AND ABUSE
FWA Insights: Uncovering improper billing in urine drug screensHeather Rickards, MS, AHFI, CFE
Jul 17, 2025
RISK ADJUSTMENT
Unlocking business value through interoperability: 3 key strategiesKatie Devlin, DHSc, MS, CPHIMS
Jul 15, 2025
PAYMENT INTEGRITY
Case study: Prepay COB boosts payment integrity results for large national payerEvan Okulanis
Jul 10, 2025
COTIVITI LEADERSHIP
CCC25: 3 key pillars required to perform beyond healthcare challengesSusan Murray
Jul 8, 2025
Yolanda Wilson, MPH, CPC
May 13, 2025
QUALITY AND STARS
Webinar: Reflecting on HEDIS MY 2024 and preparing for what’s nextJamison Gillitzer
Jul 1, 2025
PAYMENT INTEGRITY
Webinar: Billing and policy trends impacting your payment integrity programJonathan Edwards
Jun 18, 2025
FRAUD, WASTE, AND ABUSE
FWA Insights: Excessive dental restorationsMeagan Baxley, MBA, RDH
Jun 16, 2025
QUALITY AND STARS
RISK ADJUSTMENT
Webinar: Unlocking value from interoperability investmentsKatie Devlin, DHSc, MS, CPHIMS
Jun 12, 2025
RISK ADJUSTMENT
Risk adjustment: 4 strategies as CMS increases RADV auditsKatie Sender, MSN, RN, PHN, CRC
Jun 10, 2025
PAYMENT INTEGRITY
Case studies: Performing beyond expectations in payment integrityKevin Laskey
May 29, 2025
RISK ADJUSTMENT
White paper: Commercial risk adjustment updates to prepare for in 2026Amanda Liu
May 22, 2025
QUALITY AND STARS
Star Ratings: 4 recommendations for the 2026 CMS Final RuleMarge Ciancetta
May 20, 2025
FRAUD, WASTE, AND ABUSE
FWA Insights: Solving durable medical equipment (DME) challengesYolanda Wilson, MPH, CPC
May 13, 2025
PAYMENT INTEGRITY
Payment integrity: Unlocking the value of complex outpatient reviewsAmy Carleton, RN, BSN
May 7, 2025
QUALITY AND STARS
RISK ADJUSTMENT
3 updates from the 2026 CMS Final Rate AnnouncementBranka Sustic
Apr 14, 2025
FRAUD, WASTE, AND ABUSE
Busted: The top healthcare fraud schemes of Q4 2024Erin Rutzler
Mar 19, 2025
PAYMENT INTEGRITY
Webinar: Confronting payment integrity challenges in 2025Warren Lesnefsky
Mar 13, 2025
RISK ADJUSTMENT
White Paper: Preparing for success in Medicare Advantage risk adjustmentAmanda Liu
Mar 5, 2025
RISK ADJUSTMENT
INTEROPERABILITY
eBook: Driving business value through interoperabilityKatie Devlin, DHSc, MS, CPHIMS
Feb 27, 2025
FRAUD, WASTE, AND ABUSE
eBook: How to evolve your FWA program in 2025Vince Smith, AHFI, CFE
Feb 25, 2025
Jamison Gillitzer
Feb 18, 2025
FRAUD, WASTE, AND ABUSE
FWA Insights: Changes to audio-only telehealth codes sheds light on FWATimothy Sak, CPC
Feb 11, 2025
FRAUD, WASTE, AND ABUSE
6 key capabilities to advance beyond traditional FWA lead detectionVince Smith, AHFI, CFE
Jan 27, 2025
ENTERPRISE DATA ANALYTICS
Best of 2024: Explore Cotiviti’s top content from last yearJeff Robinson
Jan 14, 2025
FRAUD, WASTE, AND ABUSE
White Paper: Enhancing dental payment accuracy to combat FWASteven M. Canfield, D.D.S.
