Episource
- Company typePrivate
- Founded2006
- HeadquartersGardena, United States
- Headcount5,001–10,000
- GTM typeB2B
- OfferingSoftware
Episource firmographics
Firmographics- Name
- Episource
- Website
- https://episource.com
- Company type
- Private
- Founded year
- 2006
- Operating status
- Operating
- Headcount range
- 5,001–10,000 employees
- Ownership category
- akta.pro rank
Episource industry classification
Industry- Product category
- Healthcare Risk Adjustment Software
- NAICS
- Software Publishers (513210), Custom Computer Programming Services (541511), Information (51)
- SIC
- Services-Prepackaged Software (7372), Services-Computer Programming, Data Processing, Etc. (7370), Accident & Health Insurance (6321)
- akta.pro primary industry
- Risk Stratification, Early Warning Scores & Predictive Analytics (HLACAGAE)
- akta.pro secondary industries
- Adherence, Reminders & Engagement Automation (Medication/Follow-up) (HLACAEAJ), Diagnostic & Triage Decision Support (HLACAGAA)
Keywords
Where Episource is headquartered
LocationHeadquarters
- HQ city
- Gardena
- HQ country
- United States
- HQ region
- North America
Markets served
Episource business model
Business model- GTM type
- B2B
- Offering type
- Software
- Cost components
- Technology or R&D, Personnel, Operations, Infrastructure, Marketing or Sales
Episource product offering
Product offeringCore offering
Episource develops and delivers healthcare risk adjustment, quality, and member engagement software and services for payers and health systems. Its solutions combine analytics, AI, and clinical data management to improve risk score accuracy, HEDIS performance, and value-based care outcomes. The company also operates a clinical data platform for medical chart retrieval.
Differentiator
Problem solved
Functional benefit
Products and services
- Retrospective Solutions A retrospective risk adjustment solution suite that uses the largest Medicare Advantage database in the industry to power analytics that improve risk score accuracy and documentation completeness for healthcare payers.
- Prospective Solutions Solution suite that delivers tailored pre-visit insights and point-of-care support so that health systems, hospitals, and payers can capture complete documentation and improve member outcomes prospectively.
- Quality Solutions Suite designed to help payers improve quality performance through a comprehensive, innovative approach to managing HEDIS, closing care gaps, and supporting higher Star Ratings.
- Medicaid Risk Adjustment and Quality Solution suite that helps payers optimize and support their Medicaid risk adjustment and quality programs using Optum's expertise, breadth, and scale.
- Member Engagement Solutions Member engagement solution suite that helps payers precisely target the right members, understand how to support them, and efficiently deliver programs tailored to each member's needs to drive better health behaviors and outcomes.
- Risk Analytics Comprehensive risk adjustment analytics platform service that helps health systems, hospitals, and payers evaluate data to generate actionable insights for risk and quality programs.
- Risk Adjustment Program Assessment Consultative service that combines advanced risk adjustment analytics technology with deep subject matter expertise to give health systems, hospitals, and payers a 360-degree view of their risk adjustment program.
- Risk Adjustment Service Organization Solution suite that integrates deep risk adjustment expertise with streamlined delivery and productivity to help payers optimize the outcomes of their risk adjustment programs.
- Clinical Data Center Self-service platform service that simplifies medical chart retrieval and storage for payers, designed to lower total operational costs of clinical data management.
Companies that use Episource
Customer profileNamed customers2 records
Segments1 record
Ideal customer profiles2 records
Episource technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Episource partnerships and signals
Strategic signalPartnerships
Two partnerships are on record, tiered core.
- OptumcoreEpisource operated as a third-party business associate to Optum, providing health information management and risk adjustment services. The partnership was subject to a significant data breach in 2025 affecting Optum/UnitedHealth customer data.
- UnitedHealthcoreEpisource served as a business associate to UnitedHealth Group, providing data services for healthcare operations. A 2025 data breach exposed 5.42 million individuals through this relationship.
Scale indicators2 records
Recent moves5 records
Expansion highlights4 records
Episource competitors and assessment
Company assessmentEmerging players
- Datavant: Datavant provides health data connectivity and de-identification services that link clinical, claims, and social determinants data for payers and providers. It is comparable to Episource because it underpins risk adjustment and quality analytics workflows that depend on linking disparate clinical datasets.
