Change Healthcare

What Change Healthcare does

Change Healthcare is a U.S. healthcare technology company that operates one of the largest financial infrastructure platforms in the American healthcare system, processing claims and managing revenue cycle workflows for approximately 200 million Americans and 94% of U.S. hospitals. The company's core platform spans claims submission, adjudication, electronic remittance advice (ERA), eligibility verification, and denial management, serving as a clearinghouse between providers, payers, and pharmacies across acute care hospitals, physician practices, health plans, and pharmacy benefit managers. The platform is augmented by AI-powered modules for medical coding automation and prior authorization, FHIR-based interoperability solutions, population health analytics for value-based care, and blockchain solutions for healthcare data security developed through the acquisition of PokitDok assets in 2018.

The company's product architecture follows a platform-plus-modules model anchored on the Claims Management Platform and RCM Solutions, with add-on capabilities including Prior Authorization, Healthcare Financial Analytics, Pharmacy Benefit Management, and Value-Based Payment solutions. Change Healthcare distributes through direct enterprise sales to health systems, embedded integrations within major EHR platforms (Epic, Oracle Cerner), and—following the 2022 acquisition by Optum—through UnitedHealth Group's enterprise channel covering 8 out of 10 U.S. hospitals. Revenue is generated through a mix of transaction-based clearinghouse fees per claim processed, subscription-based RCM software licensing, and managed services for outsourced medical billing operations.

In February 2024, Change Healthcare suffered the largest healthcare data breach in U.S. history when the ALPHV/BlackCat ransomware group exploited stolen credentials on a legacy Citrix portal lacking multi-factor authentication, affecting 190–192.7 million individuals and causing an estimated $2.87–$3.09 billion in total financial impact to UnitedHealth Group. The company paid a $22 million ransom, deployed approximately $5 billion in emergency loans to affected providers, and subsequently underwent a comprehensive systems overhaul. The incident triggered 90+ pending lawsuits in multidistrict litigation and elevated regulatory scrutiny from HHS, representing a significant operational and reputational shock to the company's core infrastructure franchise.

Name

Change Healthcare

Legal name

Change Healthcare

Website

https://changehealthcare.com

Company type

Private

Founded year

2007

Operating status

Operating

Headcount range

5,001–10,000 employees

Short description

Change Healthcare operates the largest U.S. healthcare claims clearinghouse and revenue cycle management platform, processing claims for 200 million Americans and serving 94% of U.S. hospitals as a subsidiary of UnitedHealth Group's Optum division.

Ownership category

akta.pro rank

Product category

Healthcare Claims Processing and Revenue Cycle Management

NAICS

Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (518)

SIC

Services-Misc Health & Allied Services, Nec (8090), Services-Health Services (8000)

akta.pro primary industry

Healthcare Utilization, Claims & Administrative Data Analytics (HLAJAJAK)

akta.pro secondary industry

Medication Reconciliation & Transitions-of-Care Pharmacy Services (HLAFALAK)

Keywords

• Healthcare claims processing
• Revenue cycle management
• Medical billing software
• Healthcare interoperability
• Clearinghouse services

Headquarters

HQ city

Nashville

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Software

Cost components

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

Revenue model

1. Claims processing and clearinghouse fees: Change Healthcare processes healthcare claims as a clearinghouse between providers and payers, charging transaction-based fees per claim processed. The company handles a substantial share of U.S. healthcare claims transactions annually.
2. Revenue cycle management (RCM) services: RCM software and services covering the full billing lifecycle including medical coding, claims submission, payment remittance, denial management, and accounts receivable, sold to hospitals, physician practices, and specialty providers.
3. Medical billing outsourcing: Back-end RCM outsourcing services managing billing operations for healthcare facilities, competing alongside R1 RCM, Conifer Health Solutions, and Athenahealth in the medical billing outsourcing market projected to reach $46.17 billion by 2033.
4. Electronic Remittance Advice (ERA): Electronic remittance processing and payment reconciliation services enabling providers to receive and reconcile payer payments digitally, part of the broader ERA market growth from 2026 to 2033.

Go-to-market motion2 records

Distribution channels4 records

Marketing channels4 records

Core offering

Change Healthcare operates a healthcare financial infrastructure platform providing claims processing, revenue cycle management, payment automation, and interoperability solutions across the U.S. healthcare system. The company serves as a clearinghouse connecting providers, payers, and pharmacies, while also offering end-to-end RCM software, AI-powered medical coding and denial management, electronic remittance advice (ERA), prior authorization automation, and pharmacy claims switch services. Its infrastructure reaches approximately 8 out of 10 U.S. hospitals and processes claims for roughly 200 million Americans.

