Claritev Corporation

What Claritev Corporation does

Claritev Corporation (formerly MultiPlan Corporation, rebranded in February 2025) is a McLean, Virginia-based healthcare technology company founded in 1980 that provides cost management, payment integrity, network, and data analytics solutions to the U.S. healthcare ecosystem. The company operates across five product categories: Claims Intelligence Solutions (Data iSight reference-based pricing, Vistara, Pro Pricer, NSA and state surprise bill services, financial negotiations), Data & Analytics Solutions (BenInsights, Ceres, PlanOptix, CompleteVue), Network Solutions (PHCS Network with 1.4 million contracted providers, PHCS Novera launched May 2026, MultiPlan Network, ValuePoint, Claritev Payments), Payment & Revenue Integrity Solutions (advanced code editing, subrogation, data mining, coordination of benefits), and Professional Services. The platform processes approximately $45.9 billion in claims per quarter and applies machine learning across Pro Pricer, BenInsights predictive analytics, NSA pricing recommendations, and code editing workflows, with a Chief AI Officer leading AI embedding into clinical and financial decision-making.

Claritev generates revenue through subscription and transaction-based fees, processing healthcare claims for 750+ payers, 100,000 employers, 60 million consumers, and 1.4 million contracted providers. Distribution occurs via direct enterprise sales, third-party administrators, brokers (incentivized through the Premier Broker Program with 25-35% commissions), and consultants, with growing exposure to government (Medicare Advantage and Medicaid) and MENA markets through a 2025 Burjeel Holdings partnership. FY2025 revenue was $965.4 million (up 3.7% YoY) with $602.6 million Adjusted EBITDA (62.4% margin), and Q1 2026 revenue was $244.7 million (up 5.8% YoY) with record ACV bookings of $44.1 million.

The company is publicly traded on NYSE under ticker CTEV, with approximately 87.15% institutional and 7.40% insider ownership, a market capitalization of approximately $394.55 million as of April 2026, and a $4.6 billion debt load. Notable recent actions include a $75 million five-year share repurchase program (2026), a $77.25 million secondary offering (November 2025), a strategic investment in Klaim, Inc. (October 2025), and the PHCS Novera network launch (May 2026). The U.S. Department of Justice antitrust division launched a criminal price-fixing investigation in May 2026 focused on the Data iSight product, triggering a stock decline of approximately 41% and introducing material regulatory risk to the algorithmic-pricing core of the business.

Name

Claritev Corporation

Legal name

Claritev Corporation

Website

https://claritev.com

Company type

Public

Founded year

1980

Operating status

Operating

Headcount range

1,001–5,000 employees

Short description

Claritev Corporation is a publicly traded healthcare technology company that provides claims intelligence, payment integrity, provider network, and data analytics solutions to 750+ payers, 100,000 employers, and 60 million consumers across the U.S. and MENA regions.

Ownership category

akta.pro rank

Headquarters

HQ city

Mclean

HQ country

United States

HQ region

North America

Offices3 records

Markets served

GTM type

B2B

Offering type

Software

Cost components

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

Revenue model

1. Healthcare Technology Services: Claritev generates revenue through technology-enabled healthcare affordability and transparency solutions, processing approximately $45.9 billion in claims during Q3 2025. The company serves healthcare payers, employers, consumers, and providers with claims intelligence, network solutions, and data analytics.
2. Claims Processing: Revenue from processing healthcare claims through various solutions including Data iSight, Vistara, and negotiation services. Processed approximately $45.9 billion in claims during Q3 2025.

Go-to-market motion2 records

Distribution channels5 records

Marketing channels5 records

Core offering

Claritev is a healthcare technology company that provides data-driven cost management, claims intelligence, and provider network solutions to payers, employers, third-party administrators, brokers, hospitals, and government programs. Its core offerings include reference-based pricing engines (Data iSight, Vistara, Pro Pricer), the NCQA-accredited PHCS provider network covering 1.4 million providers, surprise billing compliance services, payment and revenue integrity tools, and the BenInsights analytics platform for benefit plan management.

