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Cotiviti — Profile & Assessment

Cotiviti publishes 5 of the 8 buying facts this rubric checks, including pricing but not turnaround. Cotiviti operates in the medical-record review ecosystem, within the Medical Record Retrieval / ROI, Insurance Underwriting & Payer Chart Review segment. This profile records what the company publishes, maps it to the Content Hub evaluation rubric, and cites every source behind it. 12 of 17 facts are confirmed from 13 public sources; unpublished fields are marked, never estimated.

4 sections·13 sources·Verified 2026-08-28 ✓
Disclosure
10/17 facts
01

What it does

Medical record retrieval, aggregation, indexing, and storage for health plans; supports Medicare/Medicaid/commercial risk adjustment, RADV audits, HEDIS and quality initiatives, DRG audits, life insurance underwriting, litigation discovery. Also published: Risk adjustment (retrieval, coding, suspect analytics, encounter management), HEDIS/Quality & Stars medical record abstraction, claims medical review (payment accuracy, fraud/waste/abuse detection), interoperability/data exchange. Everything above is drawn from the 13 public sources cited at the foot of this page. Fields the company does not publish are marked as unpublished below rather than estimated.

Key facts

Segment

Medical Record Retrieval / ROI, Insurance Underwriting & Payer Chart Review

Website

https://www.cotiviti.com

HQ

Not published (site references "Our Headquarters" without disclosing address in content fetched)

Ownership

Not published (privately/PE-backed historically; not confirmed via primary source in this session)

Certifications

"Associations and Certifications" page referenced but specific credentials not extracted

Founded

Founded 1979

Headcount

5,001-10,000 employees

Not publishedPricingTurnaround
02

Evaluation criteria

Content Hub rubric5 of 8 published
✓
Processing model
AI + NLP + Human Expert QA
✓
Human QA
Included (expert QA teams review NLP first-pass coding)
✓
Pricing model
Contracted/volume-based (hybrid license + managed services)
✓
Best for
Health plans - HEDIS, Star Ratings, risk adjustment review
✓
Customer satisfaction
No public reviews found
○
Not published
Indicative cost, typical turnaround, and export formats go unstated, as they do across most of this market. The questions to ask instead are below.
03

Profile notes

Who it serves
Health plans/payers, life insurers (underwriting), litigation discovery use case mentioned, 25 of 25 largest U.S. health plans (self-reported), payers, government programs, providers, employers, brokers, TPAs and retailers
Claims & platform notes
Secure Medical Record Repository, multi-channel retrieval (fax, mail, secure portals, FTP, direct EMR access), integration with risk-adjustment coding and HEDIS abstraction applications, DxCG Intelligence, Engagement Hub, Eliza (member engagement), Edifecs (interoperability) Retrieval rates typically exceeding 90%, database of 1.7 million unique providers. 3.5B+ claims processed annually and 150M+ covered lives supported (self-reported).
Review summary
Not independently rated by Medrecords AI. Cited public reviews are listed under Sources; Medrecords AI assigns no star rating without verified evidence.
Competitive coverage
Risk Adjustment Software | Top Platforms & Vendors for 2026 · Top 5 AI Platforms for Risk Adjustment · 20 Risk Adjustment Software Vendors to Consider in 2026 · The Best Risk Adjustment Companies Health Plans Should Know in 2026 · 7 Best Risk Adjustment Software Platforms for 2026 · Reveleer Alternatives and Competitors in 2026
04

What to confirm before you sign

Cotiviti publishes 5 of the 8 fields in the Content Hub rubric. Across all 270 vendors profiled in the Content Hub, the median is 5 of 8. Of the three it leaves unpublished, these two matter most.

  1. What does a real 1,000-page file cost, all in?
    Ask for a worked example rather than a rate card. Duplicate pages, rush fees and monthly minimums are where the quoted rate and the final invoice separate.
    Indicative cost82% of all profiled vendors leave this unpublishedOurs: from 10¢ to as low as 5¢ a page, duplicates free
  2. What is the turnaround on a 1,000-page file, and is that a median or a best case?
    Ask what the clock starts from — receipt, or the point the file clears intake — and what the same number looks like in your busiest week.
    Typical turnaround75% of all profiled vendors leave this unpublishedOurs: same day on the self-service plan

The other seven questions, and what all 270 profiled vendors do and do not publish, are in the evaluation guide.

Sources

How Medrecords AI does this work

Cotiviti works in medical-record review. Medrecords AI does this category of work as software: the record sorted, deduplicated and read in minutes, every statement cited back to its page, and a qualified human signs off on what it means.

SolutionLife & disability underwritingAttending-physician statements condensed for the decision in front of you.Read more →SolutionAPS medical summaryTreating records reduced to a concise, cited summary. AI never scores risk.Read more →ProductBilling summaryBilling and coding data extracted into a reviewable ledger.Read more →
Test it on a file you already have.
Send one real record set. You get back a cited chronology and decide for yourself whether the read holds up — no obligation either way.
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Explore the Content Hub

Software & platforms

AI and case-management platforms across medical-record review.

Service providers & BPOs

Record review, peer review, retrieval, LNC and BPO providers.

State programs

Rules, AMA Guides edition, and MMI standards by state.

Comparisons

Head-to-head vendor and program comparisons.

Guides

Editorial reference on report writing, MMI, and validity testing.

Conferences & events

Workers' comp, claims, insurance and medical-legal conferences with editorial takes.

Directories

Link-out rosters of examiners, LNCs, and expert witnesses.

State matrix report

All 10 verified state programs, side by side.

Content Hub home

The full index of everything in the hub.

Medrecords AIMedrecords AI

Minutes per file. Every line cited. From 10¢ to as low as 5¢ a page.

Bring the hardest file from this page. Get a cited chronology and a report draft in minutes — every line traced to its source page, ready for your review and signature.

  • Minutes per file, not days
  • Every line cited to its source page
  • From 10¢ to as low as 5¢/page, duplicates free — no license, no minimums
  • HIPAA-eligible · SOC 2 audit-ready
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See how Medrecords AI compares with anything on this page — over a 30-minute call, side by side.

Last verified: 2026-08-15