IME Hub › Service Providers & BPOs

Cotiviti — Profile & Review

Cotiviti is a medical record retrieval / roi, insurance underwriting & payer chart review operating in the medical-record review and IME ecosystem. 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

3 sections·11 sources·Verified 2026-08-15 ✓
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 || 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

02

Evaluation criteria

IME Hub rubric5 of 8 published
✓
Processing model
AI + NLP + Human Expert QA
✓
Human QA
Included (expert QA teams review NLP first-pass coding)
○
Typical turnaround
Not published
✓
Pricing model
Contracted/volume-based (hybrid license + managed services)
○
Indicative cost
Not published
○
Export formats
Not published
✓
Best for
Health plans - HEDIS, Star Ratings, risk adjustment review
✓
Customer satisfaction
No public reviews found
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, 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; 150M+ covered lives supported (self-reported)
Review summary
Not independently rated in v1. Cited public reviews are listed in Sources; MedRecords 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

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

Not publishedFounded · Headcount · Pricing · Turnaround

Sources

Explore the IME Hub

Software & platforms

AI and case-management platforms in the IME ecosystem.

Service providers & BPOs

IME, peer review, retrieval, 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

IME-ecosystem conferences with editorial takes.

Directories

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

State matrix report

All ten verified state programs, side by side.

IME Hub home

The full index of everything in the hub.

MedRecords AIMedRecords AI

MedRecords AI is faster, better, cheaper.

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
  • Flat 10¢/page, duplicates free — no license, no minimums
  • HIPAA-eligible · SOC 2 audit-ready
Test on a file Book a demo

See how MedRecords AI compares with anything on this page — over a 30-minute call, side by side.

Last verified: 2026-08-15