Performant Healthcare

What Performant Healthcare does

Performant Healthcare is a US-based healthcare payment integrity company that identifies improperly paid claims and recovers overpayments on behalf of health plans and government payers. Founded in 1976 (originally as Performant Financial Corporation) and headquartered in Plantation, Florida, the firm operates five integrated solution lines: Audit Advantage (clinical and complex claim audits across inpatient, outpatient, post-acute, and specialty categories), Data Mining Advantage (algorithmic claim analysis without medical records), MSP Advantage (Medicare Secondary Payer compliance), TPL Advantage (Medicaid Third Party Liability coordination), and Recovery Advantage (overpayment and aged-debt recovery). The platform is powered by a proprietary analytics and workflow system (HOPS) with OCR-driven document digitization and lockbox services, and is differentiated by its independence from major payers.

Performant's revenue model blends contingency-based fees for recovery and audit work with contracted fees for eligibility, data mining, and government program work. The company serves three primary verticals: commercial health plans (regional and national payers including Blues plans), government healthcare programs (CMS RAC for Regions 1 and 2, national CMS Commercial Repayment Center, HHS OIG IDIQ), and Medicaid Managed Care Organizations across 45 states. Go-to-market is enterprise field sales with dedicated account management, supported by a Knowledge Center content engine. Commercial healthcare revenue grew 66% in 2022 and 55% in 2023, with commercial implementations expanding from 21 to 41 over that period, and the customer base spans more than 200 million covered lives.

In October 2025, Machinify (backed by New Mountain Capital) completed the acquisition of Performant for approximately $670 million, taking the company private. Performant had previously been NASDAQ-listed (PFMT) and was added to the Russell 3000 Index in 2023. The acquisition is intended to integrate Performant's audit and recovery expertise with Machinify's AI platform to improve payment accuracy and reduce administrative burden in healthcare payments.

Name

Performant Healthcare

Legal name

Performant Financial Corporation

Website

https://performanthealthcare.com

Company type

Private

Founded year

1976

Operating status

Acquired

Headcount range

1,001–5,000 employees

Short description

Performant Healthcare is a US healthcare payment integrity firm that uses proprietary analytics and clinical audit workflows to identify improper claims and recover overpayments for government payers (CMS RAC, HHS OIG) and commercial health plans. It was acquired by Machinify for ~$670M in October 2025.

Ownership category

akta.pro rank

Product category

Healthcare Payment Integrity Services

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Claims Administration & Payment Integrity (Medical/Dental/Vision) (HLAEALAD)

Keywords

• Healthcare payment integrity
• Claims audit services
• Overpayment recovery
• Medicare Secondary Payer
• Coordination of benefits

Headquarters

HQ city

Florida

HQ country

United States

HQ region

North America

Offices4 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Audit Services: Post-payment recoveries and prepayment savings through clinical claim audits. Includes inpatient, outpatient, post-acute care, and specialty audits. Revenue generated through contingency fees based on identified overpayments recovered.
2. Data Mining Services: Data mining audits without medical records review using proprietary algorithms to identify claim payments inconsistent with coding standards, health plan policies, or billing inaccuracies.
3. MSP/Eligibility Services: Medicare Secondary Payer solutions including premium restoration, cost avoidance, and post-payment recoveries. Services include eligibility validation and coordination with CMS and coverage providers.
4. Recovery Services: Overpayment recovery services with proven track record managing accounts in billions of dollars. Includes aged provider debt recovery and newly identified provider recovery with dedicated account managers assigned by provider.

Go-to-market motion2 records

Distribution channels3 records

Marketing channels4 records

Core offering

Performant Healthcare is a technology-enabled payment integrity company that helps health plans, government agencies, and managed care organizations identify improper healthcare claims payments and recover lost capital. Its core offerings span five integrated solution families — Audit Advantage (clinical and complex claim audits), Data Mining Advantage (algorithmic claims analysis without medical record review), MSP Advantage (Medicare Secondary Payer compliance), TPL Advantage (Medicaid third-party liability coordination), and Recovery Advantage (overpayment and aged debt recovery) — supported by proprietary analytics and workflow technology.

Product overview

Performant Healthcare operates as a technology-enabled payment integrity platform offering five core integrated solutions: Audit Advantage® for clinical and complex claim audits across inpatient, outpatient, post-acute, and specialty categories; Data Mining Advantage™ for algorithmic claims analysis without medical records review; MSP Advantage® for Medicare Secondary Payer compliance; TPL Advantage® for Medicaid third-party liability coordination; and Recovery Advantage® for debt and overpayment recovery. The platform is powered by proprietary analytics technology and workflow systems designed to help health plans identify improper payments and recoup capital lost to errant billing practices. Services span both government programs (CMS RAC, Medicare, Medicaid) and commercial healthcare markets.

