SLC’s Cotiviti gets QECP certified, access to biggest Medicare dataset

Salt Lake City— Cotiviti, a leader in data-driven healthcare solutions, has achieved national Qualified Entity (QE) status through the Centers for Medicare & Medicaid Services (CMS) Qualified Entity Certification Program (QECP). As a certified QECP member, Cotiviti has been granted access to the most comprehensive and up-to-date normalized Medicare population dataset to study provider performance as well as patient risk.

The addition of the QE data to Cotiviti’s Network Intelligence and DxCG Intelligence solutions, as well as its Caspian Clarity dataset representing approximately 40 percent of all covered Americans, increases the volume of Medicare data to which Cotiviti has access by 38 million lives. This further enriches the data available to be used in the company’s industry-leading algorithms, advanced machine learning, and DxCG risk-prediction models to improve healthcare cost and quality.

“We are honored to be part of a select group of organizations that have achieved this premier status. Access to this high-quality, comprehensive dataset allows us to offer even more sophisticated insights to better understand member risk, quality, and effectiveness of care delivery,” said Emad Rizk, M.D., chairman, president, and CEO of Cotiviti. “For our Network Intelligence and DxCG Intelligence customers, this data will deliver immediate value by allowing us to more specifically focus on spending and outcomes while navigating the uncertainties of the COVID-19 pandemic. Access to this data will also increase the number of lives our Caspian Clarity data repository can process, furthering our mission of creating a single source of truth of all healthcare data.”

Obtaining QE certification unlocks richly detailed data that will enhance Cotiviti’s analyses of provider practice patterns, member risk, and the healthcare landscape. Additionally, the recency of QE data compared to public-use files—four to six months versus one to two years—allows Cotiviti to deliver more timely assessments of performance in different value-based initiatives.

The combination of QE with other data to which Cotiviti has access will further refine the company’s already best-in-class predictive modeling and network performance solutions by increasing the quality, depth, and breadth of the data on which the models are based. Specifically, QE data will help calibrate the company’s Medicare models to better target specific individual patients for gap closure and other medical management use cases, risk adjustment, and more accurate actuarial forecasting. This data also provides Cotiviti’s health plan clients the ability to look at the total activity within their markets and better understand, predict, and guide provider and consumer actions to succeed in value-based initiatives.

“This certification affords us a unique position to contribute to CMS’s data liberation movement and provide key insights into patient risk and provider practice pattern variation while connecting our lines of business to deliver value to our clients,” said Rachael Jones, senior vice president, performance analytics and quality at Cotiviti. “We are also looking forward to developing public reports based on the QECP data sets that can contribute to a better understanding of the Medicare population. Leveraging this broad universe of healthcare data will help us to study how healthcare is delivered and to contribute to innovative solutions to some of the biggest healthcare challenges we face.”

About Cotiviti
Cotiviti is a leading solution and analytics company that is reshaping the economics of healthcare, helping its clients uncover new opportunities to unlock value. Cotiviti’s solutions are a critical foundation for healthcare payers in their mission to lower healthcare costs and improve quality through higher-performing payment accuracyquality improvementrisk adjustment, and network performance management programs. Cotiviti’s healthcare solutions are powered by Caspian Clarity, a proprietary data and analytics platform spanning thousands of unique member and provider data types across financial and clinical domains, representing the most comprehensive longitudinal data set in healthcare. The company also supports the retail industry with data management and recovery audit services that improve business outcomes. For more information, visit