Reveleer

What Reveleer does

Reveleer is a private, PE-backed healthcare technology company headquartered in Glendale, California, that provides an AI-enabled SaaS platform for value-based care. The platform unifies risk adjustment (both prospective and retrospective), quality improvement (HEDIS, care gap management, provider profile validation), RADV audit support, and member management into a single end-to-end system serving health plans, providers, and accountable care organizations. Following the April 2025 acquisition of Novillus, Reveleer reports serving 72 million covered lives across 86 healthcare organizations, with named customers including Arkos Health, CareBridge, Health Care Service Corporation (HCSC), Managed Care Solutions, and Upward Health.

The platform is built around Reveleer's proprietary Evidence Validation Engine (EVE™), which has been upgraded to EVE™ Hybrid AI on Google Cloud, combining generative AI-based evidence extraction with a library of over 3,300 clinician-authored deterministic clinical rules. Supporting technology layers include a centralized Clinical Data Repository (HITRUST-certified and HIPAA-compliant), an AI-enabled Medical Record Retrieval module, and native bi-directional integrations with Epic, athenaOne, and Health Information Exchanges that surface clinical advisories directly inside provider workflows. The platform processes over 2.1 million clinical charts per day, with retrospective risk adjustment claiming up to 99% coding accuracy and a 42.5% reduction in coding duration.

Reveleer generates revenue primarily through SaaS subscriptions for the platform, AI-enabled coding and abstraction services bundled with subscriptions, dedicated RADV Audit SaaS subscriptions, and professional services. Pricing is custom-negotiated per enterprise customer based on member lives, chart volume, and solution bundle; tier pricing is not publicly disclosed. Go-to-market combines enterprise field sales, inside sales scaled to $65M in quota coverage, channel distribution via Epic and athenaOne EHR integrations, and event-driven demand generation. Reveleer is backed by Oak HC/FT (transformational capital partner since 2021), Upfront Ventures, and Boston Millennia Partners, and has secured $65M in debt financing from Hercules Capital (2024).

Name

Reveleer

Legal name

Reveleer, Inc.

Website

https://reveleer.com

Company type

Private

Founded year

2011

Operating status

Operating

Headcount range

251–500 employees

Short description

Reveleer is a private, PE-backed SaaS company that provides an AI-enabled platform unifying prospective and retrospective risk adjustment, quality improvement, RADV audit, and member management for U.S. health plans, providers, and ACOs, serving 72 million covered lives across 86 healthcare organizations.

Ownership category

akta.pro rank

Product category

Healthcare Risk Adjustment & Quality Analytics Software

NAICS

Computer Systems Design and Related Services (54151)

SIC

Services-Prepackaged Software (7372)

akta.pro primary industry

Electronic Data Capture (EDC) Platforms (HLACAOAA)

Keywords

• Value-based care software
• Risk adjustment platform
• Quality improvement analytics
• Healthcare AI platform
• Medicare Advantage solutions

Headquarters

HQ city

Glendale

HQ country

United States

HQ region

North America

Markets served

GTM type

B2B

Offering type

Software

Cost components

Personnel, Technology or R&D, Operations, Marketing or Sales, Infrastructure

Revenue model

1. SaaS Platform Subscriptions: Recurring subscription revenue from payers and provider organizations licensing the Reveleer platform across risk adjustment, quality improvement, member management, RADV audit, and clinical intelligence solutions; delivered via cloud SaaS.
2. AI-Enabled Coding & Workflow Services: AI-enabled clinical coding and abstraction services powered by the Evidence Validation Engine (EVE™), typically bundled with platform subscriptions for retrospective and prospective risk adjustment; engagements are volume-based with the platform processing millions of charts per customer.
3. RADV Audit SaaS Subscriptions: All-in-one RADV Audit SaaS Solution sold as subscription software to Medicare Advantage plans, co-developed with leading MAOs, integrating automated enrollee data management, multi-year retrieval and risk coding, provider attestation, and real-time reporting.
4. Professional Services & Implementation: Implementation, configuration, training, and ongoing professional services tied to platform deployment (e.g., Global Capability Center in India provides product, engineering, operations, medical coding, and QA functions).

Pricing tiers

Go-to-market motion4 records

Core offering

Reveleer provides an AI-enabled, end-to-end SaaS platform for value-based healthcare that consolidates risk adjustment, quality improvement, clinical intelligence, and member management into a unified system for health plans and provider organizations. Its proprietary EVE™ (Evidence Validation Engine) uses generative AI and clinician-authored deterministic rules to extract clinical evidence, identify HCC diagnosis gaps, and enable prospective and retrospective risk adjustment with documented high coding accuracy.

Product overview

Reveleer offers a single unified AI-enabled platform for value-based care rather than a portfolio of disconnected products. The core Reveleer Platform consolidates risk adjustment, quality improvement, clinical intelligence, and member management into one end-to-end system. Sitting on top of the platform is EVE™ (the proprietary Evidence Validation Engine, evolved into EVE™ Hybrid AI), which provides AI-driven evidence extraction, HCC suspecting, and prospective risk adjustment. Supporting technology layers include the Clinical Data Repository (centralized, AI-enriched clinical data), the Medical Record Retrieval module (AI-enabled chart collection), and bi-directional integrations with Epic, athenaOne, and HIEs. Domain solutions branch from the platform: Clinical Intelligence (prospective risk adjustment), Risk Adjustment / RADV Audit (retrospective risk adjustment including the All-in-One RADV Audit SaaS Solution), Quality Improvement (encompassing Care Gap Manager, HEDIS Audit Abstraction, and Provider Profile Validation), and Member Management (enrollment, premium billing, and revenue reconciliation). The Novillus acquisition (April 2025) added care gap management and provider engagement capabilities, and the earlier Curation Health acquisition (October 2024) added clinical insights and EHR integration technology; both feed into the unified platform.

