ABILITY Network

What ABILITY Network does

ABILITY Network is a private healthcare technology company founded in 2000 and headquartered in Minneapolis, operating with 251-500 employees. Its founding product positioning centered on CMS-approved, secure Medicare and all-payer online access for claims processing and reimbursement, serving healthcare provider organizations including acute care hospitals, post-acute and skilled nursing facilities, and ambulatory care settings. The company is referenced as serving all top 25 U.S. provider systems alongside a broader base of mid-market providers, billing services, and workforce administrators.

The company's product platform is a cloud-based suite that integrates revenue cycle management, care quality management, and workforce management into a single sign-on experience. Revenue cycle modules include Registration Workflow, Eligibility Verification, Insurance Discovery, Demographic Verification, Patient Statement and Payment Management, Claims Management (with a Medicare-specific variant), and RCM Intelligence analytics. Care quality modules comprise MDS Intelligence (with PDPM calculations), Quality Management, Payroll Based Journal submission, and the VigiLanz family for safety, pharmacy surveillance, and infection prevention. Workforce modules include Schedule Management, Workforce Intelligence, Attendance Management, Credential Management, and Agency Management. The platform is built on national-scale connectivity with real-time primary source data access, and the company exposes API-powered access for strategic partners to embed the software into third-party platforms. Documented customer outcomes include a 20% reduction in claim denials (Careficient), coverage discovery for 40% of apparently uninsured patients (Face Rock Enterprises), and a quality measure star rating improvement from 2.6 to 4.0 across 81 facilities (Prestige Healthcare).

ABILITY Network monetizes through enterprise subscription agreements with annual billing and quote-based pricing tied to organization size and module selection. Go-to-market relies on enterprise field sales with a "Request a Demo" CTA, supplemented by a self-service portal for existing customers and an API-based partner ecosystem for embedded distribution. The company pursued a deliberate platform consolidation strategy, executing seven acquisitions between 2013 and 2017 (Ivans, MD On-Line, System Designs, G4 Health Systems, eHealth Data Solutions, ShiftHound, Secure Bill Pay) and raising approximately $1.13B in cumulative disclosed funding, including a $545M round in December 2017 and a $550M Series 4 round in April 2014 led by Summit Partners.

Name

ABILITY Network

Website

https://abilitynetwork.com

Company type

Private

Founded year

2000

Operating status

Operating

Headcount range

251–500 employees

Short description

ABILITY Network is a private Minneapolis-based healthcare technology company offering CMS-approved, cloud-based revenue cycle, care quality, and workforce management software to U.S. healthcare providers, including all top 25 U.S. health systems and skilled nursing, ambulatory, and billing organizations.

Ownership category

akta.pro rank

Product category

Healthcare Revenue Cycle Management Software

NAICS

Computer Systems Design and Related Services (54151), Computer Facilities Management Services (541513)

SIC

Services-Computer Programming, Data Processing, Etc. (7370), Services-Computer Integrated Systems Design (7373)

akta.pro primary industry

Revenue Cycle, Coding & Telehealth Compliance Platforms (for provider orgs) (HLALABAM)

Keywords

• Healthcare revenue cycle management
• Medicare claims processing
• Eligibility verification software
• Healthcare provider SaaS
• Clinical surveillance software

Headquarters

HQ city

Minneapolis

HQ country

United States

HQ region

North America

Markets served

GTM type

B2B

Offering type

Software

Cost components

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

Revenue model

1. Healthcare Provider Software Subscriptions: Subscription-based access to Inovalon's Provider Solutions platform including revenue cycle management, care management, and workforce management modules. The software is accessed through a secure, easy-to-use login portal with all major web browsers supported.

Pricing tiers

Go-to-market motion1 record

Distribution channels3 records

Marketing channels7 records

Core offering

ABILITY Network provides CMS-approved, secure Medicare and all-payer online access for claims processing and reimbursement, delivering cloud-based revenue cycle management, care/quality management, and workforce management software to healthcare providers. Its capabilities now sit within Inovalon's Provider Solutions, a single sign-on platform trusted by all top 25 U.S. provider systems that connects providers to payers with real-time primary source data and advanced analytics.

Product overview

Inovalon Provider Solutions is a unified cloud-based healthcare provider software platform that integrates revenue cycle management, care management, and workforce management into a single sign-on experience. The platform comprises three core pillars: Revenue Cycle Management (including Registration Workflow, Eligibility Verification, Insurance Discovery, Claims Management, RCM Intelligence, and patient payment solutions), Care Management (featuring VigiLanz safety, pharmacy surveillance, infection prevention, MDS Intelligence, and quality management modules), and Workforce Management (including Schedule Management, Workforce Intelligence, Attendance Management, Credential Management, and Agency Management). The platform is trusted by all top 25 U.S. health systems and connects through API-powered access for strategic partners.