- Cedar Gate Technologies: Cedar Gate Technologies offers value-based care analytics, payment accuracy, and risk adjustment solutions for payers, providers, and employers. It is comparable to Episource because it sells analytics-driven risk and quality products into the same payer market segment.
- Edifecs: Edifecs provides healthcare data interoperability, risk adjustment, and quality management software for payers and providers. It is comparable to Episource because it offers overlapping risk adjustment and quality analytics capabilities, though it is more focused on EDI/interoperability and serves a slightly different buyer profile.
Direct peers
- Cotiviti: Cotiviti is a leading healthcare technology and analytics company specializing in risk adjustment, payment accuracy, and quality improvement for payers, including MA and Medicaid plans. It is directly comparable to Episource because both firms sell analytics-driven risk adjustment and quality solutions to the same payer customer base using clinical and claims data.
- Inovalon: Inovalon provides cloud-based healthcare data analytics and risk adjustment solutions to payers, providers, and pharmacy organizations. It is directly comparable to Episource because both companies use large clinical datasets and analytics engines to support payer risk score accuracy, HEDIS quality reporting, and member outcomes management.
- Evolent Health: Evolent Health provides value-based care and specialty care management services, including risk adjustment and quality performance support for payers and providers. It is directly comparable to Episource because both target the payer market with analytics and services that improve risk adjustment accuracy and value-based care outcomes.
- Health Catalyst: Health Catalyst is a healthcare data and analytics platform serving health systems and payers with population health, quality, and risk adjustment capabilities. It is directly comparable to Episource because both operate data platforms that combine clinical and claims data to drive risk and quality outcomes for payer-provider clients.
Broad incumbents
- Optum (UnitedHealth Group): Optum is Episource's parent and the broader health services and innovation arm of UnitedHealth Group, offering the same risk adjustment, quality, and member engagement capabilities at a portfolio level. It is directly comparable because Episource effectively operates as a delivery arm within Optum's risk adjustment business and competes with Optum's other internal offerings for payer mindshare.
- Change Healthcare (now Optum): Change Healthcare, acquired by Optum/UnitedHealth Group, provides revenue cycle, payment accuracy, and risk adjustment analytics across the payer-provider ecosystem. It is comparable because it competes in the same risk adjustment and healthcare analytics space as Episource and is now part of the same parent organization.
Regional players
- SCIO Health Analytics (now part of emids): SCIO Health Analytics, now part of emids, delivers risk adjustment, quality, and care management analytics services to health plans globally, with strong delivery in India. It is comparable to Episource because both offer payer-focused risk adjustment and quality analytics using clinical/claims data, with overlapping services and delivery models.
Market position
Strengths4 records
Weaknesses4 records
Competitive moat5 records
Customer concentration
Episource social profiles
Digital presenceEpisource financial estimates
Financial estimateRevenue estimate
Valuation estimate
Episource leadership team
Management profileNumber of profiles
Profiles4 records
Episource funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Episource M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Episource
What does Episource do?
Episource develops and delivers healthcare risk adjustment, quality, and member engagement software and services for payers and health systems. Its solutions combine analytics, AI, and clinical data management to improve risk score accuracy, HEDIS performance, and value-based care outcomes. The company also operates a clinical data platform for medical chart retrieval.
When was Episource founded?
Episource was founded in 2006. It employs 5,001 to 10,000 people.
Where is Episource based?
Episource is headquartered in Gardena, United States, in the North America region.
Who are Episource's main competitors?
Emerging players on record are Datavant, Cedar Gate Technologies and Edifecs. Direct peers are Cotiviti, Inovalon, Evolent Health and Health Catalyst. Broad incumbents are Optum (UnitedHealth Group) and Change Healthcare (now Optum). SCIO Health Analytics (now part of emids) is listed as a regional player.
Does Episource have an API?
No public API is recorded for Episource.
What industry is Episource in?
Episource's product category is Healthcare Risk Adjustment Software. Its primary akta.pro industry code is HLACAGAE, Risk Stratification, Early Warning Scores & Predictive Analytics, with a secondary code of HLACAEAJ, Adherence, Reminders & Engagement Automation (Medication/Follow-up). Its NAICS code is 513210 and its SIC code is 7372.