Acentra Health

What Acentra Health does

Acentra Health is a private, Carlyle-backed provider of clinical services and healthcare technology to U.S. federal and state government healthcare agencies, formed in 2023 through the merger of CNSI (healthcare technology) and KEPRO (clinical services), which together brought more than 60 years of public-sector health experience. The company serves as a prime contractor to the Centers for Medicare & Medicaid Services and 34 state Medicaid programs, including as the Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) for Medicare beneficiaries across 29 states — the largest geographic footprint of any CMS-contracted partner in the program.

The company's offerings center on three proprietary technology platforms: evoBrix X, a cloud-based modular Medicaid Management Information System (MMIS) for high-volume claims and encounter processing; Atrezzo, a configurable care management platform for utilization management, care coordination, and population health; and eCAMS HCE, a clinical assessment platform supporting eligibility determinations such as PASRR and Level of Care assessments. These platforms underpin a portfolio of service modules covering provider enrollment and screening, claims adjudication, behavioral health and clinical eligibility assessments, carceral care, pharmacy management, and quality and compliance oversight, with AI-enabled tooling (SmartDoc and Agentic AI Workflows) layered on to automate prior-authorization review and medical coding.

Acentra Health generates revenue primarily through multi-year government contracts awarded via competitive procurement, typically structured as five-year base terms plus option years, with pricing negotiated per contract (not publicly disclosed). Notable contracts include a $298 million CMS BFCC-QIO renewal (September 2024), a $113 million Virginia DMAS utilization management and behavioral health contract, a $56.9 million North Carolina CIAE contract with up to $41.9 million in extensions, and additional work for agencies in Florida, West Virginia, Arizona, Hawaii, Wyoming, Oregon, the U.S. Department of Veterans Affairs, and the Georgia Department of Education. The company employs more than 1,500 people across approximately 20 U.S. offices and is led by CEO Todd Stottlemyer.

Name

Acentra Health

Legal name

Acentra Health, LLC

Website

https://acentra.com

Company type

Private

Founded year

2023

Operating status

Operating

Headcount range

1,001–5,000 employees

Short description

Acentra Health is a Carlyle-backed government healthcare technology and clinical services firm serving CMS and 34 state Medicaid programs via proprietary platforms (evoBrix X MMIS, Atrezzo care management) and BFCC-QIO contracts spanning 29 states and 77M+ beneficiaries.

Ownership category

akta.pro rank

Product category

Government Healthcare Technology and Services

NAICS

Administration of Public Health Programs (923120), Services for the Elderly and Persons with Disabilities (624120), Health and Welfare Funds (525120)

SIC

Hospital & Medical Service Plans (6324), Services-Prepackaged Software (7372)

akta.pro primary industry

Medicare Quality, Risk Adjustment & Stars Analytics/Services (FSAIAGAJ)

akta.pro secondary industry

MA Chronic Condition Management & Supplemental Benefits (SSBCI) (HLAEACAI)

Keywords

• Government healthcare services
• Medicaid management systems
• Care management platform
• Clinical assessment services
• Utilization management solutions

Headquarters

HQ city

Mclean

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Government Healthcare Contracts: Multi-year contracts with federal and state government agencies for healthcare technology and services. Contracts typically span 5 years base plus option periods. Revenue derived from service fees under negotiated contract terms. Major contracts include BFCC-QIO services for Medicare beneficiaries, Medicaid MMIS implementation and operation, and care management services for state Medicaid programs.
2. Clinical Services & Solutions: Fee-for-service and per-member arrangements for clinical assessment, eligibility determination, utilization management, and care coordination services provided to government healthcare programs.
3. Employee Assistance Program (EAP): Acquired EAP Consultants LLC in January 2024 to strengthen employee assistance program offerings for government and commercial clients.

Pricing tiers

Go-to-market motion1 record

Distribution channels4 records

Marketing channels8 records

Core offering

Acentra Health provides healthcare technology platforms and clinical services to federal and state government healthcare agencies. Its core offerings center on proprietary technology platforms (evoBrix X MMIS, Atrezzo care management, eCAMS HCE clinical assessment) combined with clinical services including utilization management, behavioral health assessments, PASRR evaluations, quality oversight, and employee assistance programs. The company serves as a CMS-designated BFCC-QIO for Medicare beneficiaries across 29 states and holds 34 state Medicaid contracts.

Product overview

Acentra Health offers a technology platform-based portfolio of healthcare solutions for government healthcare agencies, centered on three proprietary technology platforms: the Atrezzo care management platform, the evoBrix X Medicaid Management Information System (MMIS), and the eCAMS HCE clinical assessment platform. These platforms deliver services including Provider Engagement (enrollment, screening, credentialing), Claims Processing & Adjudication, Clinical Eligibility assessments (Level of Care, PASRR, Behavioral Health), Care Management (Utilization Management, Carceral Care, Care Coordination, Pharmacy Management, EAP), and Quality & Compliance Oversight. The solutions serve federal and state government healthcare programs including Medicare, Medicaid, and behavioral health services across 34+ state contracts. The company operates as a CMS-designated Quality Improvement Organization (QIO) serving Medicare beneficiaries across 29 states.

