List of Cotiviti Payment Integrity Customers
Cotiviti
10701 S River Front Pkwy, Unit 200,
South Jordan, 84095, UT,
United States
South Jordan, 84095, UT,
United States
1 770-379-2800
Professional Services
5500
$680M
Since 2010, our global team of researchers has been studying Cotiviti Payment Integrity customers around the world, aggregating massive amounts of data points that form the basis of our forecast assumptions and perhaps the rise and fall of certain vendors and their products on a quarterly basis.
Each quarter our research team identifies companies that have purchased Cotiviti Payment Integrity for Payment Integrity from public (Press Releases, Customer References, Testimonials, Case Studies and Success Stories) and proprietary sources, including the customer size, industry, location, implementation status, partner involvement, LOB Key Stakeholders and related IT decision-makers contact details.
Companies using Cotiviti Payment Integrity for Payment Integrity include: Humana, a United States based Insurance organisation with 95500 employees and revenues of $83.06 billion, Molina Healthcare, a United States based Healthcare organisation with 18000 employees and revenues of $40.65 billion, AmeriHealth Caritas, a United States based Insurance organisation with 10000 employees and revenues of $23.70 billion, CareSource, a United States based Insurance organisation with 4500 employees and revenues of $11.80 billion, BlueCross BlueShield of Tennessee, a United States based Insurance organisation with 6500 employees and revenues of $8.60 billion and many others.
Contact us if you need a completed and verified list of companies using Cotiviti Payment Integrity, including the breakdown by industry (21 Verticals), Geography (Region, Country, State, City), Company Size (Revenue, Employees, Asset) and related IT Decision Makers, Key Stakeholders, business and technology executives responsible for the software purchases.
The Cotiviti Payment Integrity customer wins are being incorporated in our Enterprise Applications Buyer Insight and Technographics Customer Database which has over 100 data fields that detail company usage of software systems and their digital transformation initiatives. Apps Run The World wants to become your No. 1 technographic data source!
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| Logo | Customer | Industry | Empl. | Revenue | Country | Vendor | Application | Category | When | SI | Insight |
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Aetna Better Health of Kansas | Insurance | 1500 | $200M | United States | Cotiviti | Cotiviti Payment Integrity | Payment Integrity | 2024 | n/a |
In 2024, Aetna Better Health of Kansas implemented Cotiviti Payment Integrity as part of its Payment Integrity program. The deployment targets both prepayment and post payment review workflows to increase claims scrutiny across Medicaid claims processing.
Cotiviti Payment Integrity performs datamining driven post payment reviews and prepayment screening to validate claim payment accuracy against Aetna clinical and payment policies, national correct coding standards such as CMS and AAPC, and provider contracts. The implementation includes DRG Complex Chart Validation CCV reviews for retrospective inpatient documentation, coding and clinical validation using CMS Program Integrity Manual guidance, ICD-10 CM and PCS codebooks, official coding guidelines and Coding Clinics. Medical record retrieval processes are executed by Cotiviti and provider notification letters are issued when coding changes or overpayments are identified.
Cotiviti also conducts Coordination of Benefits retrospective reviews to identify claims that were incorrectly processed as primary, with formal provider correspondence detailing identified overpayments. Aetna Better Health of Kansas has contracted Equian alongside Cotiviti to validate facility claims against final itemization bills, to identify retro-terminations and to perform post payment data mining for facility and professional claims, with Equian performing direct provider outreach for medical record collection when needed.
Operational coverage spans claims operations, provider relations and medical record management within Aetna Better Health of Kansas Medicaid operations. Governance for reviews and notification workflows is anchored to ABH policies and national coding and regulatory guidance, with formalized medical record request and provider notification procedures.
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AmeriHealth Caritas | Insurance | 10000 | $23.7B | United States | Cotiviti | Cotiviti Payment Integrity | Payment Integrity | 2021 | n/a |
In 2021, AmeriHealth Caritas implemented Cotiviti Payment Integrity to strengthen Payment Integrity efforts focused on Medicare and Medicaid claim accuracy. The deployment was positioned to provide an enterprise-grade claim review and edit management capability across payer payment integrity and claims operations functions.
Cotiviti Payment Integrity was configured with a rules engine and an edit library to support both creation of new edits and maintenance of existing edits. The implementation included standard payment integrity functional modules such as prospective and retrospective review workflows, audit and recovery case management, and analytics for claim accuracy and edit performance.
