Best Payment Integrity Companies and Cotiviti Alternatives (2026)

There is no single best payment integrity company. Health plans usually run several vendors at once, each at a different point of the claim's life: before it is submitted, before it is paid (prepay) and after it is paid (postpay). The right Cotiviti alternative depends on which of those gaps you are trying to close, whether you want software or a managed service, and how much of the medical record the vendor actually reads.

Disclosure: Arkangel AI wrote this guide and is one of the vendors listed. That is why there is no ranking or score: vendors appear alphabetically and are described only with what their own websites say, read in October 2026. "Does not say" means we did not find it published, not that the product lacks it. We repeat no vendor's savings or customer figures. Pricing for every vendor is on request.

In this guide:

• What payment integrity covers, prepay vs postpay
• A comparison table of eight vendors
• Each vendor, one by one
• What "AI-native" changes
• How to choose, and what to ask in a pilot

What payment integrity covers: prepay vs postpay

Payment integrity is the set of processes, technology and controls a health plan uses to make sure claims are paid accurately, appropriately and in line with regulatory and contractual terms. Optum describes it as spanning pre-submission, prepayment and post-payment work: eligibility, coding and billing, benefits and pricing, and fraud, waste and abuse (FWA) (Optum).

• Pre-submission: educating providers or flagging likely errors before a claim exists.
• Prepay: reviewing the submitted claim before money moves: code editing, clinical and DRG validation, itemized bill review, medical necessity. Machinify's explainer frames this stage around questions such as "were the services medically necessary?" and "was the claim coded properly?" (Machinify).
• Postpay: retrospective audits, data mining, coordination of benefits, subrogation and overpayment recovery.

Prepay avoids paying the error in the first place but touches provider cash flow, so it must be accurate and defensible. Postpay is less disruptive but means chasing money already paid. Most plans use both.

Payment integrity companies compared (as of October 2026)

Vendor	What it is	Where it intervenes	How it describes its approach	Price
Alaffia Health	AI agents and managed clinical review	Across the claims lifecycle; also utilization management and appeals	AI agents read medical records and apply clinical reasoning; outputs "human validated"	On request
Arkangel AI	Medical claims audit platform for payers	Before the payment decision: the bill against the medical record, contract and tariff	98 deterministic rules; evidence per finding; uncertain results stay "not verified"; the auditor decides	On request
Claritev (formerly MultiPlan)	Payment and revenue integrity plus network and pricing solutions	Prepay and postpay	Code editing, clinical negotiation, itemized bill review, DRG validation; analytics plus expert review	On request
Codoxo	Cost containment platform (payment integrity, FWA, SIU)	Pre-claim provider education, prepay and postpay	Generative AI and automation for early intervention	On request
Cotiviti	Payment accuracy suite and managed services	Prepay and postpay ("prospective and retrospective")	Thousands of payment rules, policies and concepts; coding and clinical chart validation; FWA pattern review	On request
Machinify	Payment integrity platform ("AI operating system")	"The full spectrum of payment integrity interventions"	Unified data layer of claims, records, contracts and policies; task-specific agents with humans in the loop	On request
Optum Payment Integrity	End-to-end payment integrity suite	Pre-submission, prepay and postpay (recovery)	Modular software and services; analytics, automation and machine learning	On request
Shift Technology	AI agents for insurers, with a payment integrity product	Healthcare payment accuracy, plus P&C claims and fraud	AI agents for fraud, claims and payment integrity	On request

The vendors, one by one

Alaffia Health

Alaffia says its AI agents "process thousands of pages of records and apply clinical reasoning at scale" to catch billing issues, and that its platform digitizes unstructured clinical data and maps it to claims data. Health plans can use the AI agents themselves or hand reviews to Alaffia's clinical experts as a managed service. It also covers utilization management and appeals. Source: alaffiahealth.com, read October 2026.

Arkangel AI

Arkangel AI audits medical claims and accounts against the medical record, the contract and the tariff, with human review. It applies 98 deterministic rules (27 administrative, 29 clinical, 42 financial), delivers each finding with its reason and cited evidence, marks as "not verified" what it cannot confirm, and never denies a payment automatically: the auditor decides. It is ISO 27001:2022 certified, with HIPAA compliance and a BAA on Enterprise plans (Trust Center). Its strongest markets are insurers in Colombia, Mexico and Peru; U.S. teams can use it on Enterprise plans. See AI medical necessity review and payer compliance.

Claritev (formerly MultiPlan)

Claritev, the company formerly called MultiPlan (Helpware), offers payment and revenue integrity across the claims lifecycle. Its prepay solutions include advanced code editing, clinical negotiation, itemized bill review and DRG validation; postpay solutions include Medicare Secondary Payer validation and End-Stage Renal Disease premium restoration. It combines analytics, provider intelligence and expert review, and also sells network access and pricing transparency. Sources: Claritev payment integrity and claritev.com, read October 2026.

Codoxo

Codoxo positions its payment integrity solutions around the earliest intervention: provider education and policy alerts before claims are created, then prepay and postpay review. Its platform uses generative AI and automation and covers FWA detection, medical record and DRG reviews, audit case management, provider contract and medical policy compliance, and deepfake detection in documentation. Source: codoxo.com, read October 2026.