Differentiator

Problem solved

Functional benefit

Brands

• Atrezzo: Care management platform integrating essential care management features within a modular, configurable solution.
• evoBrix X
• eCAMS HCE
• NCLIFTSS

Products and services

• Atrezzo Care management platform that integrates essential care management features within a modular, configurable solution to enhance care team coordination and drive better care and improved outcomes. Supports utilization management, behavioral health services, and case management.
• evoBrix X Configurable, modular Medicaid Management Information System (MMIS) platform for high-volume claims and encounter processing, management, and reporting. Ensures payment cycles are not missed with rapid integration, implementation, and deployment options.
• eCAMS HCE Healthcare technology platform supporting clinical assessment and evaluation processes for government healthcare programs.
• Provider Engagement Services Digital solution for provider enrollment, screening, and credentialing including online configurable rules-driven enrollment applications and automated workflows ensuring program adherence to state and federal requirements.
• Claims Processing & Adjudication High-volume claims and encounter processing through configurable MMIS platform, ensuring payment cycle continuity with rapid integration and deployment options.
• Level of Care Assessments Clinical assessments determining appropriate care settings for patients, improving outcomes for beneficiaries with high-risk, high-cost concerns through comprehensive health overviews.
• Preadmission Screening & Resident Review (PASRR) Federally required screening and evaluation services for individuals prior to admission into Medicaid-certified nursing facilities, ensuring appropriate placement and access to needed services.
• Behavioral Health Needs Assessment Comprehensive behavioral health evaluations to identify appropriate care delivery and settings for patients with mental health concerns.
• Utilization Management Service authorization management for inpatient and outpatient medical and behavioral health services, including residential treatment and community mental health rehabilitation.
• Employee Assistance Program (EAP) Employee wellness and productivity programs providing short-term counseling, support services, and connections to long-term treatment options for beneficiaries.
• Quality & Compliance Oversight Services including CMS Waiver Support, Standard of Care Review, Managed Care Oversight, External Quality Review, and Appeals & Grievances to ensure regulatory compliance and care quality.
• Data Analytics Analytics and Machine Learning solutions transforming healthcare administration by optimizing clinical and administrative workflows, identifying fraud, and addressing population health risks through data-driven insights.

Quantifiable outcome

• 30% reduction in medical coder effort through agentic AI workflows
• +5 more outcomes

Named customers10 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

Feature5 records

Scale indicators10 records

Recent moves7 records

Expansion highlights3 records

Direct peers

• NTT DATA: NTT DATA is a major systems integrator delivering state Medicaid systems (MMIS), data analytics, and federal healthcare IT solutions. It competes on similar state Medicaid modernization RFPs that Acentra Health pursues.
• Gainwell Technologies: Gainwell Technologies is a leading provider of Medicaid Management Information Systems (MMIS), claims processing, and analytics for state Medicaid agencies. It is the most direct competitor to Acentra Health's evoBrix X MMIS platform and state Medicaid services franchise.
• Maximus: Maximus provides operational and clinical services, including clinical assessments, care management, and quality oversight, to federal and state government health programs. It directly competes with Acentra Health on state Medicaid assessment and utilization management contracts.
• Conduent: Conduent provides government healthcare services including Medicaid eligibility, claims processing, and member services across multiple states. It is a direct competitor in state Medicaid operations and benefits administration RFPs.
• ICF International: ICF delivers analytics, program implementation, and clinical advisory services to federal and state health agencies. It is a comparable competitor in health informatics, quality measurement, and CMS program support work.

Broad incumbents

• Modivcare: Modivcare provides non-emergency medical transportation and personal care services to Medicaid managed care plans and state agencies. It overlaps with Acentra Health in serving government-funded priority populations through state Medicaid programs.
• Optum (UnitedHealth Group): Optum is the health services arm of UnitedHealth Group, providing government healthcare services, analytics, and care management at massive scale. It competes with Acentra Health across state Medicaid, Medicare, and federal healthcare engagements with a much broader portfolio.
• DXC Technology: DXC Technology delivers federal and state government IT modernization services including healthcare and human services. It pursues similar large-scale government healthcare technology contracts as Acentra Health.
• Cognizant Government Services: Cognizant provides large-scale digital transformation and IT services to federal and state health agencies. It competes for multi-million-dollar government healthcare technology contracts with broader scale and delivery capabilities than Acentra Health.

Emerging players

• HealthEdge: HealthEdge provides core administrative processing systems (claims, benefits, care management) to health plans including government-sponsored plans. It competes in adjacent technology layers to Acentra Health's evoBrix X and Atrezzo platforms.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat7 records

Key risks5 records

Key highlights6 records

Customer concentration

• Xtwitter.com/AcentraHealth
• LinkedInlinkedin.com/company/acentra-health
• Instagraminstagram.com/acentrahealth

Compliance9 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 records

Subsidiaries1 record

Funding overview

Funding rounds

Investors

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

M&A4 records

Investments

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

Frequently asked questions about Acentra Health