Claritev Q3 2026 Earnings Results & Report

Claritev EPS Results

• Actual EPS: $1.77
• Consensus EPS: -$3.68
• Beat/Miss: Beat by +$5.45
• One Year Ago EPS: N/A
• EPS Beat Rate: 3 of last 4 quarters

Claritev Revenue Results

• Actual Revenue: $268.31 million
• Expected Revenue: N/A
• Beat/Miss: N/A
• YoY Revenue Growth: N/A

Claritev (NYSE:CTEV) is a healthcare technology, data and insights company focused on improving affordability,  transparency and quality. Led by deeply experienced associates, data scientists, and innovators, Claritev provides tech-enabled solutions and services fueled by multiple data sources from over 40 years of claims repricing. Claritev utilizes world-class technology and AI solutions to power a robust enterprise platform that delivers meaningful insights to drive affordability in healthcare, brings price transparency and optimizes networks and benefits design. By focusing on purpose-built solutions that support all key players — including payors, employers, patients, providers and third parties — we aim to make healthcare more accessible and affordable for all. 

Claritev Q3 2026 Earnings Call Transcript

Key Takeaways

• Positive Sentiment: Third-quarter revenue rose 9.1% year over year to $268.3 million and Adjusted EBITDA increased 4.4% to $162 million, exceeding expectations. Claritev raised its 2026 revenue, Adjusted EBITDA, and free cash flow guidance.
• Positive Sentiment: Bookings reached $27 million in Q3 and topped $100 million year to date; the company now expects $115 million–$125 million for 2026, up 70%–90% from 2025. More than half of year-to-date bookings came from outside its core payer market, supporting management’s diversification strategy.
• Positive Sentiment: Claims Intelligence grew 17.1%, with NSA dispute initiations up 75% year over year; management expects NSA activity to remain a tailwind. The company also said it expects at least $1.1 billion in revenue in 2027, a year ahead of its prior target.
• Negative Sentiment: Payment & Revenue Integrity remained below plan as clients shifted from legacy clinical negotiations, more than offsetting growth in newer offerings. Management expects the segment to return to growth in 2027, but noted that bookings typically take time to convert to revenue.
• Negative Sentiment: Claritev reported a $25.8 million Q3 free cash flow outflow and ended the quarter with $10.1 million of unrestricted cash, $95 million drawn on its revolver, and net leverage of 7.7x. Management expects a strong Q4 cash-flow rebound and reaffirmed its commitment to deleveraging.

Presentation

[Operator]

Thank you for standing by, and welcome to the Claritev Corporation Third Quarter 2026 Earnings Conference Call. All lines have been placed on mute to prevent any background noise. After the speaker's remarks, there will be a question-and-answer session. If you'd like to ask a question during this time, simply press star followed by the number one on your telephone keypad. If you'd like to withdraw your question, press star one again. Thank you. I'd now like to turn the call over to Todd Friedman, Head of Investor Relations. Todd, you may begin.

[Todd Friedman, Head of Investor Relations at Claritev]

Thanks, Rob. Good morning, everyone, and welcome to Claritev's Third Quarter 2026 Earnings Call. Joining me today are Travis Dalton, President and Chief Executive Officer, and Doug Garis, Chief Financial Officer. During our call, we will refer to information included in the supplemental slide deck that is now available in the investors portion of our website, along with the Third Quarter 2026 earnings press release that was issued earlier this morning. Our remarks and responses to questions today include forward-looking statements. These forward-looking statements represent management's beliefs and expectations only as of the date of this call. Actual results may differ materially from these forward-looking statements due to a number of risks. A summary of these risks can be found on the second page of the supplemental slide deck and a more complete description in our annual report on Form 10-K and other documents we file with the SEC.

[Todd Friedman, Head of Investor Relations at Claritev]

We will also be referring to several non-GAAP measures, which we believe provide investors with a more complete understanding of Claritev's underlying operating results. An explanation of these non-GAAP measures and reconciliations to their comparable GAAP measures can be found in the earnings press release and in the supplemental slide deck. With that, I now turn the call over to Travis.

[Travis Dalton, President and CEO at Claritev]

Good morning, and thank you for joining us. Let me start by saying it was another strong quarter for Claritev. Simply put, we are delivering on the turn and the way up. Our horizontal product and vertical market strategy is working. Revenue and Adjusted EBITDA are ahead of guidance. Our growth teams are focused on execution, delivering ACV bookings across all verticals, and we are accelerating our innovation efforts to elevate how we serve our clients and deliver meaningful, measurable value. This progress was evident at our recent Claritev Client Conference. We are gaining momentum in the attendance, participation, and enthusiasm are building year-over-year. I will share more about this event later in the call.