Product overview

Change Healthcare (now operating as part of Optum following UnitedHealth Group's $13 billion acquisition in 2022) offers a comprehensive healthcare IT and payments infrastructure platform comprising multiple interconnected product lines. The core offering centers on a Claims Management Platform and Revenue Cycle Management (RCM) Solutions that handle end-to-end medical billing, coding, claims submission, and reimbursement processing for healthcare providers across the United States. These core platforms are augmented by AI-powered claims processing modules for automation and denial management, prior authorization solutions, population health management analytics, FHIR-based interoperability solutions for data exchange, healthcare financial analytics, pharmacy benefit management capabilities, electronic remittance advice (ERA), and blockchain solutions for patient data security and supply chain tracking. The portfolio is structured as an integrated platform-plus-modules architecture where the claims management platform serves as the foundational layer, with specialized add-on modules addressing specific workflow needs including prior authorization, analytics, and interoperability.

Differentiator

Problem solved

Functional benefit

Products and services

• Claims Management Platform Change Healthcare's core claims processing platform handling healthcare claims submission, adjudication, and remittance across the U.S. healthcare system. It serves as critical payment infrastructure for providers and payers, processing claims for approximately one-third of the U.S. population.
• Revenue Cycle Management (RCM) Solutions
• AI-Powered Claims Processing Platform
• Prior Authorization Solutions
• Medical Billing Outsourcing Services
• Population Health Management Platform
• FHIR-Based Interoperability Solutions
• Electronic Remittance Advice (ERA)
• Pharmacy Benefit Management (PBM) Solutions
• Blockchain Solutions for Healthcare
• Workflow Intelligence for Radiology

Quantifiable outcome

• 94% of U.S. hospitals experienced cash flow disruptions following the Change Healthcare system outage in February 2024
• +2 more outcomes

Named customers5 records

Segments6 records

Ideal customer profiles5 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration2 records

Feature5 records

Partnerships

Three partnerships are on record, tiered core.

• PokitDok (assets acquired)coreTechnology or Integration · 1 January 2018Change Healthcare acquired key assets from PokitDok in 2018, strengthening its blockchain capabilities for healthcare data security and claims management, and consolidating its position in the healthcare blockchain and data interoperability space alongside IBM, Guardtime, and BurstIQ.
• Google CloudcoreTechnology or IntegrationChange Healthcare partnered with Google Cloud to launch AI-powered platforms for revenue cycle management and claims processing, leveraging Google Cloud's infrastructure and AI capabilities to enhance automation and scalability of healthcare financial solutions.
• Avaneer Health ConsortiumcoreStrategic or Co-development PartnerChange Healthcare participates in the Avaneer Health consortium alongside CVS Health, Aetna, and Cleveland Clinic, developing blockchain-based solutions for healthcare data exchange, insurance claims automation, and interoperability standards across the healthcare ecosystem.

Scale indicators10 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• Waystar Health: Waystar is a direct competitor in healthcare revenue cycle management and claims processing, offering cloud-based RCM software that competes head-to-head with Change Healthcare's clearinghouse and billing automation products for hospitals and physician practices.
• R1 RCM: R1 RCM provides end-to-end revenue cycle management outsourcing and technology for hospitals and physician practices, directly competing with Change Healthcare's medical billing outsourcing and RCM platform offerings.
• Conifer Health Solutions: Conifer Health Solutions delivers revenue cycle management, patient access, and value-based care services to hospitals and health systems, competing directly with Change Healthcare's RCM outsourcing and financial analytics solutions.
• Availity: Availity operates a healthcare clearinghouse and payer-provider connectivity platform that competes directly with Change Healthcare's claims processing infrastructure, particularly for eligibility, claims submission, and remittance workflows.
• Experian Health: Experian Health provides healthcare data, identity management, and revenue cycle solutions including claims management and eligibility verification, directly competing with several of Change Healthcare's RCM and patient access product lines.
• nThrive: nThrive offers revenue cycle management, medical billing, and analytics services to healthcare providers, directly competing with Change Healthcare in the AI medical billing and end-to-end RCM outsourcing markets.
• Ciox Health: Ciox Health specializes in healthcare information management and clinical data exchange, competing with Change Healthcare's data interoperability, health information exchange, and clinical connectivity product lines.

Broad incumbents

• Athenahealth: Athenahealth provides EHR-integrated revenue cycle management, medical billing, and practice management solutions. While broader in scope (EHR + RCM), it directly competes with Change Healthcare in physician-practice billing automation and clearinghouse services.
• Epic Systems: Epic Systems is both a deep integration partner and indirect competitor—its EHR platform embeds billing and claims workflows that compete with Change Healthcare's clearinghouse for hospital RCM, and customers like Star Valley Health have migrated to Epic billing post-incident.

Emerging players

• Health Catalyst: Health Catalyst provides healthcare data and analytics platforms that overlap with Change Healthcare's population health and value-based care analytics offerings, though it is more focused on outcomes analytics than claims clearinghouse.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/change_hc
• Facebookfacebook.com/changehealthcare
• LinkedInlinkedin.com/company/change-healthcare

Revenue estimate

Valuation estimate

Number of profiles

Profiles9 records

Funding overview

Funding rounds6 records

Investors9 records

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

M&A6 records

Investments1 record

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

Frequently asked questions about Change Healthcare