Interoperability Solutions

Control how healthcare data flows from intake to
activation with standards-native solutions

Discover more in Interoperability

Icon_Interoperability

Healthcare runs on fragmented and siloed data. We bring it together so you focus more on coordination, and less on administration.

Healthcare has a coordination problem, and it starts at the front door. Incomplete, misaligned or mistimed data introduces gaps at intake that can degrade downstream workflows and performance. Disparate core systems for critical functions like utilization management and inconsistent data formats create blind spots across the transaction lifecycle.

Accelerating regulatory actions are forcing organizations to take a piecemeal approach to their interoperability infrastructure, often with disparate point solutions that increase complexity with little return on investment.

Cotiviti’s Interoperability solutions bridge EDI and FHIR standards into a single shared architecture and enable healthcare organizations to control the flow of clean, standards-based data and advanced analytics into one platform that improves workflows and delivers meaningful business value.

Cotiviti’s Interoperability solutions

Enable real-time, standards-based healthcare data exchange, controlling how data moves, transforms, and drives decisions across the ecosystem.

Reduce data fragmentation and administrative burden with the market leader in interoperability

Trusted by payers for decades, our interoperability solutions bring together industry expertise, scale, and perpetual innovation to deliver value across the transaction lifecycle.

Process and exchange
data at scale

Over 3B

transactions processed annually across all data formats

Ensure clean data
enters every workflow

Up to 30%

more transaction errors identified at the gateway prior to claims processing*

Trusted by the
industry's largest plans

10 of 10

top national payers rely on our platform, with more than 300 unique clients total across the healthcare ecosystem**

Recognized as the
market leader

Ranked Best in KLAS

for CMS Payer Interoperability in 2023, 2024, and 2026

Footnotes

* Comparison of claims validation accuracy and error detection rate against a leading EDI solution.

** Based on total member enrollment, using 2025 data.

Cotiviti’s Interoperability solutions

Enable real-time, standards-based healthcare data exchange, controlling how data moves, transforms, and drives decisions across the ecosystem.

Consume
Any Transaction

One front door for every format and transaction

✖
Consume Any Transaction

Unify intake across all transaction types through a single, standardized entry point for simplified data ingestion to limit fragmentation and reduce operational complexity across workflows.

  • EDI Gateway: supports secure, compliant exchange of HIPAA transactions at scale (e.g., claims, eligibility, remittance) with validation, transformation, and routing across trading partners.
  • FHIR Gateway: enables standards-based API exchange using HL7 FHIR to support real-time data access, workflows, and compliance with CMS interoperability mandates.
Transform and
Standardize

Capture once. Use everywhere.

✖
Transform and Standardize

Translate and normalize data across formats into a clean, standards-based foundation that enables every downstream system of record and workflow.

  • Smart Trading – transform and normalize transactions across formats into a clean, standardized structure for enterprise-wide use
Orchestrate
Bi-Directional Exchange

We bridge the information gap between payers and stakeholders across every trading partner

✖
Orchestrate Bi-Directional Exchange

Orchestrate secure, bi-directional data exchange with every trading partner for both real-time and batch transactions. Enable more efficient collaboration for faster, more informed decision-making.

    • Smart Trading - securely routes and orchestrates transactions across trading partners to ensure the right data reaches the right system at the right time
    • Enrollment Management: streamlines intake of eligibility and enrollment transactions to standardize member and coverage data at the point of entry
    • Prior Authorization: consolidates and routes all prior authorization requests from any channel (EDI, HL7 FHIR, portals, or fax) into a single, unified workflow to accelerate processing and reduce administrative burden
    • Member Consent: captures and applies member consent to support secure, policy-aligned data exchange
    • Electronic Claims Attachments (53-F): supports payer and provider request-response workflows (275 and 277 RFAI transactions, CDA attachments) in compliance with HIPAA standards for electronic claims attachments transactions.
 
 
 

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