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Cotiviti Caspian

Better data. Better decisions. Better health.

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Overview

Cotiviti's Caspian platform is a powerful data and analytics engine for health plans. While not a direct provider-facing empanelment tool, it is critical in the patient attribution process from the payer side. It ingests massive amounts of clinical and claims data to help payers with risk adjustment, quality reporting (HEDIS/Stars), and payment integrity. This data is used to define the populations for which providers will be held accountable.

✨ Key Features

  • Enterprise Data Management
  • Quality and HEDIS/Stars Program Management
  • Risk Adjustment Analytics
  • Payment Integrity
  • Payer-Provider Data Exchange

🎯 Key Differentiators

  • Deep expertise in payment integrity and accuracy
  • Advanced analytics for risk and quality
  • Comprehensive solution set for health plan operations

Unique Value: Provides health plans with a unified data and analytics platform to manage the complex interplay of quality, risk adjustment, and payment integrity, driving better financial and clinical outcomes.

🎯 Use Cases (4)

Health plan quality improvement Risk adjustment optimization Payment accuracy and integrity Defining populations for value-based contracts

✅ Best For

  • Improving Star ratings for Medicare Advantage plans
  • Ensuring accurate risk adjustment submissions to CMS
  • Identifying and recovering improper payments

💡 Check With Vendor

Verify these considerations match your specific requirements:

  • Provider organizations looking for a clinical care management tool

🏆 Alternatives

Optum Veradigm Inovalon

Offers a stronger focus on the financial aspects of healthcare, such as payment integrity, compared to more clinically-focused population health vendors.

💻 Platforms

Web API

🔌 Integrations

Payer Core Systems Claims Data Feeds Provider EMR Data

🛟 Support Options

  • ✓ Email Support
  • ✓ Phone Support
  • ✓ Dedicated Support (Enterprise tier)

🔒 Compliance & Security

✓ SOC 2 ✓ HIPAA ✓ BAA Available ✓ ISO 27001 ✓ SSO ✓ HITRUST CSF ✓ SOC 2 Type 2 ✓ NCQA Certified

💰 Pricing

Contact for pricing
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