Elligint Health

What Elligint Health does

Elligint Health is a privately held healthcare technology company founded in 2024 and headquartered in Edison, New Jersey. The company provides a cloud-native clinical operating system called Helios for health plans, payers, value-based care organizations, LTSS programs, and government health programs. Helios unifies care management (Helios CM), utilization management (Helios UM), and advanced analytics in a single FHIR-native, AI-ready platform, with a curated partner ecosystem extending functionality for prior authorization (Itiliti Health), implementation (Impresiv Health), BPaaS operations (Sagility), and clinical review (MRIoA). The platform is reported to support over 13M covered lives and is positioned for compliance with CMS-0057-F prior authorization reforms, HEDIS, and NCQA standards.

The business model is primarily enterprise SaaS subscription, with annual billing on quote-based pricing, supplemented by transaction-based clearinghouse revenue (E-Connect for claims processing) and implementation services delivered through strategic alliance partners. The go-to-market is sales-led, targeting enterprise health plan decision-makers via direct field sales, with a Chief Growth Officer and dedicated account management functions. Marketing is executed through executive thought leadership, content marketing, a monthly newsletter, podcast appearances, and PR. The company combines operations of two prior award-winning companies under a unified corporate umbrella launched in January 2025, supported by a $4.2M exempt securities offering filed the same month.

Elligint Health maintains a leadership team of healthcare IT veterans, including a CEO with 30+ years of industry experience, a Chairman with similar tenure, a Chief Medical Officer, a CTO with 20+ years, and heads of growth, product, analytics, marketing, and clinical operations recruited from organizations such as HealthEC, Excellus BCBS, HCSC, Centene, Collaborative Health Systems, and the University of Rochester Medical Center. Strategic Advisory and Client Advisory Boards were established in mid-2025 to formalize industry input into product strategy. The company is recognized as a KLAS Research Top Performer for care management in 2025 and has been cited by Gartner for ecosystem-based care coordination.

Name

Elligint Health

Legal name

Elligint Health, LLC

Website

https://elliginthealth.com

Company type

Private

Founded year

2024

Operating status

Operating

Headcount range

51–100 employees

Short description

Elligint Health provides the cloud-native, FHIR-native Helios platform for health plans and value-based care organizations, unifying care management, utilization management, and advanced analytics with AI-ready architecture and curated partner integrations.

Ownership category

akta.pro rank

Product category

Healthcare Management Software

NAICS

Computer Systems Design Services (541512), Computer Systems Design and Related Services (5415), Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (51821), Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (518)

SIC

Services-Prepackaged Software (7372), Services-Health Services (8000), Services-Computer Programming, Data Processing, Etc. (7370), Services-Computer Integrated Systems Design (7373)

akta.pro primary industry

EHR Extensions, APIs, App Marketplaces & SMART-on-FHIR Apps (HLACAAAN)

akta.pro secondary industries

Data Aggregation, Interoperability & APIs for RPM (FHIR/IoMT Gateways) (HLACAFAO), Clinical Decision Support & Workflow Integration (EHR/oncology systems) (HLAAANAE)

Keywords

• Care management software
• Utilization management software
• Healthcare analytics platform
• Value-based care platform
• FHIR interoperability platform

Headquarters

HQ city

Edison

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Software

Cost components

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

Revenue model

1. Software Platform Subscription: Subscription-based SaaS model for Helios platform including Care Management, Utilization Management, and Advanced Analytics modules. Revenue generated from platform licensing to health plans and payers.
2. Clearinghouse Services: E-Connect clearinghouse services for claims processing and payment workflows, generating transaction-based revenue from payer and provider organizations.
3. Implementation Services: Implementation and consulting services through strategic alliance partners like Impresiv Health for system conversions and deployment.

Pricing tiers

Go-to-market motion2 records

Distribution channels1 record

Marketing channels6 records

Core offering

Elligint Health sells the Helios clinical operating system, a cloud-native, FHIR-native, AI-ready platform that unifies care management (Helios CM), utilization management (Helios UM), and Advanced Analytics into a single configurable ecosystem for health plans, payers, and value-based care organizations. The platform is augmented by the E-Connect cloud-based clearinghouse for claims and payment processing and a curated Partner Ecosystem of pre-built clinical integrations, with implementation and operational services delivered through strategic partners such as Impresiv Health and Sagility.

Product overview

Elligint Health offers a unified platform architecture centered on the Helios® platform, which serves as the clinical operating system for modern value-based care. The platform combines three core capabilities: Helios CM (care management) and Helios UM (utilization management) for operational workflows, Advanced Analytics for predictive insights, and a Partner Ecosystem that extends functionality through pre-built integrations. Supporting this ecosystem is Helios Hub for FHIR-native interoperability. The company also offers E-Connect as a standalone clearinghouse product for claims and payment processing.