Differentiator

Problem solved

Functional benefit

Products and services

• Audit Advantage Technology-enabled clinical and complex claim audits using predictive analytics and segment specialists to identify improper payments across inpatient, outpatient, post-acute care, and specialty claims, generating post-payment recoveries and prepayment savings for health plans and government agencies.
• Data Mining Advantage Algorithmic identification of improper claim coding, billing, or payment without medical records review, applying a library of proprietary algorithms against nationally recognized coding standards and health plan policies to surface cost containment opportunities.
• MSP Advantage Comprehensive Medicare Secondary Payer solution for Medicare Advantage plans, combining eligibility experts, proprietary algorithms for coverage identification, dedicated outreach teams for manual validation, and coordination with CMS and other coverage providers; integrates OCR and lockbox services.
• TPL Advantage Third Party Liability solution for Medicaid managed care organizations that leverages eligibility information from multiple TPL sources to identify payers that should be primary to Medicaid, enabling cost avoidance and post-payment recoveries; includes dedicated lockbox services and OCR document digitization.
• Recovery Advantage Recovery services for overpayments, debts, and aged recoveries with more than 40 years of experience, achieving a 70%+ recovery rate on non-par providers and a 95% successful contact rate within three months, backed by a 99.4% quality rating and dedicated account managers.

Quantifiable outcome

• Up to $6 PMPY savings for Medicare Advantage plans on outpatient audit program
• +5 more outcomes

Named customers3 records

Segments4 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature5 records

Scale indicators11 records

Recent moves7 records

Expansion highlights6 records

Emerging players

• Codoxo: Codoxo is an emerging AI-native payment-integrity platform serving commercial health plans with claim auditing and fraud-detection capabilities. It represents the next-generation peer applying machine learning to the same problem space Performant addresses with its HOPS platform.
• Pareto Intelligence: Pareto Intelligence provides payment-integrity, risk-adjustment, and quality analytics to health plans, with overlapping capabilities in data mining and audit. As an emerging specialist, it competes with Performant for mid-market and regional plan mandates.

Broad incumbents

• Optum (UnitedHealth Group): Optum operates a broad payment-integrity and analytics business within UnitedHealth Group, bundling claim auditing, fraud/waste/abuse detection, and eligibility services for both internal and external payers. As a payer-affiliated incumbent, it competes with Performant for CMS and large commercial plan contracts at greater scale.
• Conduent: Conduent provides claims processing, payment-integrity, and customer-service solutions to commercial and government healthcare payers. Its government healthcare practice overlaps with Performant's CMS RAC and eligibility workflows.
• Change Healthcare (now part of Optum): Change Healthcare, now part of Optum, historically provided claims editing, payment-integrity, and network analytics to payers and providers. Its claim-editing and payment-integrity tools compete with Performant's Data Mining Advantage workflow.

Direct peers

• Cotiviti: Cotiviti is a direct competitor in healthcare payment integrity, offering claim auditing, data mining, and recovery services to commercial health plans and government payers. Its suite of payment-integrity solutions overlaps closely with Performant's Audit Advantage and Data Mining Advantage products.
• Gainwell Technologies: Gainwell Technologies acquired HMS Holdings and now operates Medicaid payment-integrity, coordination-of-benefits, and RAC-adjacent services for state Medicaid agencies. It competes with Performant's TPL Advantage and eligibility offerings in the Medicaid market.
• MultiPlan: MultiPlan provides cost-containment, claim-editing, and out-of-network payment-integrity services to commercial health plans. Its data-driven savings programs overlap with Performant's Data Mining Advantage and contract-compliance review offerings.
• HMS Holdings: HMS Holdings (now part of Gainwell) historically competed with Performant in Medicaid payment integrity, coordination of benefits, and subrogation services. It remains a relevant reference point for Performant's TPL and eligibility franchises.

Others

• LexisNexis Risk Solutions: LexisNexis Risk Solutions provides data, analytics, and identity-resolution services that underpin coordination-of-benefits, fraud detection, and eligibility workflows. It is an ecosystem participant whose data products feed Performant's COB and MSP algorithms.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/performant-healthcare
• Xx.com/performantcorp

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles11 records

Subsidiaries2 records

Funding overview

Funding rounds

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 Performant Healthcare