[Travis Dalton, President and CEO at Claritev]

Doug will provide more detail on the full financial results and our outlook, but we are a full year ahead of the plan that we laid out at our investor day earlier this year. On today's call, I'll cover a few key topics. First, our third quarter results and what is driving our success. Second, the innovation and market growth happening across Claritev, including surprise bill services momentum, recent new product launches, and our progress on AI. Finally, the strength of our competitive position and why we believe we are in great shape for a breakout 2027. Let me start with the results. Bookings, revenue, and Adjusted EBITDA all exceeded our expectations. Our performance reflects the same fundamentals we've emphasized throughout the year. Listening to our clients, focusing on their needs, and delivery excellence, we keep our promises.

[Travis Dalton, President and CEO at Claritev]

This has allowed us to build on the trust we have with our clients and competitive advantages to diversify revenue growth, strengthen our vertical go-to-market strategy, and produce more product enhancements and features than ever before. It is clear that Claritev solves real and meaningful problems facing employees and constituents of healthcare. The clearest indicator of our momentum is bookings. We booked $27 million in ACV in the third quarter, bringing our year-to-date bookings to more than $100 million. We expect to finish 2026 with approximately 80% ACV growth over last year. Importantly, that growth is increasingly diversified. Bookings and pipeline are growing across every vertical market, reducing our reliance on any single market. While payer remains an important part of our business, public sector, provider, and TPA are all making meaningful contributions.

[Travis Dalton, President and CEO at Claritev]

We added five new client logos in the quarter, bringing our two-year total to 46 net new clients, giving us growth from new relationships as well as deeper partnerships with existing clients. Our renewed focus on the TPA space is delivering results, and our overall pipeline remains strong and well-balanced across vertical markets. One of the most critical elements of our long-term vision is the diversification of our revenue base, and these results provide validation that our strategy is working and clients are turning to Claritev for more of their critical needs. Last quarter, we spoke about surprise bill services in the federal NSA business. NSA was once again a key driver in our outperformance, and we expect that tailwind will persist. Dispute initiations were up 75% in Q3 over the same quarter last year.

[Travis Dalton, President and CEO at Claritev]

We continue to invest, focus, and apply our considerable talents and AI expertise in this area, which has allowed us to deliver 8% better performance than the industry average. Simply put, nobody does this better. I'm pleased with our performance and have great confidence that our growth teams will continue to perform and deliver a very strong close to our sales year to launch us into 2027. The innovation and expansion of our solutions and growing client momentum was on clear display at our annual Claritev Client Conference, which we held two weeks ago in Nashville. More than 100 clients joined together to hear about our vision and discuss the value Claritev is bringing to them. Most importantly, the event provided the opportunity for our team to hear from our clients on the issues and challenges that are most important to their businesses and their members.

[Travis Dalton, President and CEO at Claritev]

We introduced a Medicare Advantage offering, bringing together more than 15 existing solutions across Payment & Revenue Integrity and Network to better support health plan clients serving the market. We also showcased a number of new innovations leveraging AI to improve the value we deliver, including Transparency-Based Pricing, our newest Claims Intelligence offering, and Claritev Healthcare Intelligence, one of our first examples of AI-native development. Transparency-Based Pricing combines massive sets of publicly available MRF data that is ingested and standardized using AI-enabled processes with our proprietary reimbursement intelligence to provide unique claim-level reference points. Some clients prefer to use an approach built off of the MRF data sets, and this is yet another option that offers flexibility for our clients when evaluating with our ProPricer tools the insights methodology that best suits their client needs. More tools, more flexibility, more opportunity to serve employees.

[Travis Dalton, President and CEO at Claritev]

Claritev Healthcare Intelligence is a platform with a built-in AI agent, who we call Clara, that provides greater insights, cost trends, and drivers to better visualize and anticipate the critical insights that most impact a client's business. Historically, this type of analysis required weeks of manual work across disconnected data sources. We applied AI to the data we already have for our clients to put those insights into their hands in real time. This is an example of what only Claritev can do and what we have been saying on this call. We have trust, data, workflow, and years of expertise to give us a clear advantage in bringing solutions to the market. We will be sharing a demo with you of Clara in a few weeks to give you a sense of the innovation that our clients witnessed at the conference.

[Travis Dalton, President and CEO at Claritev]

Together, these new solutions demonstrate how we are strengthening our core business, expanding into new market opportunities, and bringing meaningful innovation to our clients. They are also examples of our AI strategy, bringing together our decades-long claims expertise with AI-based data science and machine learning models to create new value for clients and new growth for us. None of this works without the foundation we have spent the last two years building, organized data and modern cloud workflows, harnessing our domain expertise. We see a powerful opportunity to create agentic workflows at lightning speed that can answer almost any challenge our customers face across all of our solutions. Today, we already have dozens of agents in production across the company, with many more in progress. Each one is built to take on a specific high-value task inside our workflow, and they are delivering results.

