HiLabs
HiLabs is an AI-powered healthcare data management company that provides the MCheck platform to health plans. Its healthcare-trained machine learning models clean, enrich, and unify provider data for Medicare Advantage, Medicaid, Commercial, and behavioral health plans.
- Company typePrivate
- Founded2014
- HeadquartersBethesda, United States
- Headcount251–500
- GTM typeB2B
- OfferingSoftware
What HiLabs does
HiLabs is an AI-powered healthcare data management company serving health plans, founded in 2014 and headquartered in Bethesda, Maryland. The company targets the so-called "dirty data" problem in healthcare provider directories, which it estimates costs payers billions annually and drives more than 95% of Medicare Advantage plans to fail CMS audits. Its MCheck platform uses healthcare-specific machine learning models, geospatial technology, and turnkey interoperability to ingest raw provider data from EHRs, rosters, delegated entities, and legacy systems, then clean, standardize, enrich, and validate it into a unified provider data foundation that downstream payer workflows (network design, credentialing, directory accuracy, claims, compliance, member experience) can rely on.
The MCheck platform is composed of specialized modules: MCheck Roster Automation (touchless end-to-end roster processing with claimed 80% manual effort reduction and <48 hour turnaround), MCheck Directory Accuracy (replication of healthcare SME decision-making at scale, achieving 95% directory accuracy and 3M+ erroneous provider locations cleaned), MCheck NetworkIQ (network optimization for compliance, competitiveness, and cost of care, with a focus on ghost networks), MCheck ContractsAI (healthcare-trained contract analysis with 99% pricing extraction accuracy and an estimated $2.47 PMPY savings), MCheck Outreach Intelligence (automated provider and member outreach), plus MCheck Value Based Care and MCheck Clinical modules. The company holds SOC 2 Type II and HITRUST i1 certifications and was named to the 2025 Inc. 5000 list.
HiLabs operates an enterprise SaaS model with a direct field sales motion targeting Medicare Advantage, Medicaid, and Commercial health plans, as well as a growing presence in behavioral health. Pricing is quote-based and not publicly disclosed. The company has raised $39M in a Series B round (March 2024, led by Denali Growth Partners and Eight Roads Ventures, with F-Prime) and operates with 101-250 employees. The leadership team is anchored by co-founder and CEO Amit Garg, with Amir Desai joining as President and Chief Growth Officer in March 2026 to lead commercial scaling.
HiLabs firmographics
Firmographics- Name
- HiLabs
- Legal name
- HiLabs Inc.
- Website
- https://hilabs.com
- Company type
- Private
- Founded year
- 2014
- Operating status
- Operating
- Headcount range
- 251–500 employees
- Short description
- HiLabs is an AI-powered healthcare data management company that provides the MCheck platform to health plans. Its healthcare-trained machine learning models clean, enrich, and unify provider data for Medicare Advantage, Medicaid, Commercial, and behavioral health plans.
- Ownership category
- akta.pro rank
HiLabs industry classification
Industry- Product category
- Healthcare Data Management Software
- NAICS
- Software Publishers (513210)
- SIC
- Services-Prepackaged Software (7372)
- akta.pro primary industry
- Payer-Provider Data Exchange (X12, prior auth, claims/clinical attachment) (HLACABAK)
- akta.pro secondary industry
- Interoperability Standards, Profiles & Implementation (HL7/FHIR/IHE) (HLACABAA)
Keywords
Where HiLabs is headquartered
LocationHeadquarters
- HQ city
- Bethesda
- HQ country
- United States
- HQ region
- North America
Markets served
HiLabs business model
Business model- GTM type
- B2B
- Offering type
- Software
- Cost components
- Technology or R&D, Personnel, Marketing or Sales, Operations, Infrastructure
Revenue model
- SaaS Platform Subscriptions: Enterprise SaaS subscription model for the MCheck platform delivering provider data management solutions to health plans. Revenue derived from platform licensing and usage across payer ecosystem.
Go-to-market motion1 record
Distribution channels1 record
Marketing channels5 records
HiLabs product offering
Product offeringCore offering
HiLabs sells the MCheck® AI platform, a suite of software modules that help U.S. health plans ingest, cleanse, validate, and maintain provider, roster, directory, network, contract, and clinical data. The platform automates provider data management, roster reconciliation, directory accuracy, network adequacy analysis, contract lifecycle management, and value-based care workflows for Medicare Advantage, Medicaid, Commercial, and behavioral health plans.
Product overview
HiLabs offers a unified AI-powered data management platform called MCheck® with multiple specialized modules designed for healthcare payers. The platform translates raw, inconsistent provider data into unified, accurate, and actionable information. The portfolio consists of eight integrated solutions: MCheck® Platform as the core foundation, supplemented by six operational modules (Roster Automation, Directory Accuracy, NetworkIQ, ContractsAI, Outreach Intelligence, and Value Based Care) plus MCheck® Clinical. These modules share the unified data management infrastructure and healthcare-trained AI models, addressing the $1T healthcare data problem through purpose-built capabilities for network design, credentialing, directory accuracy, claims, compliance, and member experience.
Differentiator
Problem solved
Functional benefit
Brands
- MCheck®: AI-powered platform for healthcare data management, including Provider Data Management, Value Based Care, and Clinical solutions.
