Who we serve

A focus on healthcare payers and risk-bearing entities

Cotiviti Healthcare provides a comprehensive suite of solutions to meet the payment accuracy and network value needs of payers and other risk-bearing organizations across the U.S. healthcare landscape. Our experience with this broad client base allows us to stay at the forefront of the latest industry best practices, as well as changes in policies and clinical guidelines.

We are specialists, applying all our resources and expertise to address the unique challenges of paying healthcare claims accurately and designing physician networks aligned to the principles of pay-for-value. Working with Cotiviti Healthcare, clients have a partner that shares their priorities and understands their environment.

The service we deliver, and results that Cotiviti Healthcare helps our clients achieve, make us the payment accuracy and network value partner of choice for many leading healthcare organizations. Our ten largest clients have been with Cotiviti for an average of more than 10 years – clear evidence of the value we uncover.

A majority of the top healthcare payers and other risk-bearing healthcare entities are Cotiviti clients

Cotiviti’s expertise benefits a wide range of healthcare organizations:


Commercial – The vast majority of leading private plans, from the biggest national insurers to local payers and self-insured organizations, elect to work with Cotiviti Healthcare. We work with health plans on both fully-insured and self-insured (Administrative Services Only - ASO) programs. Our team of clinical and coding experts complements our clients’ internal capabilities in policy development and implementation, claim and chart review, as well as overpayment recovery and network optimization.

Medicaid – Cotiviti Healthcare works with many of the nation’s leading Managed Medicaid plans, helping them address the complexities of state-specific guidelines and remain in compliance with each state’s rules and regulations.

Medicare – Our long experience with Medicare and Medicare Advantage plans gives us deep understanding of CMS policies and guidelines, to the benefit of our broad portfolio of clients with Medicare Advantage lines of business. In addition as the leading CMS Recovery Audit Contractor, Cotiviti Healthcare has made over $3.9B in corrections for the Medicare Trust Fund since the inception of the program.

Other Risk-Bearing Entities

Our Network Value solutions are available to providers in shared-risk arrangements, including hospital systems, provider groups, post-acute care centers, retail clinics, and similar risk-bearing entities.