Cotiviti

As fraud, waste, and abuse schemes in healthcare grow more sophisticated, your special investigations unit (SIU) will have to adapt to these challenges. Outdated technology and ineffective detection methods can leave organizations vulnerable to growing threats. Our latest checklist outlines six essential features every SIU needs to modernize its approach and recover more effectively. https://hubs.ly/Q033W3x-0 #FWA #HealthPlans

The Affordable Care Act marketplace has reached a new milestone, with 23.6 million Americans enrolled in health coverage for 2025. This increase of 11.6 million enrollees since 2021 reflects a broader trend of growing access to affordable health insurance. https://bit.ly/4hcc3oZ Becker's Healthcare #payments #HealthPlans

Interoperability is poised for significant advancements in 2025. Epic's plan to onboard all clients to its QHIN and the upcoming requirement for QHINs to respond to healthcare operations queries by February 2026 will drive increased data availability for payers. Cotiviti's VP of Interoperability, Katie Devlin, DHSc, MS, CPHIMS, explains why these developments, alongside ongoing collaboration and innovation, signal a transformative year for healthcare data exchange. https://bit.ly/4iJG9Sn Answers Media Network #payments #HealthPlans 

Blue Shield of California has taken bold steps to enhance its operations and position itself competitively in the market. It has restructured, forming Ascendiun as a parent company to oversee its operations, including a new health services division, Stellarus. https://bit.ly/42diiEL Healthcare Dive #payments #HealthPlans

Self-funded health plans face significant cost pressures, including inflation, chronic care demands, and rising utilization rates. This comes as employers are demanding greater transparency and accountability from their TPAs, emphasizing the need for robust payment integrity solutions. Read our case study and learn how Cotiviti's payment integrity solutions deliver value for benefit administrators and their clients. https://bit.ly/3ZoVobT #payments #HealthPlans

CVS Health has launched a new approach to prescription reimbursement with its CostVantage model, a transparent pricing system designed better to reflect the actual costs of drugs and pharmacy services. This change addresses long-standing concerns about cross-subsidization in the pharmaceutical market, where some medicines were priced higher to cover losses on others. https://bit.ly/3DP8gzE Healthcare Finance News #healthcare #HealthPlans

This week we'd like to highlight an open VP of Sales position in our Retail business! Our Retail Payment Integrity Services and Solutions provides services and solutions to the world’s largest retailers, e-commerce, and commercial enterprises. This role is responsible for the development and strategic execution of annual sales plans to support the acquisition of new clients and sale of new solutions for the business. Candidates must have demonstrated experience calling on and selling to “C” level executives, SVP Business Owners, CFO’s, Procurement, VPs, and Directors in the retail industry. See additional details in the posting below! #sales #retail #paymentintegrity https://lnkd.in/ez5ZagaH

Cotiviti's popular Quality Decoded webinar series is back for 2025! This series provides healthcare professionals with the latest insights and strategies. We're covering essential topics such as CMS Star Rating changes, updates to the HEDIS MY 2026 technical specifications, and key learnings from the end of the HEDIS season. These expert-led sessions are designed to help healthcare teams navigate regulatory updates and enhance their quality reporting strategies. Sign up for the entire series or choose individual sessions tailored to your needs. https://hubs.ly/Q031lsYk0 #HealthPlans #HEDIS

Inconsistent reimbursement for prosthetic devices remains a major issue for many individuals living with limb loss. Despite the proven benefits of microprocessor-controlled knees and other advanced prosthetics, private health plans often deny coverage, citing medical necessity concerns. https://bit.ly/3WgBnSA HealthLeaders #HealthPlans #payments

Florida Blue has taken legal action against CMS, arguing that the 2023 flooding in Broward County, Florida, unfairly impacted its Medicare Advantage Star Ratings for 2025. The insurer claims that CMS's failure to grant a public health emergency designation for the disaster caused its ratings to drop significantly, costing Florida Blue tens of millions in lost bonuses. https://bit.ly/40ldX0K Becker's Healthcare #payments #HealthPlans