Cotiviti Follow Verify

www.cotiviti.com
Cotiviti, Inc.
Type	Private
Industry	Healthcare Analytics
Headquarters	10701 S River Front Pkwy, Unit 200 South Jordan, UT 84095
Key people	Emad Rizk, M.D. Chris Coloian Joe Morrissey Kerri Eskin Richard Pozen, M.D. Jordan Bazinsky Peter P. Csapo Nicole Neumarker Matthew Hawley Roy Stephens Michael Whelan
Investors	Veritas Capital
Products	Payment Accuracy, Risk Adjustment, Quality and Performance
Revenue	$505M (2014)
Number of employees	5,414

Cotiviti is a provider of payment accuracy solutions for healthcare companies. The company provides technology, data and expertise to help healthcare companies enhance their claims payment accuracy. The company claims they have helped their healthcare clients identify and correct payment inaccuracies, resulting in over $2.7 billion in savings in 2015. Cotiviti works with over 40 healthcare organizations, including eight of the ten largest U.S. commercial, Medicare and Medicaid managed health plans. The company also provides payment accuracy solutions to over 40 retail companies, including eight of the ten largest retailers in the United States.

Cotiviti was formed in May 2014 through the merger of Connolly Superholdings, Inc., a retrospective payment (post-payment) accuracy solution provider for the healthcare and retail sectors and iHealth Technologies, Inc., a prospective payment (pre-payment) accuracy solutions for the healthcare sector. Connolly was founded in 1979 and iHealth Technologies was created in 2001. Advent International, one of the largest global private equity firms, is Cotiviti’s majority shareholder, having first invested in Connolly in July 2012 and taking a significant ownership position in the combined company through the May 2014 merger.

In April 2016, Cotiviti filed for a secretive IPO valuing the company at over $3B.

Cotiviti logo

History

• 1979 - Connoly was founded as a provider of payment accuracy solutions to the retail industry
• 1988 Connoly launched a retrospective claims accuracy solutions to the healthcare industry
• 2012 Connolly was acquired by the Advent Funds
• May 2014, Connolly merged with iHealth Technologies to form Cotiviti Inc.
• May 2016 Cotiviti files for IPO

Solutions

Prospective Claims Accuracy Solutions

Cotiviti's prospective claims accuracy solutions help healthcare companies identify and address claim discrepancies following claim adjudication before a claim is paid to a healthcare provider. Cotiviti helps companies ensure that claims payments meet regulatory, compliance, industry and health plan requirements based on correct coding and clinical guidelines.

Retrospective Claims Accuracy Solutions

Cotiviti's retrospective claims accuracy solutions help health insurers identify and resolve payment inaccuracies after a claim has been paid to a healthcare provider. These solutions utilize analytics and data mining tools to identify potential inaccuracies. In 2015, Cotoviti's retrospective claims accuracy solutions analyzed over $459 billion in claims.

Other Services

Cotiviti also provides analytics and support to its clients in optimizing their operations and enterprise-wide claims payments and trends. These offerings include selective anti-fraud, waste and abuse analytics to identify abnormal patterns in coding and billing practices. The company also helps with ongoing surveillance and longitudinal analytics by reviewing claims submissions and payments across multiple dimensions, including provider, plan-type, procedure and others. In addition, Cotoviti's clients engage them for claims history analytics to identify necessary areas for direct interaction, as well as to identify policy and program changes that can improve future payment accuracy.

Healthcare Claims Payment Process and Cotiviti

Bussiness advantages

Broad suite of specialized solutions - They offer a broad suite of analytics-driven payment accuracy solutions that deliver measurable value to our clients and are highly configurable across provider settings and claim types. Their suite of solutions includes prospective and retrospective analytics that review billing accuracy, contract compliance, payment responsibility and clinical appropriateness.