Dec 18, 2024
FRAUD, WASTE, AND ABUSE
Webinar: Advancing beyond traditional FWA lead detectionRyan Cleverly, AHFI
Dec 3, 2024
PAYMENT INTEGRITY
Case study: Benefits administrator achieves millions in payment integrity valueMichael Jablon
Nov 25, 2024
FRAUD, WASTE, AND ABUSE
Realizing the evolution of FWA prevention and managementWarren Lesnefsky
Nov 18, 2024
FRAUD, WASTE, AND ABUSE
Case study: Highmark Wholecare prevents FWA with Claim Pattern ReviewErin Rutzler
Nov 6, 2024
CONSUMER ENGAGEMENT
Case study: Engaging members to apply for the Low-Income Subsidy (LIS)Leah Dewey
Oct 30, 2024
QUALITY AND STARS
3 takeaways for Medicare Advantage plans from the 2025 Star RatingsMarge Ciancetta
Oct 28, 2024
PAYMENT INTEGRITY
Webinar: What TPAs need to know about payment integrityMichael Jablon
Oct 24, 2024
CONSUMER ENGAGEMENT
Proactive member engagement strategies to close gaps in Medicare AdvantageLeah Dewey
Oct 17, 2024
RISK ADJUSTMENT
Webinar: Key updates to improve coding accuracy in 2025Katie Sender, MSN, RN, PHN, CRC
Oct 11, 2024
RISK ADJUSTMENT
Partnering for success in 3 critical areas of risk adjustmentChad Kinkead
Sep 30, 2024
FRAUD, WASTE, AND ABUSE
Webinar: Lessons learned from a successful prepay FWA programNikki Brody
Sep 23, 2024
PAYMENT INTEGRITY
Recovering improper costs in SNF and IRF claimsAmy Carleton, RN, BSN
Sep 16, 2024
PAYMENT INTEGRITY
4 attributes of a successful specialty drug payment integrity programJonathan Starr, PharmD
Sep 3, 2024
PAYMENT INTEGRITY
eBook: The three pillars of coordination of benefits (COB) successEvan Okulanis
Aug 26, 2024
QUALITY AND STARS
Podcast: Star Ratings strategies for smaller MA plansMarge Ciancetta
Aug 22, 2024
QUALITY AND STARS
Webinar: Decoding the HEDIS MY 2025 Technical SpecificationsSamantha Davis
Aug 20, 2024
FRAUD, WASTE, AND ABUSE
FWA Insights: Catching outlier behaviors in physical therapy claimsMelanie Poole
Aug 8, 2024
RISK ADJUSTMENT
Webinar: Integrating internal and external risk adjustment innovationsTracey Bradberry
Aug 6, 2024
PAYMENT INTEGRITY
Checklist: How to build a valuable coordination of benefits programEvan Okulanis
Aug 1, 2024
RISK ADJUSTMENT
Navigating new frontiers in interoperabilityKatie Devlin, DHSc, MS, CPHIMS
Jul 30, 2024
RISK ADJUSTMENT
10 tips for a successful commercial risk adjustment programKatie Sender, MSN, RN, PHN, CRC
Jul 23, 2024
PAYMENT INTEGRITY
FRAUD, WASTE, AND ABUSE
Video: Navigating new frontiers in FWA and payment integrityErin Rutzler
Jul 16, 2024
RISK ADJUSTMENT
Video: Navigating new frontiers in risk adjustmentKatie Sender, MSN, RN, PHN, CRC
Jul 9, 2024
QUALITY AND STARS
Quality Decoded webinar: Preparing for HEDIS MY 2024Jamison Gillitzer
Jul 3, 2024
PAYMENT INTEGRITY
Webinar: Provider billing accuracy and payment trendsJonathan Edwards
Jun 19, 2024
PAYMENT INTEGRITY
3 strategies for payers to curb increasing medical loss ratiosMichael Jablon
Jun 17, 2024
PAYMENT INTEGRITY
White paper: Getting self-insured employer groups on board with payment integrityMatthew Hawley
Jun 13, 2024
FRAUD, WASTE, AND ABUSE
FWA Insights: Analysis confirms >$1 million in improper claimsErin Rutzler
Jun 10, 2024
PAYMENT INTEGRITY
Case study: Protecting financial integrity with prepay review solutionsWarren Lesnefsky
Jun 5, 2024
PAYMENT INTEGRITY
Podcast: How to build a valuable coordination of benefits programBeth Waibel
Jun 3, 2024
ENTERPRISE DATA ANALYTICS
