Noridian Healthcare Solutions

What Noridian Healthcare Solutions does

Noridian Healthcare Solutions is a privately held healthcare administrative services contractor headquartered in Fargo, North Dakota, founded in 1966 and operating as an LLC under the parent holding company HealthyDakota Mutual Holdings. The company administers federal, state, and commercial healthcare programs on behalf of payers, processing over 270 million claims totaling more than $97 billion annually (FY2025 disclosed figures), serving nearly 24 million healthcare recipients, and working with over 520,000 providers, facilities, and suppliers across all 50 U.S. states and several territories. Its core customers are the federal Centers for Medicare & Medicaid Services (CMS), state Medicaid agencies (notably Iowa and North Dakota), and — increasingly — commercial health plans.

The company organizes delivery around three product suites: Noridian FHe (Federal Healthcare) for CMS MAC work, encompassing Claims Management, Medical Review, Contact Centers, and Provider Management; Noridian MXe (Medicaid Experience Elevated) for state Medicaid modular solutions under the Noridian-as-prime model; and Noridian PXe for commercial and government health plans covering Payment Integrity, Utilization Management, Provider Management, Contact Centers, and Claims Management. Underlying technology is a contracted-services architecture: a modern IT platform operated by approximately 150 IT professionals delivering FISMA High and Moderate compliant solutions, an ISO 9001:2015-certified quality management system, integrated EDI gateway (operated historically through partner EDI Partners for HIPAA X12 transactions), and a SaaS modular Medicaid stack co-developed with HHS Technology Group. Clinical depth is provided by 328 in-house clinicians including ~250 physicians and nurses serving as medical directors and reviewers, with senior medical oversight from MD/PhD-trained VP of Medical Policy Fred Mamuya.

Revenue is generated predominantly through multi-year fixed-price and cost-reimbursable government contracts awarded via competitive procurement, with disclosed contract values spanning the $525M Jurisdiction E MAC award (base + 6 option years), $227M SMRC, $137.7M DME Jurisdiction D, $90.9M DME Jurisdiction A, and a $48M Iowa Medicaid MMIS contract. Distribution is direct to government buyers supplemented by channel/sub-contractor partnerships (RELI Group, HTG, EDI Partners, Acorn Credentialing, Verve LLC). The go-to-market function was materially strengthened from late 2021 onward through additions of a Chief Growth Officer, VP of Product & Bid Management, VP of Channel Management, Director of Government Affairs, and dedicated Market Leads for Commercial Health Plans and Public Sector, oriented toward expanding beyond core MAC contracts into modular Medicaid and commercial health plan opportunities.

Name

Noridian Healthcare Solutions

Legal name

Noridian Healthcare Solutions, LLC

Website

https://noridiansolutions.com

Company type

Private

Founded year

1966

Operating status

Operating

Headcount range

1,001–5,000 employees

Short description

Noridian Healthcare Solutions is a Fargo, North Dakota-based private government healthcare contractor founded in 1966 that administers Medicare and Medicaid programs through four active MAC contracts covering all 50 U.S. states, processing over 270 million claims annually for federal, state, and commercial health-plan clients.

Ownership category

akta.pro rank

Product category

Healthcare Administration Services

NAICS

Health Care and Social Assistance (62)

SIC

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

akta.pro primary industry

Government Program Administrative Services (Medicare/Medicaid ASO/TPA) (HLAEALAO)

akta.pro secondary industry

Medicare Plan Administration & Third-Party Services (TPA/BPO, Enrollment, Billing) (FSAIAGAI)

Keywords

• Medicare administration services
• Medicaid management solutions
• Healthcare claims processing
• Medical review services
• Provider enrollment management

Headquarters

HQ city

Fargo

HQ country

United States

HQ region

North America

Offices9 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Government Healthcare Administration Contracts: Noridian generates revenue primarily through Medicare Administrative Contractor (MAC) contracts with CMS and Medicaid contracts with state governments. These are multi-year contracts with defined scopes of work for claims processing, medical review, and provider management services.
2. Medicare Part A/B MAC Contracts: Jurisdiction E and F contracts processing Medicare Part A and Part B claims. JE contract valued at $525 million with base year and six optional one-year renewals. JF contract covers 10 states serving 74,000 physicians and over 500 hospitals.
3. DME MAC Contracts: Durable Medical Equipment contracts for Jurisdictions A and D. DME JD contract valued at more than $137.7 million. DME JA contract valued at more than $90.9 million.
4. State Medicaid Contracts: Core MMIS Services contracts with state governments including Iowa ($48 million contract) and North Dakota. Covers claims processing, provider support, and program administration.
5. Supplemental Medical Review Contractor (SMRC): $227 million contract to conduct nationwide medical review of Part A, Part B and DME providers and suppliers as directed by CMS.

