About Cotiviti
Cotiviti is a leading healthcare analytics company that serves as a structural utility layer for the healthcare system, providing integrated solutions across payment integrity, risk adjustment, quality measurement, and member engagement. The company works with health plans, government programs, healthcare providers, employers, brokers, TPAs, and retailers to unlock value hiding in healthcare data. Cotiviti's Payment Accuracy solutions help clients identify and prevent inappropriate claims through integrated pre and postpayment programs, preventing over $10 billion in errors in 2023. The company's Risk Adjustment solutions ensure appropriate reimbursement through retrospective and prospective chart review and coding. Quality and Stars solutions enable HEDIS reporting and Star Ratings optimization for over 129 million members, with 44% of 5-star Medicare Advantage contracts using Cotiviti's solutions. The Engagement solutions drive member action through multi-channel outreach. With over 20 years of experience in payment integrity, Cotiviti serves 23 of the top 25 national payers and more than 100 unique payer clients. The company recently completed the acquisition of Edifecs to expand its capabilities in payer interoperability and data exchange. Cotiviti combines advanced analytics, AI-driven pattern detection, and managed services to help healthcare organizations reduce costs, improve quality outcomes, and ensure regulatory compliance across HEDIS, Star Ratings, and fraud, waste, and abuse detection.
Mission & Story
Mission
Becoming the structural utility layer for our healthcare system
Who It Serves
Milestones & Awards
Recent Milestones
Completed acquisition of Edifecs (2025/2026), Ric Sinclair joined as CEO, John Hallock joined as Chief Corporate Affairs Officer, Edifecs named 2026 Best in KLAS for CMS Payer Interoperability
Awards & Recognition
Edifecs named 2026 Best in KLAS for CMS Payer Interoperability with highest rating in product quality and customer relationships
Key Partnerships
Company Details
Work here?
Claim this listing to update company information and connect with our audience.
Claim This ListingSecurity & Compliance
Official Sources
Similar Companies in this Market
View all 56 →
16 Bit Inc
AI-driven opportunistic screening platform to improve population bone health and healthcare quality.
1m
1m empowers healthcare leaders to make confident, risk-aware decisions using continuously updated, quantified risk intelligence.
AgileMD
AgileMD provides AI-powered clinical decision support tools including eCART, an FDA-cleared early warning system for clinical deterioration, and integrated clinical pathways that embed evidence-based protocols directly into EHR workflows for hospitals and health systems.
Algorex Health
N1 Health (formerly Algorex Health) is an applied AI platform that predicts the right individuals to engage with the right interventions to drive better health outcomes. The platform combines data, models, and technology to generate member-level predictions for healthcare organizations.
Arbital Health
Arbital Health provides the first AI-powered platform built for value-based care by industry-leading healthcare actuaries. The company helps providers, payers, and VBC enablers proactively manage risk contracts through actuarial-grade analytics and conversational AI.
Arcadia.io
acquired · 360 employees
Arcadia is a healthcare data analytics platform trusted by top payers and providers to deliver insights where they matter most.
Azara Healthcare
Azara Healthcare provides population health management solutions for safety-net providers, community health centers, and physician practices. The company's flagship platform, Azara DRVS, aggregates clinical, claims, and social determinants data to enable quality reporting, care coordination, and value-based care performance.
Carrot Health
Carrot Health provides AI-powered consumer health intelligence and predictive analytics for healthcare organizations. The company helps payers, providers, and life sciences companies identify, engage, and serve patients more effectively through data-driven insights.
Data Accuracy Notice: Company information on HealthAI Central is compiled from public sources and updated regularly. While we strive for accuracy, details such as funding figures, employee counts, and product offerings may change. We recommend verifying critical information directly with the company before making business decisions.