AI Capabilities

AI that drives value responsibly

See how Cotiviti uses AI responsibly to drive value for our clients

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Our commitment

Driving value for health plans across markets

Cotiviti is committed to deploying artificial intelligence (AI) responsibly to enable our human specialists to improve value, with rigorous standards focused on accuracy, transparency, security, and accountability. Our commitment to responsible AI practices is demonstrated through a comprehensive approach to data security, privacy, and ethical AI development in healthcare applications.

No AI system makes care decisions.

Every output is reviewed by a human specialist. Cotiviti has had a formal AI Governance Committee and AI Use Policy in place since 2023.



Core Principles

Cotiviti's core AI principles

Six commitments guide every AI-enabled workflow we build.


Governance Formal AI Governance Committee and AI Use Policy in place since 2023. Data Security A comprehensive approach to data security and privacy across every workflow. Compliance Rigorous standards for accuracy, transparency, and accountability. Human in the Loop Human specialists stay in control — AI supports their expertise, never replaces it. No Care Decisions AI never makes clinical care decisions — those calls stay with human experts. Drive Value AI helps deliver year-over-year value growth without passing rising costs to clients.
AI in action

Cotiviti's use of AI in solutions

Cotiviti is committed to improving the healthcare system through our combination of advanced technology, data analytics, and specialized expertise. AI plays a critical role in helping us deliver year-over-year value growth to clients without passing along the skyrocketing cost of goods and labor.

40% Increase in client savings from our newborn COB validation model
3X Increase in identified overpayments through AI-powered data mining
45% Increase in overall payment integrity program value in 12 months

Predicting and ranking improper payments

We use internally developed expert systems and machine learning to more effectively predict or find and rank improper claim overpayments for payment integrity programs. A few examples:

Read more about AI for Payment Integrity
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  • COB Validation

  • ML predictions identify possible other-coverage instances for human validation. Our newborn model increased client savings by 40%.

  • Data Mining

  • NLP extracts key contract terms affecting reimbursement, driving a 3X increase in identified overpayments.

  • Clinical Chart Validation

  • ML-prioritized record selection for DRG, short stay, readmission, and SNF/IRF claims enabled a 45% increase in program value in 12 months.

Making your infrastructure smarter

We embed AI into our software solutions to make your entire infrastructure smarter and more capable. A few examples:

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  • Prior Authorization

  • Automation and integration into EMR — NLP auto-populates 80% of fields.

  • Risk Adjustment

  • NLP-enabled insights improve coding and diagnosis specificity, reduce manual chart review volume, and uncover information hidden in unstructured data — with confidence-scored suspect accuracy.

  • Value-Based Care

  • Real-time analytics of financial, quality, and contract performance, with AI-enabled modeling and automated VBC contract management.

Expanding GenAI responsibly

We continue to advance our use of GenAI to support claim payment policy and consumer engagement effectiveness. A few examples:

Generative AI
  • Consumer Engagement

  • HIPAA-compliant AWS ML and GenAI power text-to-speech, speech recognition, sentiment analysis, and transcription formatting.

  • Internal Policy Research

  • GenAI expands new policy research internally — not currently used for client-facing applications.

Move members to action through empathy-driven outreach

Our Engagement solutions move members to take meaningful action using a highly tailored, multi-channel approach rooted in empathy. Combining technology with the proper data and analytics as well as a clear user experience, our solutions are built to augment and improve, making it easy to implement and to scale.

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engagement Engagement

Help retailers recover substantial savings year over year

Cotiviti Retail solutions provide audit and recovery services for all retail verticals, including mass merchandisers, grocery and discount chains, department stores, and specialty retailers. Every year across our client base, we help the largest and most influential retailers in the industry save hundreds of millions of dollars.

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