Centauri Health Solutions

Name

Centauri Health Solutions

Legal name

Centauri Health Solutions, Inc.

Website

https://centaurihs.com

Company type

Private

Founded year

2014

Operating status

Operating

Headcount range

101–250 employees

Ownership category

akta.pro rank

Product category

Healthcare Data Analytics and Interoperability

SIC

Services-Health Services (8000), Hospital & Medical Service Plans (6324)

akta.pro primary industry

Chronic Condition Virtual Care & Disease Management (Payer-Sponsored) (HLALACAE)

akta.pro secondary industry

Employer/Member Engagement Platforms for Provider-Sponsored Plans (HLACAEAM)

Keywords

• Healthcare data analytics
• Risk adjustment services
• Eligibility enrollment
• Clinical data exchange
• HEDIS quality reporting

Headquarters

HQ city

Scottsdale

HQ country

United States

HQ region

North America

Offices4 records

Markets served

GTM type

B2B

Offering type

Software

Cost components

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

Revenue model

1. Health Plan Solutions: Technology-enabled services and SaaS solutions sold to Medicare Advantage and Medicaid health plans, including risk adjustment, quality optimization, benefit eligibility/enrollment, and clinical data exchange. Revenue is generated through a combination of service fees and software platform subscriptions, with outcomes-based dynamics tied to client performance metrics.
2. Hospital/Health System Solutions: Revenue cycle optimization services for hospitals and health systems including eligibility/enrollment, out-of-state Medicaid billing, pricing analytics, charge accuracy, denials intelligence, referral management, and clinical data exchange. Delivered via SaaS model and professional services engagements.

Go-to-market motion1 record

Distribution channels2 records

Marketing channels7 records

Core offering

Centauri Health Solutions is a healthcare technology company that delivers integrated SaaS platforms and technology-enabled services to U.S. health plans and health systems. Its core offerings span benefit eligibility/enrollment and retention, intelligent risk adjustment, HEDIS/Stars quality optimization, care coordination via real-time ADT notifications, and nationwide clinical data exchange through QHIN-enabled networks. Solutions are sold as standalone products (e.g., Best Benefits, PremiumAssist, SES Notify, Precise) and as an integrated suite covering 60M+ members across 60+ health plans.

Product overview

Centauri Health Solutions is a healthcare technology platform company offering integrated solutions for U.S. health plans and health systems. The portfolio operates as a platform-plus-modules architecture combining eligibility/enrollment, risk adjustment, quality optimization, care coordination, and clinical data exchange. Core products include Best Benefits (SSI/SSDI enrollment), PremiumAssist (dual eligible enrollment), Member Insights (dual member engagement), and Medicaid Retention for benefit activation; Intelligent Risk Adjustment and Quality Optimization/Precise® (HEDIS engine) for risk and quality; SES Notify (ADT notifications) and MedAllies QHIN (clinical data network) for care coordination and interoperability. Additional offerings span Stars Quality Solution, SDOH, Revenue Cycle Analytics, and referral management. The company serves 60+ health plans including all top 10 U.S. health plans, 60M+ members, and 1,000+ hospitals/5,000+ ambulatory organizations.

Differentiator

Problem solved

Functional benefit

Brands

• Secure Exchange Solutions (SES): Clinical data exchange platform providing ADT notifications, physician connectivity, and interoperability solutions. SES Notify ranked #1 in 2026 Best in KLAS for ADT Notifications.
• SES Notify
• Best Benefits
• PremiumAssist
• Member Insights
• MedAllies
• Precise

Products and services

• Intelligent Risk Adjustment Risk adjustment solution providing digital-first medical record retrieval, focused manual retrieval, and coding for accurate HCC documentation, enabling Medicare Advantage and Medicaid health plans to capture capitation revenue.
• Quality Optimization / Precise HEDIS management and reporting solution with NCQA certification continuously since 2006, covering 81+ measures with systematic sampling and survey integration to support Star Ratings improvement for Medicare Advantage and Medicaid health plans.
• SES Notify Real-time admission, discharge, and transfer (ADT) notification platform ranked #1 in the 2026 Best in KLAS, enabling care teams to receive alerts via Direct Secure Messaging and EHR integration for care coordination.
• Best Benefits SSI/SSDI eligibility and enrollment solution for Medicaid Managed Care Plans that identifies eligible members, conducts outreach, and drives disability benefit enrollment with approval rates 30-50% higher than national SSA averages.
• PremiumAssist Dual-eligible outreach, enrollment, and redetermination services for Medicare Advantage Plans and Dual Special Needs Plans, with proactive retention strategies that reduce Medicaid fall-off length by half.
• Member Insights AI-driven member engagement solution for dual-eligible Medicare Advantage members combining compassionate outreach, real-time ADT event monitoring, SDOH assessments, and referral coordination to drive retention and care coordination.
• Medicaid Retention Post-PHE recertification and retention solution helping health plans navigate Medicaid redeterminations with compassionate outreach, state-specific eligibility assessments, and retention workflows.
• Clinical Data Network / MedAllies QHIN Qualified Health Information Network (QHIN) connecting 300M+ participants through Carequality, CommonWell, eHealth Exchange, and MedAllies QHIN-enabled networks, providing nationwide clinical data exchange infrastructure supporting TEFCA participation.
• Revenue Cycle Analytics (RCA) Hospital revenue cycle optimization SaaS platform including Pricing Analytics, Charge Accuracy, Denials Intelligence, and Price Transparency, serving 120+ hospital clients.