Navigating new frontiers in healthcare: 3 takeaways from CCC24Brett Arnold
May 29, 2024
CONSUMER ENGAGEMENT
5 steps for proactive member engagement following Medicaid redeterminationsLeah Dewey
May 23, 2024
QUALITY AND STARS
Podcast: New Star Ratings strategies for success in 2025 and beyondMarge Ciancetta
May 20, 2024
PAYMENT INTEGRITY
eBook: How to achieve “total value” in payment integrityMatthew Hawley
May 8, 2024
QUALITY AND STARS
RISK ADJUSTMENT
White Paper: Executing high-performing interoperability programs to enable clinical dataKatie Devlin, DHSc, MS, CPHIMS
May 2, 2024
RISK ADJUSTMENT
3 key risk adjustment strategies to drive success in 2024Katie Sender, MSN, RN, PHN, CRC
Apr 18, 2024
PAYMENT INTEGRITY
Webinar: Unlock the “Total Value” of your payment integrity programMichael Jablon
Apr 16, 2024
QUALITY AND STARS
Webinar: Implications of the 2025 CMS Final Rate Announcement for quality programsMarge Ciancetta
Apr 11, 2024
PAYMENT INTEGRITY
Case study: Coordination of benefits (COB) results soar for large national planEvan Okulanis
Apr 9, 2024
PAYMENT INTEGRITY
Podcast: The "Total Value" approach to payment integrityJeff Robinson
Mar 26, 2024
RISK ADJUSTMENT
New approaches to enhance risk adjustment at RISE National 2024Katie Sender, MSN, RN, PHN, CRC
Mar 5, 2024
RISK ADJUSTMENT
RISE Webinar: Key risk adjustment trends to watch in 2024Branka Sustic
Feb 26, 2024
QUALITY AND STARS
Quality Decoded webinar series: 2025 CMS Advance NoticeMarge Ciancetta
Feb 20, 2024
QUALITY AND STARS
RISK ADJUSTMENT
3 interoperability updates for payers in 2024Katie Devlin, DHSc, MS, CPHIMS
Feb 14, 2024
QUALITY AND STARS
RISK ADJUSTMENT
3 takeaways from the 2025 Advance NoticeBranka Sustic
Feb 8, 2024
FRAUD, WASTE, AND ABUSE
FWA Insights: Examining a suspicious volume of HCPCS codesMelanie Poole
Jan 31, 2024
PAYMENT INTEGRITY
White Paper: Improving payment integrity with inpatient claim reviewCheri Moehring
Jan 29, 2024
FRAUD, WASTE, AND ABUSE
Case study: Integrated prepay and FWA solutions deliver improved claim accuracyVince Smith, AHFI, CFE
Jan 24, 2024
FRAUD, WASTE, AND ABUSE
Preparing for 2024 trends in healthcare FWA: CPT code updates and beyondMary Cate Anderson, HCAFA
Jan 17, 2024
FRAUD, WASTE, AND ABUSE
Webinar: Preparing for investigative strategies in 2024Mary Cate Anderson, HCAFA
Dec 5, 2023
CONSUMER ENGAGEMENT
Case study: Reaching Medicaid members amid redeterminationLeah Dewey
Nov 30, 2023
QUALITY AND STARS
Closing the Gap: Improving chronic disease screening and careJamison Gillitzer
Nov 28, 2023
PAYMENT INTEGRITY
Case study: Data mining for errors yields more accurate pharmacy paymentsMatthew Herbein
Nov 16, 2023
FRAUD, WASTE, AND ABUSE
Busted: The top healthcare fraud schemes of Q3 2023Erin Rutzler
Nov 14, 2023
FRAUD, WASTE, AND ABUSE
FWA Insights: Flagging suspicious activity related to COVID-19 testingErin Rutzler
Nov 8, 2023
CONSUMER ENGAGEMENT
Video: Reducing disparities in care during Global Health Equity WeekKassi Yozzo
Oct 26, 2023
QUALITY AND STARS
Closing the Gap: Better preventative measures for breast cancerAshley McNairy
Sep 28, 2023
QUALITY AND STARS
White paper: Implementing a digital quality strategyKatie Devlin, DHSc, MS, CPHIMS
Sep 20, 2023
QUALITY AND STARS
NCQA confirms HEDIS® updates for Measurement Year (MY) 2024Samantha Davis
Sep 18, 2023
PAYMENT INTEGRITY
Savings spotlight: Dental claim review expertise nets significant savingsSteven M. Canfield, D.D.S.