[Travis Dalton, President and CEO at Claritev]

However, AI is only as powerful as the data, expertise, and the trust behind it. That is where Claritev stands apart. I will close with a few broader macro and landscape comments. The challenges facing access, affordability, and transparency persist. We are uniquely positioned, and it is in fact our mission to address these pressing problems. The need to tame medical inflation and rising costs has never been greater, and we play an important role in tackling these challenges across the healthcare ecosystem. I also think there is a real opportunity to change how solutions are scaled and bought in this segment of the market, giving operating expense savings to our clients that can then be passed on in the form of cost reduction to employees. Continued innovation and scale advantage can make an impact on costs over time. We bring more than four decades of experience.

[Travis Dalton, President and CEO at Claritev]

We're a public company, transparent, and committed to long-term investments for our clients. We are not a widget or a point solution looking for an exit or a home. We offer proven solutions for our clients. In healthcare, those long relationships build trust. When you combine that trust with the ability to operate at scale and invest aggressively in AI and innovation, clients will turn to you to solve newer, harder, and more complex problems. This is what is ultimately driving our results and innovation agenda. We are laser-focused on access, Claims Intelligence, protecting employees, and bringing insights. Finally, let me close by saying we have used the words clarity, alignment, focus, and journey when describing our company, and others have called this a turnaround story. I think our Q3 results and the preliminary color we are providing on 2027 can only be described in one way.

[Travis Dalton, President and CEO at Claritev]

Claritev is a growth company, period. Our performance last year and forecasts for the rest of 2026 and into 2027 demonstrate without qualification that we are solidly on a durable growth trajectory. It is evident in our numbers, it is evident in our culture, and it is evident in our confidence. Our competitive position has never been stronger. We're excited about a strong fourth quarter, and we are carrying that momentum into 2027. With that, I'll turn it over to Doug to walk through the financials in more detail.

[Doug Garis, CFO at Claritev]

Thank you, Travis, and good morning, everyone. In Q3, we once again outperformed our internal expectations for revenue, Adjusted EBITDA, and free cash flow, and we remain on track to deliver against the multi-year financial targets we outlined at Investor Day. I'll provide a few highlights on how we're thinking about 2027, but the punchline is we're running about a year ahead of the financial plan targets we outlined in March. Total revenue in the quarter was $268.3 million, up 9.1% year-over-year and 4.2% sequentially, well ahead of the roughly flat sequential cadence we suggested on our last call. This marks our sixth consecutive quarter of year-over-year revenue growth and our highest quarterly revenue in 17 quarters. Keep in mind that we have previously disclosed $18.6 million of non-recurring revenue last year that passed through Adjusted EBITDA at nearly 100% margin, with $5.4 million in Q3 and Q4.

[Doug Garis, CFO at Claritev]

Our year-over-year comparisons are not adjusted for that impact. Revenue outperformance was once again driven by our largest business, Claims Intelligence, which grew 17.1% year-over-year, primarily reflecting incremental NSA volumes associated with an early 2026 client win. Our Network business declined 5.6% year-over-year, primarily due to the $5.4 million of non-recurring revenue previously mentioned. Payment & Revenue Integrity is running slightly behind our internal plan, and the decline is due to the transition of the legacy clinical negotiations business as clients adopt more of our Claims Intelligence solutions. This transition has more than offset the revenue ramp from newer solutions, including our Advanced Code Editing, or ACE, offer. As we've stated previously, we remain confident in the medium and long-term prospects for the business, and we expect a return to growth in 2027. Turning to underlying claims trends, which are reflected on slides 17 and 18 of our supplemental deck.

[Doug Garis, CFO at Claritev]

We continue to see healthy activity across our platform. PSAV claims volumes increased 8% year-over-year and were flat sequentially. Importantly, submitted charges grew 15%, reflecting both medical inflation and changes in the mix of services delivered. We continue to see meaningful activity across inpatient and outpatient care settings, including emergency, surgical, and specialty services such as behavioral health. As the value and complexity of claims evolve, so does the opportunity for our technology and clinical expertise to identify savings. This is evidenced in identified potential savings per claim increasing more than 13% year-over-year, reinforcing the value we deliver to our clients, who in turn are delivering value to employers and consumers, and which is ultimately captured in our PSAV revenue. Adjusted EBITDA was $162 million, up 4.4% year-over-year and up 4% sequentially. Adjusted EBITDA margin was 60.4% compared with 63.1% in Q3 of last year.

[Doug Garis, CFO at Claritev]

I will also note that Q3 represented our highest quarterly absolute dollar Adjusted EBITDA in 16 quarters. Through the first nine months, revenue was $770.5 million, up 7.2% year-over-year, and Adjusted EBITDA was $464.7 million, up 3%, with a margin of 60.3%. As we exited Q3, our trailing 12-month, or TTM, revenue exceeded $1 billion for the first time since Q1 of 2023, more than three years ago. This represents an important milestone and further evidence of the strength of Claritev's growth engine as we sprint into next year. Moving to cash flow. As a reminder, Q1 and Q3 are typically cash consumption quarters, while Q2 and Q4 are cash-generating quarters, a pattern we expect to continue under our current capital structure, given timing of debt and interest payments.