Differentiator

Problem solved

Functional benefit

Products and services

• ABILITY Network CMS-Approved Medicare & All-Payer Claims Access Platform ABILITY Network's flagship offering provides CMS-approved, secure online access for Medicare and all-payer claims processing and reimbursement, enabling healthcare providers to submit, track, and manage claims across payer types. It forms the historical core of what is now integrated into Inovalon's Provider Solutions platform.
• Provider Solutions (Inovalon Provider Cloud) Unified healthcare provider software platform that brings together revenue cycle management, care management, and workforce management into a single sign-on experience, trusted by all top 25 U.S. health systems. Sells to enterprise provider organizations with annual subscriptions.
• Claims Management (Claims Management Pro) Claims management software providing step-by-step guidance for claims correction prior to submission, reducing denials and improving first-pass payments and cash flow for healthcare providers.
• Eligibility Verification Software that speeds up eligibility and benefits verifications with real-time coverage checks, helping providers get paid faster and keep cash flowing.
• Insurance Discovery Coverage discovery tool that finds billable coverage for patients who appear uninsured, increasing revenue capture and patient satisfaction.
• Claims Management Medicare Medicare-specific claims management providing full visibility to manage the Medicare revenue cycle end-to-end.
• RCM Intelligence RCM analytics dashboard delivering end-to-end visibility and actionable intelligence to improve operational cash flow, revenue, and profitability.
• MDS Intelligence MDS assessment software that simplifies MDS accuracy, reduces errors, maintains survey readiness, and includes built-in PDPM calculations for skilled nursing facilities.
• Safety Management (VigiLanz) Near real-time safety event reporting software for patient harm prevention and compliance.
• Pharmacy Surveillance (VigiLanz) Clinical surveillance software for adverse drug event prevention and pharmacist intervention support, including antimicrobial stewardship and opioid stewardship.
• Infection Prevention (VigiLanz) Near real-time clinical surveillance software for infection prevention that improves safety and enhances patient care.
• Schedule Management Mobile-friendly healthcare scheduling and shift management software that reduces overtime and labor costs.
• Workforce Intelligence Staffing analytics that transform complex staffing data into clear insights to prevent staff burnout, control costs, and improve patient care.

Quantifiable outcome

• 20% reduction in claim denials
• +3 more outcomes

Named customers9 records

Segments3 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Feature8 records

Partnerships

One partnership is on record.

• Strategic Partners (API Ecosystem)coreTechnology or IntegrationInovalon provides API-powered access and connectivity for strategic partners to incorporate Inovalon's technology, connections, and data into their cutting-edge applications. Partners can embed Inovalon's software into their platforms to provide seamless customer experiences. This is positioned as a core part of the Provider Solutions value proposition.

Scale indicators4 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• R1 RCM: End-to-end RCM technology and services for hospitals and health systems, combining AI-driven workflow automation with outsourced billing services. Closely comparable in customer base (large U.S. provider systems) and end-to-end RCM scope, though more services-heavy.
• Experian Health: Provider-focused revenue cycle and patient access suite including eligibility, identity verification, claims management, and patient financing. Directly comparable to ABILITY Network's front-end RCM and insurance discovery capabilities, particularly for large provider systems.
• NextGen Healthcare: Ambulatory-focused EHR and practice management with integrated revenue cycle management, particularly strong in specialty and mid-market providers. Comparable in RCM and patient engagement functionality for provider organizations.
• Waystar: Cloud-based revenue cycle management platform for healthcare providers covering claims management, eligibility, patient payments, and analytics. Directly comparable to Inovalon Provider Solutions' RCM pillar with similar target buyers (hospitals, health systems, ambulatory) and subscription model.
• athenahealth: Cloud-based EHR and revenue cycle management platform for ambulatory providers and hospitals, including claims management and patient engagement. Comparable as a cloud-native, multi-module provider platform with a similar revenue model and target segments.
• Availity: Provider-payer data exchange network and revenue cycle platform connecting providers with payers for eligibility, claims, and prior authorization. Highly comparable to ABILITY Network's original 'all-payer connectivity' value proposition and CMS-grade data exchange role.
• Epic Systems: Dominant enterprise EHR vendor for large U.S. health systems, with growing native RCM, eligibility, and claims capabilities. Directly comparable as the incumbent platform that 'all top 25 U.S. provider systems' typically run, and the primary competitive threat on RCM bundling.

Emerging players

• Health Catalyst: Healthcare data and analytics platform for providers and payers, with a growing footprint in quality and cost analytics. Comparable as a complement/competitor to RCM Intelligence and quality-measure analytics within the provider ecosystem.

Broad incumbents

• Oracle Health (formerly Cerner): Enterprise health IT platform from Oracle covering EHR, revenue cycle, and population health for large health systems. Overlaps with Inovalon Provider Solutions' RCM and care management modules but as part of a much broader enterprise portfolio.
• Change Healthcare (Optum): Pre-acquisition clearinghouse and RCM network connecting providers, payers, and patients. Direct analog to ABILITY Network's all-payer connectivity franchise; now part of Optum, broadening the portfolio but anchoring similar provider workflows.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/ABILITYNtwrk
• Facebookfacebook.com/ABILITYnetwork
• LinkedInlinkedin.com/company/ability-network

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds6 records

Investors6 records

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

M&A7 records

Investments

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

Frequently asked questions about ABILITY Network