Quantifiable outcome

• Best Benefits program reveals $2.3 billion annually in health plan revenue and member payments/resources.
• +4 more outcomes

Named customers3 records

Segments3 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability7 records

Feature8 records

Partnerships

Three partnerships are on record, tiered minor and core.

• Elevate Patient Financial SolutionsminorOthers · 16 February 2026ElevatePFS completed the acquisition of Centauri Health Solutions' Health Systems Services division in February 2026, expanding its revenue cycle management capabilities to include Medicaid and disability enrollment services and out-of-state billing.
• MedAlliescoreStrategic or Co-development Partner · 24 April 2025Centauri acquired MedAllies in April 2025, adding a Qualified Health Information Network (QHIN) and HISP infrastructure. The acquisition added 1,000 hospitals, 5,000 ambulatory organizations, and 125,000 healthcare providers to Centauri's national clinical exchange network.
• Secure Exchange Solutions (SES)coreStrategic or Co-development Partner · 8 December 2021Centauri acquired Secure Exchange Solutions in December 2021, expanding clinical data exchange capabilities and physician connectivity. SES is a Rockville, Maryland-based health IT provider focused on clinical data exchange. SES Notify became a #1 KLAS-ranked ADT notification platform.

Scale indicators13 records

Recent moves6 records

Expansion highlights6 records

Broad incumbents

• Optum (UnitedHealth Group): Largest healthcare technology and services platform globally, providing risk adjustment, quality, care coordination, and clinical data analytics to payers and providers. Operates a much broader portfolio than Centauri, including OptumInsight (formerly Change Healthcare), OptumRx, and OptumHealth, making it the dominant incumbent against which Centauri competes in payer analytics.
• Change Healthcare (OptumInsight): Major healthcare technology company (now part of Optum following 2022 acquisition) providing revenue cycle, clinical data exchange, payer-provider connectivity, and analytics. Overlaps with Centauri's hospital revenue cycle and clinical data exchange products at much larger scale.
• Cognizant (Healthcare Business): Global IT services firm with a sizable healthcare practice delivering payer consulting, risk adjustment, quality, and digital transformation services. Competes for similar enterprise payer B2B services budgets as Centauri but from a consultancy/outsourcing model.
• Merative (formerly Truven Health Analytics): Healthcare analytics company (owned by Francisco Partners) providing outcomes research, payer analytics, risk and quality solutions for health plans and providers. Comparable payer-analytics and quality/risk product set with broader outcomes research capabilities.

Direct peers

• Cotiviti: Private-equity-backed (Veritas Capital) healthcare analytics company providing payment integrity, risk adjustment, quality (Stars/HEDIS), and clinical data exchange solutions to health plans. Closest direct peer to Centauri in payer risk adjustment and quality optimization.
• Inovalon: Healthcare data analytics platform serving health plans and providers with risk adjustment, quality, provider engagement, and clinical data exchange products. Highly comparable to Centauri on payer-facing risk adjustment and quality workflow.
• Edifecs: Healthcare data interoperability and analytics company specializing in payer-provider data exchange, risk adjustment analytics, and value-based care enablement. Directly comparable technology stack and customer base to Centauri's interoperability and risk adjustment business.
• EXL Health (EXL Service): Analytics and digital solutions division of EXL Service providing risk adjustment, care management, and population health analytics for health plans. Similar payer-services-and-analytics business model competing for similar payer budgets.

Emerging players

• Health Catalyst: Public health system-focused data and analytics platform providing population health, quality, and revenue cycle analytics. Historically more provider-side than Centauri but increasingly overlapping in payer-provider data exchange.
• Persivia: Population health management and risk adjustment analytics company serving health plans, ACOs, and providers. Competes with Centauri in risk adjustment and population health segments at smaller scale.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks5 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/1611744362392370
• LinkedInlinkedin.com/company/centauri-health-solutions
• Instagraminstagram.com/centaurihs
• Xx.com/centaurihs

Compliance6 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles15 records

Subsidiaries8 records

Funding overview

Funding rounds3 records

Investors2 records

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

M&A10 records

Investments

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

Frequently asked questions about Centauri Health Solutions