Alivia Analytics

What Alivia Analytics does

Alivia Analytics is a Boston-based private healthcare technology company founded in 2014 that sells AI-powered payment integrity and fraud, waste, and abuse (FWA) detection solutions to government healthcare agencies and commercial health plans. The company's flagship offering is the Alivia 360™ unified platform, which integrates pre-payment prevention (FWA Claims Manager™), post-payment recovery analytics (FWA Finder™, Alivia Case Manager™), and a healthcare data fabric (DataChrome™) into a single claims-lifecycle system. Underlying technology combines supervised and unsupervised machine learning, natural language processing of unstructured clinical notes, behavioral modeling that targets the "Gray Zone" between error and fraud, and proprietary scoring with configurable pend-and-review triggers.

The company monetizes through a hybrid model: SaaS subscription fees for the Alivia 360 platform and trademarked modules, paired with tech-enabled professional services including clinical audits, Special Investigations Unit (SIU) staffing, claims system modernization, legacy platform intelligence (LegacyIQ™), and PHI de-identification. Pricing is quote-based and negotiated per engagement. Customers span State Medicaid agencies (Arizona AHCCCS, Missouri), commercial plans (CDPHP, CommunityCare of Oklahoma, regional plans of 350K–1.2M members), and federal healthcare programs. The go-to-market is direct enterprise field sales supported by partnerships with Snowflake, HealthEdge, Cognizant (via the SourcEdge acquisition), Qlik, and Perforce Delphix. The company is backed by Council Capital and Health Enterprise Partners following an October 2022 platform investment, and has offices in Boston, Philadelphia, Nashville, and New York City.

Name

Alivia Analytics

Legal name

Alivia Analytics LLC

Website

https://aliviaanalytics.com

Company type

Private

Founded year

2014

Operating status

Operating

Headcount range

11–50 employees

Short description

Alivia Analytics is a Boston-based private healthcare technology company that sells the AI-powered Alivia 360 platform for payment integrity and fraud, waste, and abuse detection to government healthcare agencies and commercial health plans in the United States.

Ownership category

akta.pro rank

Product category

Healthcare Payment Integrity Software

NAICS

Claims Adjusting (524291), Custom Computer Programming Services (541511)

SIC

Services-Computer Programming Services (7371)

akta.pro primary industry

Eligibility & Benefits Verification (HLACACAD)

akta.pro secondary industry

Enterprise AI Governance, Risk & Compliance Platforms (Model Risk, Audit, Policies) (HDAEANAE)

Keywords

• Payment integrity software
• Healthcare fraud detection
• Claims analytics platform
• FWA prevention solutions
• Medical claims auditing

Headquarters

HQ city

Boston

HQ country

United States

HQ region

North America

Offices4 records

Markets served

GTM type

B2B

Offering type

Software

Cost components

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

Revenue model

1. SaaS Platform Fees: Alivia 360™ platform delivered as Software as a Service with subscription-based pricing for access to the unified FWA and payment integrity platform, analytics tools, and workflow management.
2. Tech-Enabled Services: Professional services including clinical audits, SIU services, data mining, and claims system modernization. Services combine expert human reviewers with AI-powered tools for payment integrity and FWA detection.
3. Data & IT Transformation Services: Claims system modernization, data warehouse/EDW development, PHI de-identification, and advisory services for healthcare payer IT modernization.
4. Specialty Staffing Services: Staffing services to fill gaps when internal resources are limited, including Configuration, Testing, EDI, Project Management, and Development.

Go-to-market motion3 records

Distribution channels2 records

Marketing channels6 records

Core offering

Alivia Analytics provides the Alivia 360™ unified AI-powered platform for healthcare payment integrity and fraud, waste, and abuse (FWA) detection, combining pre-payment prevention and post-payment recovery analytics. The platform integrates FWA Claims Manager™, FWA Finder™, Alivia Case Manager™, DataChrome™, LegacyIQ™, claims editing, clinical audits, and data/IT modernization services to help government health agencies and commercial health plans identify improper payments and reduce fraud.