[Doug Garis, CFO at Claritev]

In Q3, we generated $18.1 million of operating cash flow and had a use of $25.8 million in free cash flow, with capital expenditures net of proceeds from disposals of $43.9 million. Unlevered free cash flow was $104.4 million, with adjusted cash conversion of 64.5%. For the first nine months, operating cash flow increased 27% to $65 million, and unlevered free cash flow increased 16% to $230.7 million versus prior year. Our nine-month adjusted cash conversion improved to 50%, up 6 percentage points from 44% last year. We remain well on track to deliver greater than 50% cash conversion for full year 2026. We ended the quarter with $10.1 million of unrestricted cash and $95 million drawn on our revolver. Our net leverage ratio improved to 7.7x-a 0.1 turn improvement compared with Q3 2025. Turning to bookings.

[Doug Garis, CFO at Claritev]

Travis hit the highlights, but I want to emphasize how our strong bookings performance also reflects the diversification in our business that we have built over the past few years. In Q3, we booked $27 million of ACV, bringing year-to-date bookings to more than $100 million, compared with $67 million for the full year of 2025. Notably, 78% of our year-to-date bookings came from our existing client base, and more than 50% of our bookings have come from other verticals outside of our core payer market. This included 26% from the TPA market and another 25% from our newer markets, primarily provider, public sector, and international. We now believe we will deliver ACV bookings of $115 million-$125 million for the full year, which represents 70%-90% growth over 2025.

[Doug Garis, CFO at Claritev]

As a reminder, new bookings typically take two to four quarters to begin to convert to revenue, followed by another four quarters to reach their full annualized revenue contribution. Turning to guidance. Given the strength of Q3 and our outlook for Q4, we are raising our full-year revenue guidance to a new range of $1.038 billion-$1.043 billion, a $30.5 million increase at the midpoint from our previous guidance. Our updated guidance implies full-year revenue growth of 7.5%-8%, with Q4 revenues of $270 million at the midpoint. This represents a low single-digit sequential increase over a particularly strong Q3 and a 9.5% growth over Q4 2025. Keep in mind, Q4 last year included the final $5.4 million of one-time revenue at 100% margin. We are raising our full-year Adjusted EBITDA guidance to $625 million-$630 million, an increase of $12.5 million at the midpoint.

[Doug Garis, CFO at Claritev]

We are also raising free cash flow guidance to $10 million-$20 million, up $5 million at the midpoint, and tightening our CapEx guidance to $165 million-$170 million. I will note that the combination of high single-digit revenue growth and an Adjusted EBITDA margin above 60% brings us meaningfully closer to our long-term objective of becoming a Rule of 70 company. I want to turn for a moment to Q4 and our full year free cash flow expectations. We said at the beginning of the year that returning to positive free cash flow was our management team's number one financial priority. Based on our performance through the first nine months and our outlook for Q4, we remain firmly on track to deliver on that commitment.

[Doug Garis, CFO at Claritev]

In Q4, we expect operating cash flow of $110 million-$120 million, with growth of 66%-81% year over year, and free cash flow of $74 million-$84 million, with growth of 103%-131%. This would mark our first return to more than $100 million of quarterly operating cash flow in several years, alongside what we expect to be our strongest free cash flow generating quarter in more than four years. Before turning the call back to Travis, I am going to briefly address our initial outlook for 2027, which we have included in today's press release. As I mentioned earlier, we are running about a year ahead of the financial plan we laid at our March investor day. Our multi-year outlook at the time contemplated $1.1 billion of revenue in 2028.

[Doug Garis, CFO at Claritev]

We now expect to achieve at least $1.1 billion of revenue in 2027, driven by our strong performance this year, continued momentum in ACV bookings, and the ability of our growth and operation teams to translate those bookings into revenue. It is only November 9th, and we still have important work ahead of us to finish the year and finalize our plans for 2027. We intend to provide more comprehensive Adjusted EBITDA and free cash flow guidance, along with a more detailed revenue bridge when we report Q4 results in February. We are operating with confidence in our revenue trajectory and expect to deliver another year of meaningful financial progress in 2027 while maintaining a high SAIDU ratio. As Travis said earlier, Claritev is no longer simply a turnaround or transformation story.

[Doug Garis, CFO at Claritev]

We are a growth company with a significantly stronger financial foundation and the capacity to continue investing in the opportunities that lie ahead. With that, I'll gladly turn the call back over to Travis for a few final remarks before we take your questions.

