# Cotiviti — Profile & Review | Medrecords AI

> 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

Canonical page: https://medrecords.ai/ime-hub/services/cotiviti/

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## 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

## Evaluation criteria

| Criteria | Detail |
|---|---|
| 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 |

## 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](https://www.foreseemed.com/risk-adjustment-software) · [Top 5 AI Platforms for Risk Adjustment](https://keebler.health/top-5-ai-platforms-for-risk-adjustment/) · [20 Risk Adjustment Software Vendors to Consider in 2026](https://arcadia.io/resources/risk-adjustment-software) · [The Best Risk Adjustment Companies Health Plans Should Know in 2026](https://markets.financialcontent.com/stocks/article/globeprwire-2026-4-28-the-best-risk-adjustment-companies-health-plans-should-know-in-2026) · [7 Best Risk Adjustment Software Platforms for 2026](https://techbullion.com/7-best-risk-adjustment-software-platforms-for-2026/) · [Reveleer Alternatives and Competitors in 2026](https://www.pelica.com/blog/reveleer-alternatives)

## Key facts

- **Segment:** Medical Record Retrieval / ROI, Insurance Underwriting & Payer Chart Review
- **Website:** [https://www.cotiviti.com](https://www.cotiviti.com)
- **Founded:** Not published
- **HQ:** Not published (site references "Our Headquarters" without disclosing address in content fetched)
- **Headcount:** Not published
- **Ownership:** Not published (privately/PE-backed historically; not confirmed via primary source in this session)
- **Pricing:** Not published
- **Turnaround:** Not published
- **Certifications:** "Associations and Certifications" page referenced but specific credentials not extracted

## Sources

- [Source](https://www.cotiviti.com/solutions/quality-and-performance/medical-record-retrieval)
- [Cotiviti website](https://www.cotiviti.com)
- [Cotiviti Second Level Review](https://www.cotiviti.com/solutions/risk-adjustment/second-level-review)
- [Cotiviti Risk Adjustment Solutions](https://www.cotiviti.com/solutions/risk-adjustment)
- [Cotiviti Medical Record Retrieval](https://www.cotiviti.com/solutions/risk-adjustment/medical-record-retrieval)
- [ForeSee Medical: Risk Adjustment Software | Top Platforms & Vendors for 2026](https://www.foreseemed.com/risk-adjustment-software)
- [Keebler Health: Top 5 AI Platforms for Risk Adjustment](https://keebler.health/top-5-ai-platforms-for-risk-adjustment/)
- [Arcadia: 20 Risk Adjustment Software Vendors to Consider in 2026](https://arcadia.io/resources/risk-adjustment-software)
- [FinancialContent / GlobePRwire: The Best Risk Adjustment Companies Health Plans Should Know in 2026](https://markets.financialcontent.com/stocks/article/globeprwire-2026-4-28-the-best-risk-adjustment-companies-health-plans-should-know-in-2026)
- [TechBullion: 7 Best Risk Adjustment Software Platforms for 2026](https://techbullion.com/7-best-risk-adjustment-software-platforms-for-2026/)
- [Pelica Health: Reveleer Alternatives and Competitors in 2026](https://www.pelica.com/blog/reveleer-alternatives)

Last verified: 2026-08-15