Product overview

Alivia Analytics offers a unified platform-plus-modules architecture centered on the Alivia 360™ platform for healthcare fraud, waste, and abuse (FWA) detection and payment integrity. The platform integrates pre-payment prevention through FWA Claims Manager™ and post-payment recovery through FWA Finder™ and Alivia Case Manager™, unified by a shared analytics engine and workflow system. Supporting modules include DataChrome™ for claims data integration and standardization, Healthcare Claims Edit Engine for claims validation, and Comprehensive Clinical Audit Solutions for medical necessity reviews. The Data & IT Services portfolio encompasses Healthcare Claim Systems Modernization (optimizing TriZetto Facets, QNXT, HealthRules), LegacyIQ™ for legacy platform intelligence, and Healthcare Data De-Identification for PHI protection. The company delivers solutions as both SaaS platforms and tech-enabled services for government and commercial healthcare payers.

Differentiator

Problem solved

Functional benefit

Brands

• Alivia 360: A unified platform for FWA and payment integrity, enabling earlier detection, shared insights, and action at any point in the claims lifecycle.
• FWA Claims Manager
• FWA Finder
• Alivia Case Manager
• DataChrome
• LegacyIQ

Products and services

• Alivia 360™ A unified platform for FWA and payment integrity that enables earlier detection, shared insights, and action at any point in the claims lifecycle, powering pre- and post-payment analytics, payment integrity services, and SIU workflows from a single integrated system for healthcare payers.
• FWA Claims Manager™ Pre-payment prevention solution that flags high-risk providers before payment using advanced scoring, configurable pend-and-review triggers, and built-in compliance checks to reduce improper payments and streamline early case review.
• FWA Finder™ AI-driven precision analytics platform for post-pay fraud detection that uncovers hidden fraud risks and generates investigative leads faster using machine learning to identify patterns missed by traditional detection methods.
• Alivia Case Manager™ Centralized, scalable post-pay case management solution that helps track, manage, and resolve complex fraud cases with centralized SIU case tracking and evidence management to accelerate case resolution.
• DataChrome™ Healthcare-focused data fabric solution that centralizes fragmented claims data and converts it into standardized, analytics-ready formats to improve reporting, FWA detection analytics, and payment integrity initiatives.
• LegacyIQ™ Legacy platform intelligence and stabilization solution that provides insight into aging systems and code written decades ago (COBOL, RPG, Java, .NET/Visual Basic, C/C++), enabling platform stabilization and assessment of modernization paths.
• Healthcare Claims Edit Engine Claims validation solution that serves as a primary, secondary, and/or post-payment editor backed by industry experts and advanced technology to ensure claims accuracy.
• Data Mining Health Plan Solutions Post-pay analytics solution that identifies billing anomalies, duplicates, and trends using powerful data mining to uncover hidden errors and non-compliant practices.
• Healthcare Data De-Identification PHI de-identification solution that safeguards patient privacy and supports regulatory compliance with advanced data masking to protect PHI in non-production environments, including X12 EDI formats.
• Comprehensive Clinical Audit Solutions Expert clinical audit services that ensure medical necessity and reduce overpayments with reviews across high-risk post-pay claims, including prebuilt audit workflows for DRG, SNF, and behavioral health.
• SIU Services Outsourced Special Investigations Unit services that augment internal SIU teams with expert investigators and coders to accelerate case resolution and recovery efforts.
• Healthcare Claim Systems Modernization Claims system optimization and modernization services for platforms including TriZetto Facets, QNXT, HealthEdge HealthRules, and extending the life of legacy platforms like AMISYS and Conduent HSP.

Quantifiable outcome

• 10x improvement in process clarity, system reliability, and operational efficiency
• +9 more outcomes

Named customers6 records

Segments2 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration5 records

AI capability7 records

Feature8 records

Partnerships

Five partnerships are on record, tiered core and supporting.