[Travis Dalton, President and CEO at Claritev]

Thanks, Doug. I'll close with a few brief thoughts. We said at the start of the year that we would deliver on our promises, and through three quarters, we are doing exactly that. Record bookings, consistent revenue growth, expanding markets, and real innovation in front of our clients. Our priorities remain crystal clear: continued growth and investment in our core, diversification of our revenue base into new markets, free cash flow, and delevering the business. Finally, I want to thank our 3,000 Claritev associates for their dedication and commitment to our clients. None of this happens without them. With that, I'll turn it to the operator for questions. Thanks.

[Operator]

Thank you. If you would like to ask a question, please press star one on your telephone keypad. To withdraw your question, simply press star one again. We ask that you please limit yourself to one question and one follow-up. Your first question today comes from the line of Jason Cassorla from Guggenheim Securities. Your line is open.

[Jason Cassorla, Analyst at Guggenheim Securities]

Great. Thanks. Good morning, and congrats on the quarter. Appreciate the early look on preliminary 2027 revenue. I guess, can you just give us a sense of how you're thinking about the puts and takes around growth at the segment level, and then perhaps any early indication on the balancing items like gross revenue retention, and how you're thinking about kind of organic or in-client currently versus like ACV-related contribution? Just any incremental thoughts would be very helpful. Thanks.

[Doug Garis, CFO at Claritev]

Hey, Jason. Thanks, and thanks for the sentiment. I mean, we are running pretty firmly ahead. We did also mention that we expect Payment & Revenue Integrity to return to growth. Our Network business would be up about 5% if you excluded the one-time revenue this year. And our Claims Intelligence business has been our largest business, has been performing exceedingly well. We are going to hold off further guidance for now. We need to finish the year. But I would expect, I think the biggest thing to intuit is, in the prepared remarks, we expect our Payment & Revenue Integrity business to return to growth next year.

[Jason Cassorla, Analyst at Guggenheim Securities]

Okay, got it. Very helpful. And then maybe just a quick one on CapEx. You narrowed to the high end of the range previously. I guess, was that simply a pull forward versus what you had expected to spend for next year? And then maybe if you can provide any early CapEx priorities you have for next year, if you would expect similar spending levels, or how to balance what you have spent this year against your run rate going forward would be helpful. Thanks.

[Doug Garis, CFO at Claritev]

Yeah, for us, for 2026, we just narrowed the guide. We feel really comfortable about our multi-year investment framework and our Vision 2030 transformation. And look, in 2025, when we announced our transformation, R&D as a percentage of revenue was about 16.5%. That is going to trend down to about 16% this year, and that will continue to improve over time. We have one final chunk of investment in our previously announced transformation program. But as we outlined in our investor day, we expect the return on capital expectations of the transformation program to be strong, and then we expect our R&D as a percentage of revenue to start to normalize, and we expect to get some of that leverage next year.

[Doug Garis, CFO at Claritev]

That is about all I am going to say on the CapEx priorities for 2027, and of course, we will give a more fulsome bridge when we do our full year guide in February.

[Jason Cassorla, Analyst at Guggenheim Securities]

Okay. Thank you very much.

[Operator]

Your next question comes from the line of Richard Close from Canaccord Genuity. Your line is open.

[Richard Close, Analyst at Canaccord Genuity]

Yeah, thanks for the questions, and congratulations on the strong results here. Doug, maybe just on the Payment Integrity, appreciate the return to growth next year. Can you talk a little bit about maybe the ACV or bookings so far this year, or what is really providing that confidence? Then maybe why has it underperformed in the quarter?

[Doug Garis, CFO at Claritev]

Yeah, so maybe I'll take the second one first. So we have a clinical negotiations business that is within our Payment & Revenue Integrity segment. We've had some clients kind of move over to our Claims Intelligence solutions, which are embedded in our financial negotiations business. This is pure geography. The clinical negotiations business is about a third of the Payment & Revenue Integrity business. So while in the grand scheme of things, it's not an overall net large impact to our consolidated revenue, it does have an outsized impact on the segment. Look, over the last four quarters, we've booked north of $40 million of ACV in our Payment & Revenue Integrity business, and those are primarily in our higher value categories and some of our newer solutions. I think only 20-ish percent of that has converted into revenue.

[Doug Garis, CFO at Claritev]

We have great insight into 2027 and beyond in the Payment & Revenue Integrity business, and we are fairly bullish on the medium to long-term prospects of that business.

[Richard Close, Analyst at Canaccord Genuity]

Okay, that is really helpful. Then, maybe on, I guess, the last point in terms of the 20% conversion, how do you guys think about, as you expand, I guess, outside the payer segment in terms of, does that change anything with respect to the two to four quarters at implement and four quarters to fully ramp to the full revenue? Does the bookings conversion to revenue change at all?