The solution was set up to ingest Medicare and Medicaid claim streams and to operate within AmeriHealth Caritas claims operations and payment integrity teams, enabling analysts to validate policy alignment and author targeted edits. Operational coverage emphasized Payment Integrity and Claims Operations as primary business functions, with deployment allowing senior payment analysts to focus on edit lifecycle, testing, and policy conformance.
Governance was articulated around an edit authoring and change control process that assigned payment integrity analysts responsibility for edit creation and ongoing maintenance. The implementation narrative documents an operational shift toward centralized edit governance, standardized testing workflows, and role-based access for content authors and reviewers to ensure alignment with current policy.
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Blue Cross Blue Shield of North Dakota | Insurance | 2500 | $1.0B | United States | Cotiviti | Cotiviti Payment Integrity | Payment Integrity | 2022 | n/a |
In 2022, Blue Cross Blue Shield of North Dakota implemented Cotiviti Payment Integrity under the Payment Integrity category. The deployment operationalized a Clinical Chart Validation CCV process flow, an analysis-driven audit requiring review of medical records and complex DRG, diagnosis, revenue code and procedure code review beyond basic coding and documentation review. Medical record requests are issued by Cotiviti on behalf of BCBSND, delivered as letters to providers, and specify submission methods and a 60 day submission window. The Cotiviti Retrieval Operations Center is the contact point for medical record retrieval at 833-931-1789.
The Cotiviti Payment Integrity implementation centers on automated claim identification and case management for selected claims, medical records retrieval orchestration, and an audit determination workflow that issues No Change or Change outcomes. The audit determination workflow produces formal letters within 60 days of record review and includes structured acceptance, reconsideration, and second-level appeal pathways. Reconsideration handling is formalized, with Cotiviti returning a reconsideration determination within 60 days of receipt and providing documented next steps for providers.
Operationally the implementation binds Cotiviti review outputs to BCBSND claims adjudication actions, with Blue Cross Blue Shield of North Dakota adjusting claims within 60 days of notification from Cotiviti. Business functions directly affected include claims adjudication, provider relations, clinical audit teams and payment integrity governance. All communications to providers are routed through Cotiviti letters and providers must follow the letter-specified submission methods, failure to reply within required windows results in claim denial or automatic adjustment and forfeiture of further reimbursement rights.
Governance is rules-based and timeline driven, providers have 60 days to submit records from the medical records request, 60 days to request a reconsideration from the audit determination date, and determinations are returned within 60 days at each stage, with failure to meet deadlines resulting in claims being adjusted to reflect audit findings. Cotiviti and BCBSND will not reimburse providers for record retrieval or expedited mailing costs, and providers with audit or reconsideration questions are directed to Cotiviti at 770-379-2169. The Cotiviti Payment Integrity deployment formalizes end-to-end clinical chart validation workflows and embeds audit determination and reconsideration governance into BCBSND payment integrity operations.
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BlueCross BlueShield of Tennessee | Insurance | 6500 | $8.6B | United States | Cotiviti | Cotiviti Payment Integrity | Payment Integrity | 2022 | n/a |
In 2022 BlueCross BlueShield of Tennessee implemented Cotiviti Payment Integrity as part of an enhanced Payment Integrity program offered to plan sponsors. The Board reviewed and approved an opt in for Metro's PPO plan after being briefed by Christina Hickey and an overview from Russ Henderson, creating formal authorization to proceed with the Cotiviti partnership.
Cotiviti Payment Integrity is positioned as a final filter layered on top of BCBST's existing claim payment review system, adding adjudication stage controls focused on coding accuracy. The deployment emphasizes miscoding detection workflows including inappropriate override modifier use, evaluation and management coding validation, and rule sets that require complex logic and clinical review, supported by trained, certified clinical coders.
Operationally the implementation is scoped to plan sponsors who elect the enhanced program, with Metro's PPO explicitly approved for onboarding and an estimated 60 day implementation window to operationalize the final filter within the claims review pipeline. Cotiviti Payment Integrity interoperates with BCBST's claim review processes to surface additional coding-related recoveries and to route cases requiring clinical coder adjudication.
Governance for the program was board driven, with an opt in decision required by plan governance, and a contingency based commercial model where the plan incurs no fee unless additional savings are recovered. The contractual recovery split is explicit, Cotiviti retains 29 percent of recovered savings and the plan retains 71 percent, which frames the financial incentives for deploying Cotiviti Payment Integrity across participating benefit plans.