Large and expanding library of information and knowledge assets - Their robust library of information assets includes proprietary algorithms and concepts developed by their research teams over 15 years. Library of accumulated information and unique knowledge assets is a differentiator that is difficult to replicate by current or potential competitors and provides a competitive advantage. They continuously expand and improve the quality of their library by regularly incorporating new claims data and up-to-date algorithms and concepts. They also have a team of full-time, dedicated, doctors, nurses, claims coders, forensic auditors, and other experts focused on developing new proprietary algorithms and analytics assets for our payment accuracy solutions. Additionally, their specialists monitor hundreds of content sources on medical and payment policy to ensure their algorithms and concepts incorporate the latest standards.

Advanced and proprietary technology platform and analytics capabilities - Advanced proprietary platform and analytics capabilities are the results of significant investment in their technology infrastructure and applications. They are continually developing and improving scalable technology platform to deliver the speed, integrity, and quality necessary for client-specific business solutions. In addition, their focus on analytics, automation, and knowledge-sharing allows them to quickly and accurately implement existing algorithms and concepts as well as solutions for newly identified reimbursement discrepancies.

Aligned financial model that delivers measurable return - Their financial performance is directly tied to the savings they deliver to their clients. The majority of their contracts are structured such that they receive a percentage of the savings that they help their clients achieve. They have consistently generated a high return on investment for their clients of approximately 4 to 1 as a result of their aligned financial model. The savings they deliver are incremental to their clients' internal payment accuracy capabilities. As a result, they can provide a substantial contribution to their clients' earnings and create strong alignment and durability in their client relationships. In 2015 and 2014, their commercial healthcare clients realized over $2.5 billion and over $2.0 billion, respectively, in savings using their solutions.

Long-standing and expanding client relationships - Their client base includes the largest and most recognized healthcare organizations in the United States, including eight of the ten largest U.S. commercial, Medicare and Medicaid managed health plans, as well as CMS. The average length of their relationships with our top ten healthcare clients is approximately ten years. They also have strong, long-standing relationships with over 40 retail clients, including eight of the ten largest U.S. retailers. Over time, they have expanded the breadth and depth of their existing client relationships, thus further integrating them into their clients' payment accuracy processes.

Attractive operating model - They have an attractive operating model due to the recurring nature of their revenue, the scalability of their solutions and the low capital intensity/high free cash flow conversion of their business. Since January 1, 2013, they have successfully retained all of their healthcare clients except one, who represented less than 2% of their revenue. They believe their client retention rate reflects strong satisfaction with their solutions. Additionally, their information asset and technology platform are highly scalable, which allows them to accommodate significant additional transaction volumes with limited incremental costs. They have low capital needs that allow them to generate strong cash flow. In 2015, thier capital expenditures as a percentage of revenue were 4.2%. We believe their recurring revenue, combined with their scalable solutions and low capital intensity, will continue to contribute to their long-term growth, strong operating margins and flexibility in allocating capital.

History of innovation - They have a long history of developing innovative solutions which they continuously incorporate into their suite of offerings. Many of their solutions have been generated as a response to complex client issues. This development process has continually enhanced their solutions, thereby optimizing the value they deliver to their clients over time and allowing them to thrive in an ever-changing and increasingly complex healthcare environment. Their track record of innovation is strengthened by the diverse backgrounds of our clinical and coding specialists who continually and consistently update and develop their content library and analytical algorithms and identify new ways to accelerate their value creation for their clients.

Experienced management team with a track record of performance - Their leadership team brings extensive and relevant expertise in the accuracy payment market. Their management has a proven track record in adapting to clients' needs and developing innovative analytical solutions to drive growth and profitability. With thier talented management team, they are positioned for long-term growth.

Latest Tweets

Date	Author	Comment
April 18, 2023	Cotiviti	Using Cotiviti’s Payment Accuracy solutions, a New York health plan gained operational improvements and mature poli… https://t.co/5f7FIdv5pI
April 17, 2023	Cotiviti	🎙️ Listen as Cotiviti's Erin Rutzler joins @HCNowRadio's "Healthcare de Jure" podcast to discuss how Cotiviti's inv… https://t.co/kdwQY58LKv
April 17, 2023	Cotiviti	A "pay and chase" approach to coordination of benefits can increase provider abrasion. Learn how one health plan pa… https://t.co/W9BnabNZAK

References

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