[Doug Garis, CFO at Claritev]

No, not really. The mix of bookings, I would just say if you look at kind of some of our additional beat this year, some of our solutions we can turn on fairly quickly, especially within Claims Intelligence where we already have an install base. I would point you to our year-to-date bookings. About 78% of the $100 million we booked has been within the current install base. Payment & Revenue Integrity solutions tend to take a little bit longer to turn on and realize full value, especially within that new install. When you look at a Network, for instance, with our World Trade Center win, it took us about three quarters to build all the requirements with our primary on that. The two to four quarters is a good blended assumption.

[Doug Garis, CFO at Claritev]

I would say the over-performance of our Claims Intelligence business and the ACV to revenue conversion has been a bright spot for us this year. On balance, two to four quarters is still kind of our planning assumption.

[Richard Close, Analyst at Canaccord Genuity]

Okay, thanks. I'll get back in the queue.

[Operator]

Your next question comes from the line of Jessica Tassan from Piper Sandler. Your line is open.

[Jessica Tassan, Analyst at Piper Sandler]

Hi, guys. Thanks for taking the question. PSAV claims volume was stable quarter-over-quarter and up about 8% year-over-year. Appreciate that you all are launching a new NSA customer, but can you kind of help us better understand the normal quarterly seasonality for PSAV claims volume and whether your expectations for long-term claims volume growth have changed at all in light of recent strength?

[Doug Garis, CFO at Claritev]

Yeah, thanks for the question, Jess. The NSA business has been a bright spot for us this year, and the growth year-over-year is primarily due to the NSA business. In fact, our NSA volumes grew sequentially as well, and we're still taking some time to understand the new rule changes. It's kind of hard to give you an outlook on the next few years, which is why we're saving more detailed guidance on revenue for 2027. Look, when we gave our investor day, we felt pretty good at the out-of-network business being 7%-8% of all dollars. We kind of planned for modest claims volumes. We're two to three points ahead of where we planned, which is why we raised the guide.

[Doug Garis, CFO at Claritev]

But the growth and progression of out-of-network is a business that we feel really good about, and it's two-thirds of our business. Claims volumes, I think, will continue to be stable, and that's how we've modeled it in our multi-year outlook, with the exception of the NSA win, which has obviously given us the uplift on revenue.

[Jessica Tassan, Analyst at Piper Sandler]

Okay, that's helpful. So we should think about the uplift as being the product of this new NSA customer. Then just maybe my follow-up is, can you elaborate on the contraction in Payment & Revenue Integrity year over year and sequentially? Is this business growing or flat, excluding the one customer you mentioned? Then maybe just what does this transition involve? When did it commence? And what is the benefit to Claims Intelligence in Q3 from that transition? Thank you.

[Doug Garis, CFO at Claritev]

Yep. So, the business excluding the clinical negotiation business was about flat this quarter. And Richard had asked a question. We feel really good about the medium and long-term prospects of the business, especially in our solution areas that have, quite frankly, grown substantially over the last four to six quarters, namely our DRG and ACE solutions, which are prepay, more valuable Payment & Revenue Integrity solutions. Our financial negotiations and clinical negotiation business have similar operations, and there's probably a point and a half to a two-point benefit to our Claims Intelligence business from some of that switching. So it's not isolated to one client, more of a preference. But the Claims Intelligence business is where some of that volume or some of those revenue dollars were captured.

[Doug Garis, CFO at Claritev]

Not as significant to Claims Intelligence because it's about six or seven times the size, but obviously meaningful from a segment perspective when you break it out. Then the final point I would add is, on the bookings and revenue conversion, we expect that business to return to growth going forward, and we're pretty excited about the prospects. And I think maybe, Travis, you have a couple comments too.

[Travis Dalton, President and CEO at Claritev]

Yeah, I was going to make just a slightly broader comment. I think a huge positive for us is the forward indication relevant to our bookings and pipeline. One of the big goals, really, since we launched into our Vision 2030, was diversification of markets, using our product capabilities to the fullest, and expanding that into new markets. As you look at our bookings for the year, it's not occurring in a single market vertical, which would be payer. It's spread across multiple. In addition to that, our pipeline growth is significant. We're about 60% year-over-year on pipeline growth, and less than half of that is coming from the, quote-unquote, "payer market." And we have 46 new logos.

[Travis Dalton, President and CEO at Claritev]

As we kind of evaluate our future, we actually see a more durable path for us relevant to the markets we serve, claims volumes, the resiliency of the business, and our ability to press forward and move forward on a growth trajectory. I think that's an important note for us as we progress. I'll just add that as we go to the next question. Thank you.

[Jessica Tassan, Analyst at Piper Sandler]

Great. Thanks.

[Operator]

Your next question comes from the line of Glen Santangelo from Barclays. Your line is open.

[Glen Santangelo, Analyst at Barclays]

Yeah. Thanks for taking my question. Travis, I also wanted to follow up on the outperformance in the Claims Intelligence business. In your prepared remark, you obviously talked about the NSA and the key driver it has been, and you are making the case that it is going to persist. But I was curious if you could maybe unpack that growth a little bit more and how much came from that incremental new customer to help us think about what the real organic growth rate is here so we can think about the durability. Because looking at the initial guidance that you have given us for FY 2027, and assuming we get growth in Payment & Revenue Integrity and Network, that assumes a pretty sharp deceleration, I would assume, in Claims Intelligence. And I am just trying to put all these pieces together.