Sep 13, 2023
FRAUD, WASTE, AND ABUSE
Webinar: Finding new schemes with AI and investigative techniquesErin Rutzler
Sep 11, 2023
QUALITY AND STARS
Podcast: Enhancing interoperability for better risk and quality outcomesKassi Yozzo
Sep 6, 2023
QUALITY AND STARS
Closing the Gap: Maintaining healthy cholesterol and improving medication adherenceMatt Simon
Aug 31, 2023
PAYMENT INTEGRITY
Podcast: Payment integrity for self-insured (ASO) employer groupsJeff Robinson
Aug 16, 2023
PAYMENT INTEGRITY
Video: A new approach to prepay coordination of benefits (COB) validationNaomi Murphy
Aug 14, 2023
FRAUD, WASTE, AND ABUSE
FWA Insights: Catching schemes related to Ozempic, Wegovy, and semaglutidesMelanie Poole
Aug 2, 2023
QUALITY AND STARS
Closing the Gap: National Immunization Awareness MonthJamison Gillitzer
Jul 31, 2023
QUALITY AND STARS
Navigating changes in Star Ratings programs: Enhancing success with four key stepsMarge Ciancetta
Jul 24, 2023
PAYMENT INTEGRITY
Webinar: Making payment integrity work for your self-insured groupsAllyn Sullivan
Jul 19, 2023
PAYMENT INTEGRITY
4 strategies to curb medical cost increases as healthcare utilization reboundsMatthew Hawley
Jul 10, 2023
QUALITY AND STARS
Closing the Gap: Minority Mental Health AwarenessKatie Devlin, DHSc, MS, CPHIMS
Jun 29, 2023
CONSUMER ENGAGEMENT
Podcast: Preventing coverage loss during redeterminationJeff Robinson
Jun 14, 2023
QUALITY AND STARS
Preparing for a “Universal Foundation” of quality measuresBranka Sustic
Jun 12, 2023
FRAUD, WASTE, AND ABUSE
How to sequence FWA investigations for greater impactErin Rutzler
Jun 7, 2023
FRAUD, WASTE, AND ABUSE
FWA Insights: Flagging high-frequency telehealth claimsErin Rutzler
Jun 1, 2023
QUALITY AND STARS
Webinar: Optimizing MA Star Ratings with Star IntelligenceAshley McNairy
May 23, 2023
PAYMENT INTEGRITY
White paper: The “smart prepay” approach to payment integrityMatthew Hawley
Apr 20, 2023
QUALITY AND STARS
CONSUMER ENGAGEMENT
Closing the Gap: National Minority Health MonthLeah Dewey
Apr 17, 2023
PAYMENT INTEGRITY
Savings spotlight: Cotiviti takes on payment integrity in 5 new case studiesWarren Lesnefsky
Apr 3, 2023
FRAUD, WASTE, AND ABUSE
FWA Insights: Prepay review leads to >$100K in projected annual savingsErin Rutzler
Mar 28, 2023
FRAUD, WASTE, AND ABUSE
Webinar: Sequencing investigative activities for greater provider impactErin Rutzler
Mar 22, 2023
QUALITY AND STARS
Closing the Gap: Improve screening rates during Colorectal Cancer Awareness MonthThelma Belli
Mar 21, 2023
FRAUD, WASTE, AND ABUSE
Podcast: How health plans investigate and prevent FWAJeff Robinson
Mar 2, 2023
QUALITY AND STARS
Summary: NCQA releases proposed HEDIS changes for MY 2024 and MY 2025Samantha Davis
Feb 23, 2023
QUALITY AND STARS
Closing the Gap: Preventative measures for better heart healthAshley McNairy
Feb 21, 2023
QUALITY AND STARS
Rounding up Star Ratings changes in the 2024 Advance NoticeAshley McNairy
Feb 16, 2023
QUALITY AND STARS
Closing the Gap: Improving cervical cancer preventionJamison Gillitzer
Jan 25, 2023
PAYMENT INTEGRITY
eBook: The payment integrity playbook for success in 2023 and beyondJordan Bazinsky
Jan 17, 2023
FRAUD, WASTE, AND ABUSE
FWA Insights: Catching improper billing within genetic testing and molecular pathologyMelanie Poole
Dec 21, 2022
FRAUD, WASTE, AND ABUSE
Webinar: Deter FWA in 2023 with the latest investigative strategiesErin Rutzler
Nov 29, 2022
FRAUD, WASTE, AND ABUSE
Focusing on prepay FWA prevention at NHCAA's Annual Training ConferenceErin Rutzler
Nov 14, 2022
CONSUMER ENGAGEMENT