Product overview

Claritev offers a comprehensive healthcare technology platform with five core solution categories: Claims Intelligence Solutions (Data iSight, Vistara, Pro Pricer, Surprise Bill Services, Financial Negotiations), Data & Analytics Solutions (BenInsights, Ceres, PlanOptix, Medical Claims Integration, CompleteVue), Network Solutions (PHCS Novera, PHCS Network, MultiPlan Network, ValuePoint, Claritev Payments), Payment & Revenue Integrity Solutions (Advanced Code Editing, Clinical Negotiation, Itemized Bill Review, Coordination of Benefits, Subrogation, Data Mining, Revenue Integrity), and Professional Services. The platform is powered by 45 years of healthcare data processing and serves payers, employers, providers, brokers, and government entities across the U.S. and MENA regions.

Differentiator

Problem solved

Functional benefit

Brands

• PHCS Network: National PPO network providing access to healthcare providers across the United States.
• HealthEOS Network
• Beech Street Network
• Vistara
• Data iSight
• BenInsights
• Ceres
• PlanOptix
• CompleteVue
• Pro Pricer
• Claritev Payments
• ValuePoint by Claritev
• Claritev Cares

Products and services

• Data iSight Alternative reimbursement solution for out-of-network charges using publicly available claims data and proprietary benchmarking to calculate fair, cost-based reimbursement with same-day turnaround on over 98% of claims; for health plans, employers, TPAs, and government programs.
• Vistara Integrated reference-based pricing solution combining PHCS Network for professional claims with transparent Medicare-based reference pricing for facility claims; for self-funded employers and TPAs seeking to control healthcare costs while providing quality network access.
• Pro Pricer Data-driven, configurable out-of-network cost management solution that blends available pricing approaches and balances savings goals with member satisfaction on a claim-by-claim basis using machine learning that learns from claims experience; for health plans, TPAs, and employers.
• No Surprises Act (NSA) Services Federal surprise bill compliance solution providing turnkey NSA support using data science and machine learning to anticipate best outcomes and reduce arbitration for health plans, TPAs, and employers.
• State Surprise Bill Services State-level surprise billing compliance solution navigating interplay between state laws and the No Surprises Act, with expertise handling multi-state requirements and managing pricing, post-payment negotiation, and arbitration components; for multi-state health plans, TPAs, and employers.
• Financial Negotiations Experienced negotiators performing claim-specific reductions on low- and high-dollar facility and professional claims, leveraging an advanced technology suite to secure reductions and protect members from balance billing; for health plans, TPAs, and employers.
• BenInsights Strategic healthcare benefit plan management platform combining advanced analytics, clinical expertise, and strategic guidance with over 200 data connections combining financial, clinical, pharmacy, and biometric data; includes Plan Design Explorer, Plan Design Optimizer, and Smart Cards; for employers, brokers, TPAs, and health plans.
• Ceres Voluntary benefits analytics platform providing predictive risk modeling to recommend appropriate supplemental benefit programs to the right populations before costs escalate; for employers and benefits administrators.
• PlanOptix Market intelligence platform that transforms publicly available price transparency data into clear, comparable market intelligence based on actual contracted provider rates for network benchmarking and negotiation support; for health plans, employers, and providers.
• Medical Claims Integration AI/ML-powered solution leveraging publicly available medical claims data to proactively identify eligible supplemental benefit claims and simplify the filing process, increasing voluntary benefits utilization; for benefits administrators and voluntary benefits providers.
• CompleteVue Financial and revenue transformation solution leveraging enriched public price transparency data to benchmark rates across payers, compare contract performance, and model financial outcomes for stronger pricing strategies; for hospitals and health systems.
• PHCS Novera Primary network solution that combines strong local provider access with nationwide coverage to balance cost, access, and member experience, anchored by regional health systems Banner Health and Ascension; for self-insured employers and TPAs.
• PHCS Network NCQA-accredited national PPO network providing primary network access across the United States for health plans, TPAs, and employer-sponsored plans, supported by NCQA credentialing accreditation.
• MultiPlan Network Nationwide complementary PPO network offering additional provider choice and discounted services for health plan members; for health plans and TPAs seeking expanded access.
• ValuePoint by Claritev Nationwide access (discount) network providing supplementary provider access options for health plans and members; complements primary network offerings.
• Claritev Payments Payment simplification solution enhancing provider relationships with scalability, 1099 management, enhanced fraud protection, and security for payment workflows; for payers and providers.
• Professional Services Technology consulting services including implementation, application management, and infrastructure optimization to help healthcare organizations stabilize systems and reduce operational risk; for health plans, providers, and TPAs.