[Glen Santangelo, Analyst at Barclays]

Doug, my follow-up question would be on the margin side. We typically think about Claims Intelligence as being an above-average margin business, and when we look at gross margins down this quarter, higher operating expenses maybe for reasons we know about, how should we think about the margins going forward into 2027 if Claims Intelligence is going to continue to be the fastest-growing business? Thanks so much.

[Travis Dalton, President and CEO at Claritev]

Yeah. Thanks, Glen. I think there are a few questions in there, so we will do our best. Look, let me just make a high-level comment, and then I am going to let Doug talk about some specifics here. Actually, we have a lot of room to go when I look at this. So, what I think about in terms of our growth thesis is, I do think that NSA obviously is core to our growth right now, and we expect to continue to be. I actually think in healthcare, there will be continued movement of care outside the four walls, which will continue to sustain out-of-network claims and out-of-network claims volumes over time, in addition to what you may or may not see with NSA, which we think will continue to be a driver for us. So, NSA claims volume, a driver.

[Travis Dalton, President and CEO at Claritev]

The movement of healthcare outside the four walls into behavioral health and other areas as a higher savings environment is important for us on the macro. I will also just say that, you look at the core business, I think that beyond that, I am really excited. Look, we have room to go. We are not just looking at this going, "Man, I hope we can squeeze one more penny out of a claim." You look at the business PRI, we are just getting started in that business, and our bookings pipeline and bookings growth have been good. Now, we have to turn that into revenue, right? So, we are going to be laser-focused on execution against the TPA business, which has a lot of Payment & Revenue Integrity sales in it, into revenue.

[Travis Dalton, President and CEO at Claritev]

I would look for us to improve there, and that should be an indicator for all of you as we progress forward, and that will be an important area for us. Then MA, we mentioned MA on the call. We are involved with almost all of these clients providing MA plans, and we just have not packaged a solution that is marketed and meaningful enough to them yet to get what I would consider to be meaningful progression in that business. Aside from NSA, aside from pure Claims Intelligence, which we expect to be durable and consistent and will continue to find value per claim, we actually are going to go and attack these other markets around PRI, which we have great products and we are not well-known for, and we should be, and we are going to go and attack other areas that I have just mentioned.

[Travis Dalton, President and CEO at Claritev]

That is a broad brush of what you might be able to look for and how we are thinking. Then I will let Doug hit a couple specifics relevant to your questions on volumes and numbers.

[Doug Garis, CFO at Claritev]

Yeah. I would say, I think a couple of the biggest highlights that are maybe the undercurrents is our charges submitted to us were up 15% year-over-year. Our savings rate, our ability to capture savings on higher charges went up, and then our PSAV savings dollars eclipsed $5 billion for the first time in, I do not know, maybe four or five years, on top of delivering more than $1,500 of savings per claim. The mix has been our friend. We have helped our clients offset inflation. As you correctly pointed out, I mean, it has boded well for our largest and most profitable business. I would also highlight you to the fact that when we started the year, we indicated that we would invest purposefully $20 million-$25 million in our sales marketing, our go-to-market, as well as our delivery functions.

[Doug Garis, CFO at Claritev]

We feel like those are good investments. If you look at the proof, you need to invest money to deliver $100 million bookings. We really like the investment. If you look at the business on a comparable basis and roll it forward, our medium to long-term outlook here is to run a Rule of 70 company. We are willing to invest money to diversify the business. If you look at what we have booked so far this year, more than 50% of it has come outside of our core business. As Travis indicated, our goal is to run a diversified, durable, and increasingly financial strong business. We will save follow-on comments for 2027, and we will give a little bit more details on each of the segments to help you guys unpack that.

[Doug Garis, CFO at Claritev]

But across the board, I think that the punchline for us is this was a banner quarter, a breakout quarter, and we couldn't be more pleased with the financial progress of this company.

[Glen Santangelo, Analyst at Barclays]

Thank you.

[Operator]

Your next question comes from the line of Stan Berenshteyn from Wells Fargo. Your line is open.

[Stan Berenshteyn, Analyst at Wells Fargo]

Yes. Hi, good morning. Thanks for taking my questions. First, maybe on AI, I think you had mentioned in the prepared remarks or in the press release that agents are doing a bit more of the workflows. Can you just discuss, maybe give us some examples of what that entails, and does that translate into any changes into the size of your financial negotiation team as we think about next year? Thanks.