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CareSource | Insurance | 4500 | $11.8B | United States | Cotiviti | Cotiviti Payment Integrity | Payment Integrity | 2020 | n/a |
In 2020, CareSource announced a partnership with Cotiviti and implemented Cotiviti Payment Integrity in the Payment Integrity category, with periodic post payment reviews scheduled to begin in February 2021. The initial communication was a December 15, 2020 notice to Ohio Medicaid and Medicare Advantage providers announcing that Retrospective Accuracy and Clinical Claim Validation reviews would be conducted by Cotiviti beginning February 2021, and that providers would receive claim-specific letters with guidelines and timeframes.
Cotiviti Payment Integrity was deployed to execute two explicit review capabilities, Retrospective Accuracy, which focuses on coding correctness and does not require additional provider documentation, and Clinical Claim Validation, which evaluates proper billing and may require medical record submission. The implementation leverages Cotiviti clinical and claims expertise, including registered nurses and coding specialists, to perform structured post payment review workflows and adjudication support consistent with Payment Integrity functional terminology.
Operational integration centers on claims operations and provider record access, Cotiviti acting as a Business Associate under HIPAA to receive medical and financial information to the same extent as CareSource staff. The vendor will notify providers when claims are selected, and CareSource and Cotiviti are implementing processes to minimize duplicate medical record requests, embedding the review work into existing provider communications and claim appeals channels for Ohio Medicaid and Medicare Advantage networks.
Governance for the initiative emphasizes HIPAA compliance and collaborative oversight, with Cotiviti expected to work alongside CareSource to create strategies to prevent future payment errors and improve reimbursement processes. Provider-facing governance elements include formal letters identifying selected claims, defined timeframes for record submission, and routing questions to CareSource Provider Services during stated business hours.
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Insurance | 400 | $65M | United States | Cotiviti | Cotiviti Payment Integrity | Payment Integrity | 2023 | n/a |
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Insurance | 2000 | $1.9B | United States | Cotiviti | Cotiviti Payment Integrity | Payment Integrity | 2018 | n/a |
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Insurance | 4500 | $4.4B | United States | Cotiviti | Cotiviti Payment Integrity | Payment Integrity | 2019 | n/a |
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Healthcare | 24000 | $7.7B | United States | Cotiviti | Cotiviti Payment Integrity | Payment Integrity | 2020 | n/a |
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Healthcare | 1400 | $300M | United States | Cotiviti | Cotiviti Payment Integrity | Payment Integrity | 2016 | n/a |
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Buyer Intent: Companies Evaluating Cotiviti Payment Integrity
ARTW Buyer Intent uncovers actionable customer signals, identifying software buyers actively evaluating Cotiviti Payment Integrity. Gain ongoing access to real-time prospects and uncover hidden opportunities. Companies Actively Evaluating Cotiviti Payment Integrity for Payment Integrity include:
- Arkansas Blue Cross and Blue Shield, a United States based Insurance organization with 3375 Employees
- Red Wing Shoe, a United States based Retail company with 2100 Employees
- LaplandUK, a United Kingdom based Leisure and Hospitality organization with 140 Employees
Discover Software Buyers actively Evaluating Enterprise Applications
| Logo | Company | Industry | Employees | Revenue | Country | Evaluated | ||
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FAQ - APPS RUN THE WORLD Cotiviti Payment Integrity Coverage
Cotiviti Payment Integrity is a Payment Integrity solution from Cotiviti.
Companies worldwide use Cotiviti Payment Integrity, from small firms to large enterprises across 21+ industries.
Organizations such as Humana, Molina Healthcare, AmeriHealth Caritas, CareSource and BlueCross BlueShield of Tennessee are recorded users of
Cotiviti Payment Integrity for Payment Integrity.
Companies using Cotiviti Payment Integrity are most concentrated in Insurance and Healthcare, with adoption spanning over 21 industries.
Companies using Cotiviti Payment Integrity are most concentrated in United States, with adoption tracked across 195 countries worldwide. This global distribution highlights the popularity of Cotiviti Payment Integrity across Americas, EMEA, and APAC.
Companies using Cotiviti Payment Integrity range from small businesses with 0-100 employees - 5.88%, to mid-sized firms with 101-1,000 employees - 17.65%, large organizations with 1,001-10,000 employees - 58.82%, and global enterprises with 10,000+ employees - 17.65%.
Customers of Cotiviti Payment Integrity include firms across all revenue levels — from $0-100M, to $101M-$1B, $1B-$10B, and $10B+ global corporations.
Contact APPS RUN THE WORLD to access the full verified Cotiviti Payment Integrity customer database with detailed Firmographics such as industry, geography, revenue, and employee breakdowns as well as key decision makers in charge of Payment Integrity.