Quantifiable outcome

• Processed approximately $45.9 billion in claims during Q3 2025
• +4 more outcomes

Named customers2 records

Segments6 records

Ideal customer profiles6 records

Technology focussed Yes

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration1 record

AI capability8 records

Feature6 records

Partnerships

Four partnerships are on record, tiered core.

• Banner HealthcoreTechnology or Integration · 1 May 2026Banner Health serves as anchor regional health system for PHCS Novera primary network solution, providing Arizona market coverage for TPAs balancing regional provider depth with national coverage.
• AscensioncoreTechnology or Integration · 1 May 2026Ascension serves as anchor regional health system for PHCS Novera primary network solution, providing Texas and Tennessee market coverage.
• Kinetiq HealthcoreStrategic or Co-development Partner · 21 January 2026Strategic relationship integrating Kinetiq Health's healthcare risk management services into Claritev's BenInsights analytics platform. Partnership aims to reduce high-cost medical and pharmacy spending by providing employers, brokers, TPAs, and health plans with tools to identify emerging high-cost risks, support diagnostic accuracy, and improve financial outcomes. Kinetiq Health clients held healthcare claims trend to 2.48% compared to industry average of 8% from 2020-2024.
• Burjeel Holdings - Claims CarecoreStrategic or Co-development Partner · 1 February 2025Strategic partnership to deploy advanced claims-analytics and revenue-cycle management solutions across the Middle East and North Africa (MENA) region. Part of $334.6 billion healthcare claims management market projected growth.

Scale indicators13 records

Recent moves8 records

Expansion highlights6 records

Emerging players

• Edifecs: Edifecs provides healthcare data interoperability, compliance, and analytics solutions for payers, with overlap to Claritev's claims processing and regulatory compliance use cases.
• Health Catalyst: Health Catalyst provides healthcare data and analytics platforms for health systems, intersecting with Claritev's BenInsights analytics and CompleteVue revenue transformation offerings for provider and payer customers.
• Definitive Healthcare: Definitive Healthcare delivers commercial intelligence and analytics on the healthcare ecosystem, comparable in data-driven approach to Claritev's PlanOptix and CompleteVue market intelligence products.

Direct peers

• Cotiviti: Cotiviti provides payment integrity, claim editing, and analytics to health plans and retailers, overlapping directly with Claritev's payment and revenue integrity solutions and code editing capabilities.
• Lyric (formerly ClaimsXten): Lyric offers claims editing, payment integrity, and AI-driven clinical content for payers, directly overlapping with Claritev's Advanced Code Editing, Itemized Bill Review, and broader payment integrity suite.
• Quest Analytics: Quest Analytics specializes in provider network adequacy, directory accuracy, and network performance analysis, directly competing with Claritev's PHCS Novera and broader network solutions for health plans and government programs.
• nThrive: nThrive provides end-to-end revenue cycle management and payment integrity solutions to hospitals and health systems, comparable to Claritev's provider-facing CompleteVue and pre-payment integrity offerings.
• Zelis Healthcare: Zelis is a direct competitor in healthcare claims cost management, payment integrity, and provider network solutions, serving payers, TPAs, and employers with overlapping products in reference-based pricing and network access.

Broad incumbents

• Optum (Change Healthcare): Optum operates a broad portfolio of healthcare data, claims processing, and analytics assets including the former Change Healthcare business, competing with Claritev across claims intelligence, network, and payment integrity at much greater scale.
• Premier Inc. Premier operates a healthcare improvement company with provider networks, supply chain, and performance services, comparable in serving health systems and managing cost, quality, and network programs at greater scale.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights6 records

Customer concentration

• Facebookfacebook.com/claritev
• LinkedInlinkedin.com/company/claritev
• Instagraminstagram.com/claritevcorp
• Xx.com/claritev

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles6 records

Funding overview

Funding rounds7 records

Investors4 records

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

M&A5 records

Investments3 records

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

Frequently asked questions about Claritev Corporation