Claritev Corporation is a technology data and insights company focused on improving transparency affordability and quality across the healthcare system. The company applies data analytics and artificial intelligence to help payers employers and providers understand costs pricing and payment dynamics. Founded in 1980 Claritev draws on over 45 years of claims experience to deliver solutions that reduce medical cost burdens and support fair reimbursements. The company’s mission is to bring transparency affordability and quality to the healthcare system by turning claims data into actionable insights. Claritev leverages artificial intelligence and machine learning to analyze vast datasets and identify cost saving opportunities for its clients.

Claritev generates revenue by selling its four solution categories to healthcare payers third party administrators employers brokers consultants providers and government entities. The company offers claims intelligence network payment and revenue integrity and data and analytics solutions that are typically delivered under multi year contracts with automatic renewal provisions. The majority of revenue comes from fees charged per claim processed or per member per month depending on the solution. Long term contracts with automatic renewals provide a stable revenue base and support ongoing investment in technology and data assets. Revenue is primarily recurring reflecting the ongoing use of its platform to process claims and provide analytics services.

The company operates through the following segments: Claims Intelligence Solutions Network Solutions Payment and Revenue Integrity Solutions and Data and Analytics Solutions. These segments reflect the way management evaluates performance and allocates resources.

• Claims Intelligence Solutions: This segment provides data driven algorithms and insights that identify out of network claims priced above fair market value and negotiates or recommends appropriate reimbursement using reference based pricing and negotiation services including Vistara solutions that bundle reference based pricing with member and provider engagement tools.

• Network Solutions: This segment delivers contracted discounts with more than 1,400,000 healthcare providers forming one of the preferred provider organizations in the United States and offers outsourced network development and management services that are applied before claim payment.

• Payment and Revenue Integrity Solutions: This segment uses data technology and clinical expertise to detect improper unnecessary and excessive charges before or after claims are paid and to recover underpaid premium dollars through services such as clinical negotiation pre payment integrity post payment integrity coordination of benefits subrogation and revenue integrity for Medicare Advantage plans.

• Data and Analytics Solutions: This segment provides descriptive predictive and prescriptive analytics to help customers optimize benefit plan design improve clinical outcomes and reduce total cost of care through products such as PlanOptix CompleteVue BenInsights Risk Scores Supplemental Carrier Services and Medical Claims Integration.

Claritev holds a leading position as an independent provider of cost management and payment integrity solutions in the United States healthcare market. The company differentiates itself through long standing relationships with over 750 payers a deeply integrated technology platform that processes claims before payment and proprietary data assets accumulated from decades of claims experience. Competitors vary by service and include firms such as 6Degrees Zelis Optum Conduent Cotiviti and Milliman among others. Claritev’s advantages also stem from its operational scale processing billions of dollars in claim charges annually and its ability to bundle multiple solutions into a single workflow for clients. The company’s proprietary claim pricing methodologies are supported by a patented benchmarking process that enhances provider acceptance and ensures fair reimbursements. Claritev’s nationwide network of over 1,400,000 contracted providers gives it a scale advantage that few competitors can match.

Claritev serves a diverse customer base that includes commercial healthcare payers third party administrators employers brokers consultants providers government healthcare payers and system integrators. The company works with over 750 payers and more than 100,000 employers and plan sponsors whose members collectively represent over 60,000,000 individuals with access to its solutions. Although Claritev’s direct clients are primarily payers and third party administrators the ultimate beneficiaries of its solutions are employers plan sponsors and the patients and members they serve. The company’s solutions are available in all fifty states and the District of Columbia allowing broad geographic reach. While specific customer names are not disclosed the filing notes that a small number of large accounts contribute a significant portion of total revenue.