What Definiti does

Definiti is a national Workers' Compensation Cost Containment provider founded in 2002 and headquartered in Lake Forest, California, with an additional office in Phoenix, Arizona. The company operates as an Ethos Risk company and serves Third Party Administrators (TPAs), self-insured employers, insurance brokers, self-administered entities, occupational accident insurers, public sector entities, and Longshore/Maritime employers across the United States. Its stated scale includes 251-500 employees, over 900,000 bills processed historically, and 75+ combined years of Workers' Compensation Bill Review experience across the executive team.

Definiti's core products are organized around a rules-based bill review technology platform and comprise six integrated offerings: Medical Bill Review (state fee schedule-compliant re-pricing), Specialty Bill Review (fair-value pricing for out-of-network services, claiming 55-85% savings off billed charges), National and Regional PPO/Ancillary Networks (access to 20+ networks spanning imaging, PT, dental, DME, and other ancillary services), Technology Solutions (the underlying bill review platform with web portal, reporting, and customizable workflow rules), UR Integration (linking utilization review decisions with bill review), and DefinitiRx (a Pharmacy Benefit Management service with a 70,000+ pharmacy national network). The platform integrates with multiple claims management systems, clearinghouses, and utilization review providers via customizable interfaces.

The business model is B2B with a transaction-fee revenue structure on bill processing and managed services for PBM, distributed through direct enterprise sales (targeting large TPAs, carriers, self-insured employers, and government entities), inside sales/account management for mid-market customers, and broker/referral partnerships. Pricing is quote-based and not publicly disclosed. The company pursues a relationship-driven, retention-focused go-to-market anchored by a 'Clients for Life' positioning, with no observable venture capital or growth-equity footprint beyond a single disclosed funding event.

Name

Definiti

Legal name

Definiti

Website

https://definiti.net

Company type

Private

Founded year

2002

Operating status

Operating

Headcount range

251–500 employees

Short description

Definiti is a national workers' compensation cost containment provider founded in 2002, offering medical bill review, specialty bill review, PPO network access, utilization review integration, and pharmacy benefit management. It serves TPAs, self-insured employers, brokers, and public sector clients as an Ethos company.

Ownership category

akta.pro rank

Product category

Workers' Compensation Cost Containment Services

akta.pro primary industry

Regulatory Compliance Management (RegTech) (BPAEAPAB)

Keywords

• Workers compensation bill review
• Pharmacy benefit management
• Medical cost containment
• Specialty bill review
• PPO network services

Headquarters

HQ city

Lake Forest

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Medical Bill Review Services: Core bill review services combining technology automation with expert analyst review to achieve cost containment on workers' compensation medical bills. Revenue generated through service fees based on bill processing.
2. Specialty Bill Review Services: Specialty bill review for services not covered by state fee schedule or PPO networks, ensuring fair and reasonable payment of medical bills through benchmarking and negotiation.
3. PPO/Ancillary Network Access: Access to over 20 leading national and regional PPO networks along with ancillary networks for imaging, diagnostics, PT, chiro, OT, FCE, implants, DME, transport, dental, and other services.
4. DefinitiRx Pharmacy Benefit Management: PBM services providing prescription cost reduction through a network of 70,000+ pharmacies, clinical management programs, mail order pharmacy, and specialty pharmacy services.
5. UR Integration Services: Integration services linking bill review with utilization review decisions for collaborative utilization control and cost containment.

Go-to-market motion1 record

Distribution channels4 records

Marketing channels5 records

Core offering

Definiti is a national workers' compensation cost containment provider that combines rules-based bill review technology with expert human analyst review to deliver medical bill re-pricing, state fee schedule compliance, and PPO network optimization. Its core offerings include Medical Bill Review, Specialty Bill Review, National & Regional PPO/Ancillary network access, UR Integration, and DefinitiRx pharmacy benefit management services.

Product overview

Definiti offers a unified Workers' Compensation Cost Containment platform that combines rules-based technology with expert human analysis. The core platform powers six integrated products: Medical Bill Review (primary state fee schedule-compliant re-pricing), Specialty Bill Review (fair value pricing for out-of-network services), a National/Regional PPO/Ancillary network solution (access to 20+ networks), Technology Solutions as the underlying bill review platform, UR Integration (linking bill review with utilization review), and DefinitiRx as the PBM/pharmacy component. All modules share the same rules-based technology foundation and integrate through a central web portal with claims management system connectivity.

Differentiator

Problem solved

Functional benefit

Brands

• DefinitiRx: Pharmacy Benefit Management service offering serving Workers Compensation, Longshore/Maritime, Occupational Accident industry and Auto sectors. Features a national network of over 70,000 pharmacies.

Products and services

• Medical Bill Review Primary bill review service combining rules-based technology with expert analyst review to ensure compliance with state fee schedules and maximize cost containment for workers' compensation medical bills. Targeted at TPAs, self-insured employers, insurance carriers, brokers, and public sector entities.
• Specialty Bill Review

Quantifiable outcome

• 55-85% savings on specialty bill review (billed charges)
• +3 more outcomes

Named customers3 records

Segments7 records

Ideal customer profiles5 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature8 records

Partnerships

One partnership is on record.

• Ethos RiskcoreOthersDefiniti is now proudly an Ethos company. Ethos Risk is the parent company that acquired Definiti Comp Solutions, integrating them into their risk management and cost containment portfolio.

Scale indicators8 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• CorVel Corporation: CorVel provides workers' compensation medical bill review, PPO networks, case management, and integrated claims technology to TPAs, carriers, and self-insureds. It directly overlaps with Definiti's bill review and PPO offerings and competes for the same customer segments.
• Healthesystems: Healthesystems is a workers' compensation pharmacy benefit manager and ancillary medical management provider. It is the closest peer to DefinitiRx and competes for WC PBM, specialty drug, and clinical management mandates from the same payer set.
• Genex Services: Genex provides workers' comp medical cost containment including bill review, utilization review, case management, and network services. It targets the same TPA, carrier, and self-insured employer customers and offers an overlapping suite of services.
• PMSI (now part of Healthesystems): PMSI was a workers' compensation PBM and medical cost containment provider that has been combined into Healthesystems. It is a direct peer to DefinitiRx for WC pharmacy, clinical, and bill review services.
• Helios (Optum Workers' Comp): Helios, now part of Optum, is a leading national workers' compensation cost containment and medical bill review provider. It competes head-to-head with Definiti for TPAs, carriers, and self-insured employer accounts in WC bill review and network management.
• Mitchell International: Mitchell International is a long-established provider of workers' compensation and auto medical bill review, PPO networks, and claims management technology. It is a direct competitor to Definiti's bill review, specialty review, and PPO network products.
• Apricus (formerly known as APRIMA/Align Networks): Apricus/Align Networks provides workers' compensation PPO networks, bill review, and ancillary network management. It is a direct competitor to Definiti's national and regional PPO/Ancillary and bill review solutions for the same payer customers.

Broad incumbents

• Sedgwick: Sedgwick is a large, diversified claims management and cost containment provider serving workers' comp, auto, and disability lines. It overlaps with Definiti through bill review, utilization review, and network services but operates a much broader portfolio.

Market position

Strengths1 record

Weaknesses1 record

Competitive moat4 records

Key risks5 records

Key highlights6 records

Customer concentration

Revenue estimate

Valuation estimate

Number of profiles

Profiles3 records

Funding overview

Funding rounds1 record

Investors

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

M&A

Investments

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

Frequently asked questions about Definiti