Cotiviti

Cotiviti has completed its acquisition of Edifecs, a pioneer in healthcare data interoperability. Read our press release and learn how this acquisition will drive transformation in value-based care, interoperability, and streamlined operations across payers and providers. 📰⬇️

Cigna Global Health Benefits has partnered with Carrot Fertility to offer members comprehensive fertility and hormonal health support worldwide. This program provides access to a network of over 11,000 providers across 170 countries and includes direct communication with experts such as OB-GYNs, doulas, and menopause specialists. https://bit.ly/4ib5MLf

Telehealth provides valuable access to care but also introduces new risks for fraud, waste, and abuse (FWA). Recent CMS updates to telemedicine guidelines, especially concerning audio-only telehealth, have significant implications for coding compliance. In our latest FWA Insights blog, learn how these changes could lead to FWA and discover strategies to mitigate the risks. https://bit.ly/40X1qjt

Achieving a sustainable healthcare system requires bold changes across clinical roles, technology, and operational strategies. Shifting care to lower-cost settings, streamlining administrative processes, and integrating pharmacy spending into healthcare costs can drive affordability and efficiency. https://owy.mn/4kYkOpo

Health plan special investigations units (SIUs) often face significant challenges, such as outdated tools, false-positive leads, and a lack of resources. Use a proactive, data-driven approach to overcome these obstacles. Our new checklist provides six key capabilities that can improve FWA detection, prevention, and recovery. https://bit.ly/42MTSCq

Delivering exceptional value requires more than just technology—expertise drives actual outcomes. Cotiviti combines machine learning with decades of clinical experience to support health plans in achieving tangible results. With over $8B in payment errors avoided or corrected each year, $2B in annual risk adjustment revenue, and 147M member lives processed through our quality solutions, learn how Cotiviti makes a measurable difference. https://hubs.ly/Q035fbbc0

Are you keeping up with the latest market and regulatory trends impacting your payment integrity programs? Watch as Cotiviti's Matthew Herbein, vice president of data mining, explains the importance of integration. ▶️

Each February, the Centers for Medicare & Medicaid Services (CMS) publishes an Advance Notice detailing proposed methodological changes for the Medicare Advantage and Part D Star Ratings Program. After evaluating feedback and questions from the public, CMS issues a Final Rule that outlines the confirmed measure and policy changes. Join us on April 23 at 1:00 PM ET when our experts will: ▪️Provide an overview the 2026 Medicare Advantage and Part D Final Rule ▪️Outline key changes that will impact Star Ratings in 2026 and beyond ▪️Offer recommendations to prioritize and prepare Learn more and register here > https://bit.ly/4iMtJsh

Cigna Healthcare is launching a multiyear initiative to enhance the prior authorization process by adding concierge teams directly supporting customers and physicians. The initiative includes improvements to digital status trackers and a more streamlined submission process for physicians. https://bit.ly/3QcqfCT Healthcare Finance News

The 2026 CMS Medicare Advantage and Part D Advance Notice presents several key updates for MA plans. One significant change is the expected revenue increase of 4.3%, driven by higher Medicare fee-for-service costs and updates in risk adjustment models. Health plans should also prepare for potentially declining quality bonus payments due to changes in the Star Ratings program. Cotiviti 's Branka Sustic shares the details. https://bit.ly/3DatZ4Q