How payers can drive collaboration to support health equityLeah Dewey
Nov 8, 2022
RISK ADJUSTMENT
Webinar: How to build risk adjustment into your value-based care strategyJonas Foit
Nov 4, 2022
QUALITY AND STARS
Webinar: Optimize Medicare Advantage Star Ratings with Star IntelligenceAshley McNairy
Nov 1, 2022
PAYMENT INTEGRITY
3 key tips for managing your payment integrity portfolioJordan Bazinsky
Oct 24, 2022
RISK ADJUSTMENT
OIG risk adjustment compliance audit showcases 3 clear takeawaysCotiviti
Oct 11, 2022
FRAUD, WASTE, AND ABUSE
FWA Insights: Spotting overpayments in mental health servicesMelanie Poole
Sep 28, 2022
FRAUD, WASTE, AND ABUSE
FWA Insights: Catching inappropriate billing within ASD servicesErin Rutzler
Sep 14, 2022
FRAUD, WASTE, AND ABUSE
SIU panel discussion: Best practices in healthcare payer FWAErin Rutzler
Sep 12, 2022
QUALITY AND STARS
Moving to in-year HEDIS: 5 best practices to boost scores and member engagementCotiviti
Aug 30, 2022
FRAUD, WASTE, AND ABUSE
FWA Insights: Spotting red flags in adult day care claimsErin Rutzler
Aug 18, 2022
QUALITY AND STARS
Podcast: Cotiviti SVP Rachael Jones on health equity strategyJeff Robinson
Aug 11, 2022
FRAUD, WASTE, AND ABUSE
FWA Insights: Flagging potential physical therapy schemesMelanie Poole
Aug 4, 2022
PAYMENT INTEGRITY
Video: How to shorten time to payment integrity resultsMatthew Hawley
Aug 3, 2022
QUALITY AND STARS
HEDIS® strategies: 4 ways to prepare for the ECDS transitionAshley McNairy
Jul 18, 2022
QUALITY AND STARS
Webinar: Reviewing HEDIS MY 2021 and looking ahead to MY 2022Jamison Gillitzer
Jun 30, 2022
PAYMENT INTEGRITY
3 key elements of a successful employment verification processNaomi Murphy
Jun 15, 2022
CONSUMER ENGAGEMENT
White paper: How to engage Medicaid members for more equitable outcomesRoberto Arce
Jun 8, 2022
PAYMENT INTEGRITY
FRAUD, WASTE, AND ABUSE
White paper: Detecting and preventing FWA in behavioral health claimsErin Rutzler
Jun 1, 2022
PAYMENT INTEGRITY
eBook: The payment integrity leader’s playbook for success in 2022 and beyondBrett Arnold
May 26, 2022
COTIVITI LEADERSHIP
Moving from surviving to thriving: 5 takeaways from CCC22 to improve U.S. healthcareJordan Bazinsky
May 19, 2022
NETWORK AND CLINICAL ANALYTICS
Podcast: The importance of interoperability in value-based careJeff Robinson
May 13, 2022
RISK ADJUSTMENT
OIG report highlights beneficiary protections as Medicare Advantage program growsCotiviti
May 6, 2022
PAYMENT INTEGRITY
Section 340B overview: Medicare, Medicaid, covered entities, and moreKristie Ressler, D.O.
May 3, 2022
RISK ADJUSTMENT
Medicare Advantage risk adjustment in 2022: Driving to fierce and focusedCotiviti
Apr 21, 2022
NETWORK AND CLINICAL ANALYTICS
Podcast: Improving risk assessment for better care outcomesJeff Robinson
Apr 12, 2022
RISK ADJUSTMENT
5 takeaways from the 2023 Medicare Advantage and Part D Final Rate AnnouncementCotiviti
Apr 7, 2022
PAYMENT INTEGRITY
Specialty drugs: Why go beyond prior authorization?Jonathan Starr, PharmD
Mar 23, 2022
QUALITY AND STARS
NETWORK AND CLINICAL ANALYTICS
CONSUMER ENGAGEMENT
3 areas of investment for payers to improve health equity in 2022Cotiviti
Mar 17, 2022
NETWORK AND CLINICAL ANALYTICS
Webinar: The path to adopting a successful Alternative Payment ModelMary Srinivas
Mar 15, 2022
QUALITY AND STARS
HEDIS MY 2023: Noteworthy topics to consider during NCQA’s public comment periodSamantha Davis
Mar 9, 2022
PAYMENT INTEGRITY
On-demand webinar: Beyond prior authorization: Ensuring accuracy of specialty drug claimsJonathan Starr, PharmD
Mar 2, 2022