[Travis Dalton, President and CEO at Claritev]

Yeah. Hey, Stan. Thanks for the question. I could sit here and say AI 30x, like a lot of people do on calls, but to me, it's a tool that enables us to better serve our clients. We're obviously prioritizing and deploying our AI agents specifically around NSA, which I mentioned. So we have projects inside the company that will allow us to more quickly evaluate and modernize the work that we're doing inside of the company. So, we expect to be able to generate more positive returns for our clients, frankly, in terms of protecting employees and employers, but we also think that we can gain operating efficiency inside of the business. We still have areas of the business that are highly manual in nature, in terms of intake, in terms of how we process claims, in terms of how we do things internally.

[Travis Dalton, President and CEO at Claritev]

AI is a very key priority for us as we think about how to get more efficiency and how to ultimately truly unlock the potential of the company on a multi-year basis to get more operating leverage across the business as we proceed forward. I've given a few examples around NSA. There are others inside the company. We're using it in our sales processes on how we better identify leads and target those. We're really using it at this point as almost across the entirety of our business and everything we do every day. I'll just make one editorial comment and let Doug comment. I think the key to the use of AI is not going to be the use of it, but working on the right things.

[Travis Dalton, President and CEO at Claritev]

We have put a lot of focus and energy on things internal to the company that may not be obvious, relevant to an earnings call, but are very obvious when you look at our results. Moving to a segment strategy that has a general management solution organization allows us to target the right priorities. That's why we changed the structure of the company so that we could get much flatter, better alignment to our segment leaders who hear the needs of our clients, to our general managers that ultimately produce the solutions and capabilities against that. Lining that up against our priorities is allowing us to move much faster, which, again, last thing I'll say is, you have to, because the competition is out there. We know that.

[Travis Dalton, President and CEO at Claritev]

Our clients are out there, and the next big thing is always there, and we have to go find it first. It's imperative that we apply our resources in a very specific prioritized way. So those would be my comments on AI and how we're thinking about it and our focus, and Doug, if you want to jump in.

[Doug Garis, CFO at Claritev]

On the financial elements, we are not going to give specific comments on any line of business and headcount. What I would say is we take a very circumspect look at AI. We have a great AI organization within our Chief Digital Officer's team. We have four dozen AI scientists. We are working on dozens of important things, and we have a very great way to make sure that there is an economic return on where we are investing our dollars. It would be natural to expect one of two outcomes from our investments in AI. We can do a whole lot more with less, or we can do an order of magnitude more with the same amount of folks. In our Q1 earnings call, we said 53% of our code in Q1 was delivered using AI.

[Doug Garis, CFO at Claritev]

We had also said in Q2 that was going to be between 60%-80% by the end of the year. We have a large organization that is spending a lot of money on R&D. I would continue to think about our progression and our R&D to scale over time, and then our organization to do a whole lot more with less, and that is where we will leave those comments.

[Stan Berenshteyn, Analyst at Wells Fargo]

Appreciate the color. Maybe as a follow-up, on IDR volumes, I believe in August, I think you had mentioned maybe you need a couple of quarters to really see whether there is a volume uplift from the IDR rules. Did Q3 show any changes in eligible volume, and can you maybe talk about win rates and economics related to that? Thank you.

[Doug Garis, CFO at Claritev]

Yeah. I think we do formal releases when CMS publishes their data. What I would say is claims volumes were up sequentially in NSA, part of the reason why our Q3 results were strong and why we raised our guide $30.5 million at the midpoint. It is still taking a little while for the final rules to settle in, but we remain positive that we are a market leader in our category, and the value we deliver to our clients is exceptional, and we are getting rewarded for it for additional volumes.

[Stan Berenshteyn, Analyst at Wells Fargo]

Got it.

[Todd Friedman, Head of Investor Relations at Claritev]

Stan repeated the data point we actually gave in the prepared remarks. Some of this is related to the client add, but our dispute initiations were up 75% year-over-year, over Q3 of last year.

[Stan Berenshteyn, Analyst at Wells Fargo]

Got it. Thank you.

[Operator]

That concludes our question and answer session. I will now turn the call back over to the company for closing remarks.

[Travis Dalton, President and CEO at Claritev]

Yeah. I will just close out very briefly. Thanks, everyone, for the time. As I mentioned, we have been on a journey. We are proud of the progress we have made. At the end of the day, it is about our people, and we have to prove ourself every day. So, second this call is over, we are back to work for our clients. So thanks for your time, thanks for listening, and appreciate the questions and the attention. Thanks.

[Operator]

This concludes today's conference call. Thank you for your participation. You may now disconnect.

Participants

Executives

• Todd Friedman, Head of Investor Relations
• Travis Dalton, President and CEO
• Doug Garis, CFO

Analysts

• Jason Cassorla, Analyst at Guggenheim Securities
• Richard Close, Analyst at Canaccord Genuity
• Jessica Tassan, Analyst at Piper Sandler
• Glen Santangelo, Analyst at Barclays
• Stan Berenshteyn, Analyst at Wells Fargo