Linked research, clinical, and regulatory source pathways.
Company profile
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.
Company description Cotiviti official website
Primary marketPopulation Health & Healthcare Analytics
Commercial modelCommercial information available on request
Company presenceOfficial website
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01 · Operating footprint
Where the Company operates
Company-profile context for clinical focus, customers, deployment, integration, milestones, and partnerships.
Clinical focus
No clinical focus areas are currently listed.
Who it serves
- Brokers
- Employers
- Government
- Healthcare Providers
- Payers
- Retailers
- TPAs
Deployment & integration
Deployment information is currently being developed.
Geographic context
MarketsUnited States
Company sourceOfficial website
Company milestones
Platform expansion
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
Partnerships
Recorded partners
- Edifecs (acquired)
- NCQA
02 · Flagship portfolio
Products, workflows, and platform capabilities
Selected source-backed Company products and the available commercial context.
No source-backed Company products are currently listed.
03 · Research intelligence
Research Intelligence evidence
Publications, preprints, clinical validation, and regulatory records in Evidence Position order.
Evidence position
Publications, clinical validation, and regulatory records connected to this Company appear here.
Research
Publications & preprints
Comment on "Artificial intelligence in clinical nutrition: A narrative review".Clinical nutrition ESPEN · Aug 1, 2026
Comment on "using mobile applications for body composition analysis: A technical review of an artificial intelligence-based tool".Clinical nutrition ESPEN · May 27, 2026
Clinical validation
Clinical-trial records
No linked records are currently available.
Regulatory
Regulatory records
No linked records are currently available.
04 · Company-reported outcomes
Outcomes and case studies
Company-reported outcomes and customer stories are distinct from linked Research Intelligence evidence.
>$10B in errors prevented or corrected
Payment integrity in 2023
60-120 days until identification of savings begins
Time to value for payment accuracy solutions
80% of overpaid findings as cost savings
COB Validation
3-4% savings on inpatient spend
Clinical Chart Validation
>90% medical record retrieval rate
HEDIS reporting
44% of 5-star contracts
Medicare Advantage plans using Quality and Stars solutions
>129M members reported to NCQA
Quality Intelligence processing
05 · Leadership
Leadership team
Leadership profiles and professional links from the current Company record.
No active leadership profiles are currently listed.
06 · Company updates
Updates from Cotiviti
Recent articles published on Cotiviti's official website.
No Company updates are currently listed.
07 · HAIC coverage
Coverage and analysis
Health AI Central reporting that mentions this Company.
No HAIC coverage is currently linked to this Company.
08 · Official presence
Company sources and channels
Curated official destinations from the active Company record.
09 · Market pathway
Additional Companies in this Market
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Market context
Population Health & Healthcare Analytics
Companies providing AI-powered analytics for population health management, healthcare data integration and analysis, risk stratification, care gap identification, or value-based care analytics. Focuses on analyzing data across patient populations to improve outcomes at scale and enable data-driven decision-making across health systems.
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