Differentiator

Problem solved

Functional benefit

Brands

• EVE™ (Evidence Validation Engine): Reveleer's proprietary AI engine/assistant combining generative AI-based evidence extraction with clinician-authored deterministic clinical formulas. Built on Google Cloud.

Products and services

• Reveleer Platform AI-enabled end-to-end SaaS platform for value-based care that consolidates risk adjustment, quality improvement, clinical intelligence, and member management into a single unified system for health plans and provider organizations.
• EVE™ (Evidence Validation Engine) / EVE™ Hybrid AI Proprietary AI engine that filters clinical noise and surfaces high-value opportunities; the Hybrid AI version combines generative AI-based evidence extraction with clinician-authored deterministic formulas for explainable, auditable diagnosis suspecting and prospective risk adjustment.
• Clinical Data Repository Centralized AI-enabled clinical data management solution that allows health plans to store, enrich, and reuse medical records across risk adjustment, quality reporting, audit response, and care management programs.
• Medical Record Retrieval AI-enabled medical record collection and management software that handles structured and unstructured data from a wide range of sources to minimize manual chart retrieval, errors, and document routing for HEDIS, RADV, and risk adjustment programs.
• Clinical Intelligence Solution Prospective risk adjustment solution that surfaces potential diagnosis gaps to providers at the point of care by tapping a nationwide network of clinical data to deliver a longitudinal patient compendium pre-encounter.
• Risk Adjustment Solution Retrospective risk adjustment offering featuring dynamic, targeted HCC optimization to prioritize the highest-value charts, supporting superior RAF accuracy and reduced coding errors.
• All-in-One RADV Audit SaaS Solution All-in-one RADV Audit SaaS solution for Medicare Advantage plans that integrates AI-enabled retrieval, intelligent coding validation, multi-year risk coding, provider attestation workflows, and real-time reporting into a single defensible platform for CMS audit readiness.
• Quality Improvement Solution Quality improvement offering including HEDIS Audit Abstraction, Care Gap Manager, and Provider Profile Validation, enabling proactive care delivery with data-driven analytics to identify high-risk members and improve STAR ratings.
• Member Management Solution Holistic member management suite providing centralized enrollment, premium billing, and revenue reconciliation to streamline Medicare Advantage member lifecycle management.

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration3 records

AI capability10 records

Feature6 records

Recent moves7 records

Expansion highlights6 records

Direct peers

• Health Catalyst: Health Catalyst is a healthcare data and analytics enterprise platform serving health systems and payers, with adjacent capabilities in value-based care performance, quality, and population health. It overlaps Reveleer in data infrastructure and value-based care analytics, though Health Catalyst skews more provider-side.
• Cedar Gate Technologies: Cedar Gate provides value-based care analytics, payer-provider performance management, and risk-sharing platform software to payers, providers, and employers. It competes with Reveleer in payer-side value-based care platforms and risk adjustment workflow tooling.
• Inovalon: Inovalon delivers cloud-based analytics and platforms for payers and providers focused on value-based care, quality, and risk adjustment, including the AHA Moment platform. It is a direct competitor in retrospective and prospective risk adjustment and quality reporting for health plans.
• Arcadia: Arcadia provides a healthcare data platform with value-based care, risk stratification, and quality measure analytics primarily for provider organizations and ACOs. It overlaps Reveleer on the provider side for clinical intelligence and care gap management.
• Cotiviti: Cotiviti provides payment accuracy, risk adjustment, quality, and analytics software to U.S. health plans — directly overlapping Reveleer's core risk-adjustment and quality improvement offerings for payers and competing for the same Medicare Advantage customers.
• Edifecs: Edifecs offers healthcare data integration, risk adjustment, and quality management solutions for payers and providers, including AI-powered coding and HEDIS tools. It is a directly comparable vendor in risk adjustment and quality data management for health plans.
• Apixio (Centene): Apixio provides AI-powered risk adjustment, quality, and clinical analytics for health plans and providers, including HCC suspecting and chart retrieval. It is a direct competitor in the AI-enabled risk adjustment category that Reveleer targets with EVE.

Emerging players

• Aledade: Aledade partners with independent primary care practices and ACOs in value-based care arrangements and increasingly invests in data and analytics tooling. It represents an emerging player in the value-based care ecosystem where Reveleer sells its clinical intelligence and risk adjustment solutions.
• Cohere Health: Cohere Health is a high-growth AI platform for prior authorization, utilization management, and payer-provider collaboration. It is an emerging adjacent competitor pursuing AI-driven payer workflow transformation similar to Reveleer's value-based care thesis.

Broad incumbents

• Optum (UnitedHealth Group): Optum is the largest healthcare data, analytics, and services platform in the U.S., offering risk adjustment, quality, and value-based care tooling as part of a much broader portfolio that includes claims processing and pharmacy. It is the dominant incumbent competing against Reveleer for payer risk-adjustment and quality budgets.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks5 records

Key highlights6 records

Customer concentration

• LinkedInlinkedin.com/company/reveleer
• Xx.com/reveleer
• Facebookfacebook.com/reveleer

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles8 records

Subsidiaries4 records

Funding overview

Funding rounds10 records

Investors5 records

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A4 records

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Reveleer