• Cognizant (via SourcEdge acquisition)coreTechnology or Integration · 27 February 2024In 2024, Alivia acquired SourcEdge, Cognizant's First Healthcare Certified Consulting Partner, bringing proven expertise in migrating, configuring, and optimizing TriZetto Facets and QNXT healthcare management platforms. This enhances Alivia's Data & IT Services including claims system modernization, PHI de-identification, and data ingestion for data warehouses and AI integrations.
• SnowflakecoreTechnology or IntegrationAlivia integrates Snowflake's cloud data warehouse platform with SaaS analytics solutions to enhance data management, operational efficiency, security, and accuracy. The partnership provides scalability with independently scaled compute and storage, built-in encryption and data masking for HIPAA compliance, and secure real-time data sharing between Alivia and customers.
• Perforce DelphixcoreTechnology or IntegrationAlivia partners with Perforce Delphix to deliver robust de-identification solutions using innovative data masking strategies. The partnership leverages Delphix's DevOps Data Platform to automate delivery of masked, compliant datasets across diverse environments, ensuring privacy without compromising data utility for HIPAA and GDPR compliance.
• HealthEdgecoreTechnology or IntegrationAlivia partners with HealthEdge to drive claims systems modernization through seamless integration with HealthRules Payor and Burgess Source. HealthEdge's platforms enable agile, real-time claims processing and benefit administration, while Alivia delivers streamlined, compliant, and cost-effective claims workflows.
• QliksupportingTechnology or IntegrationAlivia partners with Qlik to enhance its DataChrome solution, enabling efficient data fabric conversions for healthcare claims. Qlik's data integration and analytics platforms facilitate seamless transformation and centralization of diverse healthcare data sources, ensuring compliance and real-time access.

Scale indicators22 records

Recent moves6 records

Expansion highlights6 records

Direct peers

• Cotiviti: Cotiviti is a leading payment integrity and FWA vendor serving health plans and government payers with pre-pay and post-pay analytics. It is the closest direct competitor to Alivia 360, competing for the same Medicaid and commercial plan RFPs.
• MultiPlan: MultiPlan provides cost-containment and payment integrity services to commercial, government, and auto payers, including FWA and out-of-network claim analytics. It is a direct peer offering payment integrity services to similar payer buyers.
• EXL Service (EXL Health): EXL Health delivers payment integrity, clinical audit, and FWA services for health plans, often combining tech-enabled services with analytics. It is a comparable mid-size peer competing for similar payer and government contracts.
• Inovalon: Inovalon provides cloud-based healthcare analytics, including payment integrity and FWA, to payers and providers. It is a comparable analytics-focused peer serving similar payer customers.
• SCIO Health (emids): SCIO Health (now part of emids) provided analytics-driven payment integrity, FWA, and clinical audit services to payers. It is a direct peer offering tech-enabled payment integrity services to similar customers.
• Lyric (formerly ClaimsXten): Lyric (formerly ClaimsXten) provides claims editing and payment accuracy software widely embedded in payer claims systems. It is a direct peer in the claims editing and payment integrity software market, including within TriZetto and other core platforms Alivia targets.

Broad incumbents

• Optum (UnitedHealth Group): Optum operates one of the largest healthcare analytics and payment integrity practices in the U.S., serving payers, providers, and government programs. Its scale and data advantage make it the dominant incumbent Alivia competes against for large enterprise deals.
• Change Healthcare (now Optum): Change Healthcare provided claims editing, payment integrity, and analytics across the U.S. healthcare system prior to its Optum acquisition. It is a broad incumbent reference point for Alivia's claims editing and analytics capabilities.

Emerging players

• Health Catalyst: Health Catalyst offers healthcare data and analytics platforms, including payment and population health analytics for payers and providers. It is an emerging player with overlapping analytics capabilities but a broader focus than Alivia's payment integrity niche.
• Apixio (Centene): Apixio applies AI/NLP to clinical and claims data for risk adjustment and payment integrity, and was acquired by Centene. It is a relevant emerging peer in AI-driven payer analytics with overlapping NLP and risk-scoring capabilities.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks5 records

Key highlights6 records

Customer concentration

• YouTubeyoutube.com/@AliviaAnalytics
• LinkedInlinkedin.com/company/aliviaanalytics
• Xx.com/aliviaanalytics

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles18 records

Subsidiaries1 record

Funding overview

Funding rounds2 records

Investors2 records

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

M&A1 record

Investments

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

Frequently asked questions about Alivia Analytics