Cotiviti

Cotiviti presents "integrated prospective and retrospective payment integrity solutions" for health plans, built over 20+ years, with "thousands of payment rules, policies, and concepts". Its Payment Accuracy suite covers coordination of benefits, coding accuracy, validation of suspect claims against medical records, and AI-driven FWA pattern review before and after payment. Source: cotiviti.com, read October 2026.

Machinify

Machinify describes an "AI operating system" for healthcare payment: a unified data layer that brings together claims, medical records, contracts and policies; foundation models trained on healthcare data; task-specific agents; and feedback loops from humans in the loop. It supports insourced, hybrid or fully managed models across "the full spectrum of payment integrity interventions". Source: machinify.com, read October 2026.

Optum Payment Integrity

Optum sells payment integrity to health plans as one modular suite of software and services across the claim lifecycle, with a focus on preventing errors upstream: real-time error detection before payment and recovery of overpaid claims after it. It cites 25+ years of experience and uses analytics, automation and machine learning. Source: optum.com, read October 2026.

Shift Technology

Shift Technology builds AI agents for insurers, mostly known in property and casualty claims and fraud. Its product lineup includes payment integrity to "ensure healthcare payment accuracy and maximize plan savings with AI", alongside agents for fraud and risk, coverage, subrogation and injury claims. Source: shift-technology.com, read October 2026.

Other vendors health plans often evaluate include Carelon, Zelis, Milliman, EXL, Conduent, Gainwell, HealthEdge and CGI ProperPay. KLAS Research tracks the category as Pre-Payment Accuracy & Integrity Solutions (Payer).

What "AI-native" changes in payment integrity

Traditional payment integrity runs on claim data: code edits, policy rules and statistical outliers, often delivered as a managed service paid from the savings found. That catches coding errors well but struggles with questions that only the medical record can answer, such as medical necessity, level of care or whether a billed item was actually documented.

The newer, AI-native vendors (Alaffia, Arkangel AI, Codoxo and Machinify in this list) read the clinical documentation itself. That moves more review to prepay and lets a smaller team cover more claims. It also raises the bar on proof: every finding that delays a provider's payment must be explainable in an appeal. Before you buy, ask how the AI reaches each finding, what it does when it is unsure, and who signs off.

How to choose a payment integrity vendor

1. Map your gaps first. List which claim types and intervention points (pre-submission, prepay, postpay) your current vendors already cover, and where overpayments still leak.
2. Decide software vs managed service. Do you want your own team to run the tool, a vendor to do the reviews, or a hybrid?
3. Ask for evidence per finding. Every clinical finding should cite the medical record and the policy or guideline behind it.
4. Check how uncertainty is handled. Results the system cannot confirm should stay pending for a human, never become automatic denials.
5. Understand the pricing model. Ask whether fees are a share of savings, a per-claim or per-member fee, or a software license, and how savings are measured.
6. Run a pilot on the same batch. Give each shortlisted vendor the same claims and compare findings, false positives and turnaround against your own audit team.
7. Verify security. Ask for current certifications, a trust center and the contract terms for protected health information (a BAA in the U.S.).

For a deeper look at the software side, see our AI claims audit software compared guide, or the buyer page AI medical claims audit for insurers.

Frequently asked questions

What are the main Cotiviti alternatives?

Health plans comparing Cotiviti most often look at Optum Payment Integrity, Claritev (formerly MultiPlan), Codoxo, Machinify, Alaffia Health and Shift Technology. Arkangel AI is an option for record-level claims audit with human review, mainly for insurers in Colombia, Mexico and Peru and for U.S. teams on Enterprise plans. Compare them in a pilot on the same batch of claims.

What is the difference between prepay and postpay payment integrity?

Prepay review checks a claim before it is paid, through code editing, clinical and DRG validation or medical-necessity review, so errors are never paid. Postpay review audits claims after payment and recovers overpayments, for example through coordination of benefits or subrogation. Prepay avoids recoveries but must be accurate because it affects provider cash flow.

Does Optum do payment integrity?

Yes. Optum sells payment integrity solutions to health plans as a modular suite of software and services covering pre-submission, prepayment and post-payment work, including real-time error detection and recovery of overpaid claims. Pricing is on request.

How much do payment integrity companies charge?

None of the vendors in this guide publishes a price; all pricing is on request. Models vary: some vendors are paid a share of the savings they identify, others charge per claim, per member or a software license. Ask each vendor how savings are measured and who validates them before comparing proposals.

Is AI replacing human reviewers in payment integrity?

No. The vendors that use AI to read medical records still keep clinicians or auditors in the loop, and defensible programs leave the final decision to a human. AI shortens review time and widens coverage; the reviewer decides each finding, and uncertain results should stay pending rather than become automatic denials.

Sources (read October 2026)

• Alaffia Health. Official site.
• Claritev. Payment and revenue integrity solutions and official site.
• Codoxo. Payment integrity solutions.
• Cotiviti. Payment accuracy solutions.
• Machinify. Official site and What is payment integrity?.
• Optum. Payment integrity solutions for health plans.
• Shift Technology. Official site.
• Helpware. Healthcare payment integrity companies (source for the MultiPlan to Claritev name).
• KLAS Research. Pre-Payment Accuracy & Integrity Solutions (Payer).
• Arkangel AI. Trust Center.