- MCheck® Roster Automation
- MCheck® Directory Accuracy
- MCheck® NetworkIQ
- MCheck® ContractsAI
- MCheck® Outreach Intelligence
- MCheck Value Based Care
- MCheck Clinical
Products and services
- MCheck Platform
Quantifiable outcome
- 95% directory accuracy achieved with MCheck Directory Accuracy
- +7 more outcomes
Companies that use HiLabs
Customer profileNamed customers1 record
Segments3 records
Ideal customer profiles3 records
HiLabs technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
AI capability5 records
Feature7 records
HiLabs partnerships and signals
Strategic signalPartnerships
One partnership is on record.
- A Leading National Behavioral Health PlancoreDeployment of MCheck NetworkIQ platform with a national behavioral health organization serving millions of members to achieve 'True Network Adequacy' and address the ghost network problem in healthcare provider directories. Partnership comes as federal regulators intensify scrutiny on health plans with studies showing up to 55% of behavioral health providers listed in Medicare Advantage directories are inactive.
Scale indicators11 records
Recent moves6 records
Expansion highlights10 records
HiLabs competitors and assessment
Company assessmentDirect peers
- Kyruus: Kyruus operates a provider data management and scheduling platform for health systems and payers, directly competing with HiLabs in provider directory, network adequacy, and provider search capabilities.
- Ribbon Health: Ribbon Health provides a provider data platform and API used by health plans and digital health companies to power accurate provider directories, network adequacy, and referral routing — a direct competitor to HiLabs's MCheck Directory Accuracy and NetworkIQ modules.
- Health Gorilla: Health Gorilla operates a clinical data exchange and interoperability network connecting payers, providers, and HIEs, overlapping with HiLabs's payer-facing interoperability and data ingestion capabilities.
- Particle Health: Particle Health provides a clinical data network and API for payers and digital health companies to access unified patient records, competing with HiLabs in payer-facing data aggregation and clinical data normalization.
- Verato: Verato provides identity resolution and master data management for healthcare, including provider identity matching — a direct functional overlap with HiLabs's entity resolution, NPI standardization, and provider record-linking capabilities.
- 1UpHealth: 1UpHealth operates an FHIR-based healthcare data platform enabling payers and providers to ingest, store, and exchange clinical and claims data, competing with HiLabs's interoperability and data unification layer.
- b.well Connected Health: b.well offers a healthcare data interoperability and consumer health data platform used by payers, comparable to HiLabs in payer-side data unification and member/provider data management.
Broad incumbents
- Symplr: Symplr is a large healthcare operations platform spanning provider credentialing, payer/provider data management, and compliance — overlapping with HiLabs's credentialing and provider data offerings as part of a much broader portfolio.
Emerging players
- Zus Health: Zus Health provides a shared healthcare data platform for builders and digital health companies, with partial overlap with HiLabs in payer-facing provider and clinical data aggregation.
Others
- Definitive Healthcare: Definitive Healthcare is a healthcare commercial intelligence and analytics platform providing provider and market data — adjacent to HiLabs in serving healthcare data buyers, though its focus is industry intelligence rather than provider data management.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat4 records
Key risks6 records
Key highlights7 records
Customer concentration
HiLabs social profiles
Digital presenceHiLabs compliance and trust
Trust signalCompliance2 records
HiLabs financial estimates
Financial estimateRevenue estimate
Valuation estimate
HiLabs leadership team
Management profileNumber of profiles
Profiles6 records
HiLabs funding detail
Funding detailFunding overview
Funding rounds2 records
Investors4 records
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
HiLabs M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about HiLabs
What does HiLabs do?
HiLabs sells the MCheck® AI platform, a suite of software modules that help U.S. health plans ingest, cleanse, validate, and maintain provider, roster, directory, network, contract, and clinical data. The platform automates provider data management, roster reconciliation, directory accuracy, network adequacy analysis, contract lifecycle management, and value-based care workflows for Medicare Advantage, Medicaid, Commercial, and behavioral health plans.
Is HiLabs a public or private company?
HiLabs is a private company. It is classified as venture growth investor backed and is currently operating.
When was HiLabs founded?
HiLabs was founded in 2014. It employs 251 to 500 people.
Where is HiLabs based?
HiLabs is headquartered in Bethesda, United States, in the North America region.
How does HiLabs make money?
One revenue line is on record: saaS Platform Subscriptions.
Who are HiLabs's main competitors?
Direct peers on record are Kyruus, Ribbon Health, Health Gorilla, Particle Health, Verato, 1UpHealth and b.well Connected Health. Symplr is listed as a broad incumbent. Zus Health is listed as an emerging player. Definitive Healthcare is listed as an others.
Does HiLabs have an API?
No public API is recorded for HiLabs.
What industry is HiLabs in?
HiLabs's product category is Healthcare Data Management Software. Its primary akta.pro industry code is HLACABAK, Payer-Provider Data Exchange (X12, prior auth, claims/clinical attachment), with a secondary code of HLACABAA, Interoperability Standards, Profiles & Implementation (HL7/FHIR/IHE). Its NAICS code is 513210 and its SIC code is 7372.