Differentiator

Problem solved

Functional benefit

Brands

• Helios: Elligint Health's flagship clinical operating system platform for modern value-based care, including Helios CM (Care Management), Helios UM (Utilization Management), and related modules.
• E-Connect

Products and services

• Helios Platform Cloud-native, FHIR-native, AI-ready clinical operating system for modern value-based care that unifies care management, utilization management, and analytics in a single configurable ecosystem with 90% configurability out-of-the-box. Sold to health plans, payers, and value-based care organizations.
• Helios CM (Care Management) Care management module that streamlines proactive care management through configurable workflows, intelligent automation at scale, intelligent care planning, assessments and risk stratification, transitions of care, chronic disease management, and referral tracking. Sold to health plans and value-based care organizations.
• Helios UM (Utilization Management) Utilization management module that streamlines prior authorization, automated decision support, smart routing, configurable tracking, grievances and appeals, and medical necessity review aligned with CMS-0057-F reforms. Sold to health plans and payers.
• Advanced Analytics Analytics module that transforms clinical, financial, and operational data into predictive insights, surfacing risk, quality gaps, and performance across clinical, operational, and financial domains, including risk adjustment insights for value-based contracts. Sold to health plans, payers, and value-based care organizations.
• E-Connect Clearinghouse Cloud-based clearinghouse platform providing real-time eligibility verification, instant claims validation and submission, automated remittance and payment processing, built-in payer rules updates, and robust reporting for streamlined claims and payment workflows. Backed by over 14 years of payer endorsements. Sold to payer and provider organizations.

Quantifiable outcome

• 93% efficiency gains reported by clients
• +4 more outcomes

Named customers2 records

Segments4 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability8 records

Feature8 records

Partnerships

Six partnerships are on record, tiered core and strategic.

• Impresiv HealthcoreImplementation/ SI/ Consulting Partner · 13 January 2026Healthcare consulting firm specializing in clinical operations transformation and software consulting. Works alongside Elligint Health to help organizations successfully transition to the Helios platform and accelerate operational readiness. Provides gold-standard implementation model with pre-configured program structures, clinically informed workflows, and structured deployment methodology.
• Medical Review Institute of America (MRIoA)strategicStrategic or Co-development Partner · 14 May 2025Strategic collaboration announced May 2025 to transform clinical decision-making through integration of advanced data analytics and expert clinical insights. Combines Helios platform with MRIoA's industry-leading clinical expertise to streamline medical review processes, improve prior authorization efficiency, and reduce administrative burdens.
• Itiliti HealthcoreTechnology or Integration · 1 January 2024Partnership announced in 2024 to enhance Helios platform for utilization management and prior authorization. Combined solution streamlines automation, boosts interoperability, guides decisions with evidence-based support, and clearly communicates payer rules. Provides rules engines, clinically vetted UM/CM workflows, and integration with InterQual and MCG guidelines.
• Amazon Web Services (AWS)coreTechnology or IntegrationAWS supports the secure, scalable cloud foundation behind Elligint Health's Helios platform. Together they enable organizations to operate with greater resilience, security, and agility while supporting AI-enabled capabilities. Provides advanced data and AI capabilities supporting continuous innovation.
• LabcorpstrategicStrategic or Co-development PartnerBrings decades of experience, broad healthcare market perspective, diagnostic expertise, and data-informed insight. Through this strategic relationship, Elligint Health benefits from expanded visibility into healthcare trends, emerging opportunities, and clinical/operational dynamics shaping payer and provider organizations.
• SagilitystrategicImplementation/ SI/ Consulting PartnerHealthcare operational services providing consulting, analytics, and Business Process as a Service (BPaaS). Supports payers and providers in operating and scaling care and utilization management programs with end-to-end operational support and scalable teams.

Scale indicators4 records

Recent moves6 records

Expansion highlights7 records

Direct peers

• Medecision: Medecision provides the Aerial platform for payer care management, utilization management, and member engagement — a direct competitor in the same health plan clinical operations category as Elligint.
• ZeOmega: ZeOmega provides the Jiva platform for payer care management, utilization management, population health, and value-based care — the closest functional analog to Elligint's Helios suite across health plan workflows.
• Cohere Health: Cohere Health is an AI-powered prior authorization and utilization management platform for health plans, directly competing with Helios UM in the same CMS-0057-F regulatory buying window.
• VirtualHealth: VirtualHealth offers HELIOS (unfortunate name collision), a care management and UM platform for health plans and managed care organizations with comparable modular architecture and value-based care focus.
• Altruista Health (HealthEdge): Altruista Health, now part of HealthEdge, delivers the GuidingCare care management platform for Medicaid, Medicare, and commercial health plans — overlapping deeply with Helios CM and UM.

Broad incumbents

• HealthEdge: HealthEdge provides a broader payer technology suite (core admin, payment integrity, care management via Altruista) that competes across multiple layers of the stack Elligint targets.
• Inovalon: Inovalon offers data-driven healthcare analytics, risk adjustment, and quality measurement for payers — overlapping with Elligint's Advanced Analytics and value-based care reporting capabilities.
• Health Catalyst: Health Catalyst is a healthcare analytics and outcomes improvement vendor with payer/provider-facing data and workflow solutions that overlap with Elligint's Advanced Analytics layer.

Emerging players

• Innovaccer: Innovaccer provides a unified health data platform with FHIR-native interoperability, analytics, and care management workflows targeted at payers and providers — comparable in architecture and buyer.
• Aledade: Aledade partners with independent primary care providers in value-based care arrangements — sharing the same value-based care buyer/ecosystem as Elligint, though focused on provider enablement rather than payer workflows.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/elligint-health

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles14 records

Funding overview

Funding rounds1 record

Investors

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

M&A

Investments

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

Frequently asked questions about Elligint Health