To: Board of Supervisors
From: Dr. Grant Colfax, Health Services Director
Report Title: Contract Amendment #27-791-15 with Cotiviti, Inc.
?Recommendation of the County Administrator ? Recommendation of Board Committee
RECOMMENDATIONS:
APPROVE and AUTHORIZE the Health Services Director, or designee, to execute on behalf of the County Contract Amendment #27-791-15 with Cotiviti, Inc., a corporation, effective April 14, 2026, to amend Contract #27-791-14, to increase the payment limit by $2,250,000, from $3,000,000 to a new payment limit of $5,250,000, for code editing and validation capabilities concerning its hosted software solution for analyzing Healthcare Effectiveness Data and Information Sets (HEDIS) for fraud, waste and abuse for Contra Costa Health Plan (CCHP) with no change in the term November 1, 2025 through October 31, 2028.
FISCAL IMPACT:
Approval of this Contract Amendment will result in additional annual expenditures of up to $2,250,000 as budgeted by the department and funded 100% by CCHP Enterprise Fund II revenues.
BACKGROUND:
This Contract meets the needs of the County by providing proprietary data analysis software for HEDIS projects and reports to support State and contractual requirements for CCHP. Cotiviti, Inc., provides its licensed program, Quality Intelligence, used by CCHP to calculate and analyze HEDIS measures. HEDIS Measures, are a requirement for accreditation certification with the National Committee for Quality Assurance (NCQA) and mandated by the Department of Health Care Services, for which CCHP is assessed. HEDIS scores are used to determine Plan assignment, and therefore impact capitation payments from the state. HEDIS is also utilized for Quality Rate Factor payments in which capitation is not only based on monthly membership numbers but also HEDIS scores in comparison to other Plans. HEDIS is a heavily structured, highly audited process and calculations will not be accepted without the use of NCQA certified software to pr...
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