Connected Healthcare Intelligence

Turning Healthcare Complexity Into Performance

Healthcare organizations are under pressure to improve financial performance, reduce administrative complexity, and deliver better outcomes. Cotiviti connects data, workflows, and intelligence across the healthcare ecosystem, helping payers, providers, and government programs operate with greater accuracy, efficiency, and confidence.

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Payment Integrity

Everest Group names Cotiviti highest-designated Leader for market impact

See why Cotiviti earned this recognition in the Pre-payment Integrity Solutions PEAK Matrix® Assessment 2026.

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Leadership

Cotiviti CEO Ric Sinclair joins Lifers podcast

Watch the interview as he discusses Cotiviti’s vision of becoming the structural utility layer for our healthcare system with host Chrissy Farr.

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Recognition

Edifecs named 2026 Best in KLAS® for CMS Payer Interoperability

Learn why Edifecs earned the highest rating in product quality and customer relationships.

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Leadership

Ric Sinclair joins Cotiviti as CEO

Learn how Cotiviti will shape the next era of platform-led healthcare innovation.

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Leadership

John Hallock joins Cotiviti as Chief Corporate Affairs Officer

Learn more about how this new leadership role reflects Cotiviti’s accelerating expansion and long-term vision.

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Payment Integrity

Overloaded with improper DRG claims?

Discover how one plan used prepay DRG review and realized a significant increase in program value in one year alone.

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The Challenge

As healthcare data has expanded, the challenge of connecting it has only grown.

Healthcare has digitized nearly every transaction, workflow, and interaction.

Yet critical information remains fragmented across payers, providers, government programs, employers, and members. As data has expanded, visibility has not.

The result is delayed decisions, administrative complexity, payment inaccuracies, missed opportunities, and rising costs.

Organizations do not suffer from a lack of data. They struggle to turn fragmented information into coordinated action.

The Opportunity

Fragmented Information Creates a Performance Problem

Cotiviti helps bridge those gaps

By connecting the data, intelligence, and workflows that drive healthcare’s most important financial and operational decisions.

Every major industry relies on infrastructure that helps information move seamlessly between systems, organizations, and decision makers.

Healthcare remains one of the few industries where critical information is still fragmented across disconnected technologies and workflows. The result is delayed decisions, avoidable costs, administrative burden, and missed opportunities to improve outcomes.

The opportunity isn’t simply to digitize healthcare—it’s to create greater coordination across the data, workflows, and decisions that drive performance.

The Platform

The Infrastructure Layer Powering Healthcare Performance

Cotiviti connects data, workflows, intelligence, and action across healthcare’s most critical financial, clinical, and operational functions. By creating a shared foundation across fragmented systems, we help organizations operate with greater visibility, precision, and control.

Our Core Pillars

Connected Data

Real-time interoperability across healthcare systems

Shared Intelligence

Insights informed by one of healthcare’s broadest and most connected datasets

Workflow Orchestration

Action embedded directly into operational workflows

Measurable Outcomes

Financial, clinical, and operational performance improvements

Solutions

One Connected Platform. Multiple Ways to Create Value.

Every solution is built on the same connected foundation of data, intelligence, and workflow orchestration, helping organizations create value faster while expanding capabilities over time.

Interoperability

Connect and exchange healthcare data with greater speed, accuracy, and compliance.

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Health Enablement

Transform data into action across risk adjustment, quality improvement, and member engagement.

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Payment Integrity

Improve payment accuracy and reduce unnecessary costs across the claims lifecycle.

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AI at Cotiviti

AI Requires More Than Data

For AI to deliver meaningful results in healthcare, it needs trusted data, connected workflows, operational context, and measurable outcomes.

Cotiviti provides the foundation that helps organizations put AI to work in real-world healthcare environments. Built on billions of healthcare transactions and embedded directly into real-world workflows, our AI capabilities help organizations improve accuracy, automate workflows, support faster decisions, and identify opportunities that would otherwise remain hidden.

The goal is not more AI. The goal is better outcomes.

By the Numbers

Trusted Across Healthcare’s Most Critical Workflows

3.5B+ Claims processed annually
150M+ Covered lives
140M+ Lives supported through Quality and Stars
$10B+ Inappropriate payments identified and recovered annually
25 of 25 Largest U.S. health plans

Every interaction strengthens the insights, intelligence, and expertise we bring to clients. This scale enables us to identify patterns, uncover opportunities, and deliver outcomes that point solutions alone cannot easily replicate.

How we help

Why Cotiviti Is Uniquely Positioned

Scale

3.5B+ claims and 150M+ covered lives provide unmatched visibility across the healthcare ecosystem.

Connectivity

Deep integration across financial, administrative, and clinical workflows.

Intelligence

Advanced analytics, automation, and AI built on decades of healthcare expertise.

The Path Forward

Helping Healthcare Perform Better

Healthcare’s future depends on more than digitization. It requires connected data, coordinated workflows, shared intelligence, and the ability to act with greater speed, accuracy, and confidence.

Cotiviti is helping healthcare move beyond fragmentation, creating the infrastructure that enables better decisions, stronger financial performance, and better outcomes for everyone it serves.

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