Pricing tiers

Go-to-market motion3 records

Distribution channels4 records

Marketing channels5 records

Core offering

Noridian Healthcare Solutions is a government contractor that administers federal and state healthcare programs, providing claims processing, medical review, provider enrollment and management, contact center operations, payment integrity/utilization management, and EDI services. As a Medicare Administrative Contractor (MAC), it processes Medicare Part A/B and Durable Medical Equipment (DME) claims for CMS across multiple jurisdictions, and operates state Medicaid management information systems (MMIS) for agencies in Iowa and North Dakota, serving federal, state, and commercial health plan customers nationwide.

Product overview

Noridian Healthcare Solutions operates as a platform-plus-modules architecture offering administrative services for federal, state, and commercial healthcare programs. The Federal Programs (FHe) suite includes Claims Management, Medical Review, Contact Centers, and Provider Management. The State Programs use the Medicaid Experience Elevated (MXe) product suite for utilization management, provider management, contact centers, and claims processing. Health Plans are served through the PXe platform offering Payment Integrity & Utilization Management, Provider Management, Contact Centers, and Claims Management. Additionally, Noridian holds multiple CMS Medicare Administrative Contractor contracts including Jurisdiction E (Part A/B for CA, NV, HI, territories), Jurisdiction F (Part A/B for AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY), DME Jurisdiction A (12 Northeast states), and DME Jurisdiction D (20 Western/Midwestern states). The company also provides EDI outsourcing services, Iowa Medicaid MMIS services, Supplemental Medical Review Contractor (SMRC) services, and Unified Program Integrity Contractor (UPIC) services.

Differentiator

Problem solved

Functional benefit

Brands

• Noridian FHe: Federal healthcare program solutions including claims management, medical review, contact centers, and provider management for federal programs.
• Noridian MXe
• Noridian PXe

Products and services

• Noridian FHe (Federal Healthcare) Suite Integrated suite of services for federal healthcare programs that administers Medicare claims processing, medical review against CMS guidelines, provider enrollment and management, contact center support for providers and members, and domain & system expertise. Sold as a multi-module offering tailored for federal healthcare program customers such as CMS MAC contracts.
• Noridian MXe (Medicaid Experience Elevated) Suite Medicaid Experience Elevated product suite for state Medicaid programs that delivers utilization management, provider enrollment/management, contact center services for members and providers, and claims management under the Core MMIS structure. Targeted at state Medicaid agencies needing to stand up or scale operations quickly and manage compliance.
• Noridian PXe (Payer Experience Elevated) Suite Payer Experience Elevated product suite for commercial and government health plans delivering payment integrity and utilization management, provider network management, contact center services, and claims management. Named a preferred vendor by ACAP (Association for Community Affiliated Plans), providing administrative outsourcing for community health plans.
• Medicare Part A/B MAC Jurisdiction E Contract Medicare Administrative Contractor contract processing Part A and Part B claims for California, Nevada, Hawaii, American Samoa, Guam, and Northern Mariana Islands. Serves 118,765 physicians and over 440 hospitals. Represents nearly 10% of national Medicare Part A and B claims volume.
• Medicare Part A/B MAC Jurisdiction F Contract Medicare Administrative Contractor contract processing Part A and Part B claims for Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming. Serves 74,000 physicians and over 500 hospitals. Represents 6.2% of national Part A and B claims volume.
• DME MAC Jurisdiction A Contract Durable Medical Equipment Medicare Administrative Contractor contract covering 12 Northeast states including Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont. Accounts for approximately 18% of national Medicare DME claims volume.
• DME MAC Jurisdiction D Contract Durable Medical Equipment Medicare Administrative Contractor contract covering 20 Western and Midwestern states including Alaska, Arizona, California, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming.
• Supplemental Medical Review Contractor (SMRC) Contract to conduct nationwide medical review of Part A, Part B, and DME providers and suppliers as directed by CMS, valued at $227 million. Supports CMS program integrity and fraud, waste, and abuse prevention goals.
• Iowa Medicaid Enterprise (IME) Core MMIS Services Medicaid Management Information System services for Iowa's Medicaid program, maintaining the system that processes Medicaid claims, supports providers, and manages the IME mailroom. Serves over 588,000 managed care members and 50,000 monthly fee-for-service members. Contract valued at $48 million.
• Unified Program Integrity Contractor (UPIC) Program integrity contract participating in a CMS initiative to consolidate fraud, waste, and abuse programs across Medicare and Medicaid. Delivered under a $2.5 billion IDIQ vehicle awarded in 2016.
• EDI Outsourcing Services Electronic Data Interchange outsourcing services for healthcare payers, supporting HIPAA X12 transactions including eligibility verification, claims collection, claims status, claims remittance, and clinical information exchange. Established through a partnership with EDI Partners announced March 19, 2017.

Quantifiable outcome

• Processed over 270 million claims totaling more than $97 billion
• +4 more outcomes

Named customers6 records

Segments3 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Partnerships

Five partnerships are on record, tiered minor and core.

• Verve, LLCminorStrategic or Co-development Partner · 22 February 2023Partnership with Verve, LLC (Service-disabled Veteran-owned Small Business, Women-owned small business) to support the Department of Veterans Affairs in implementing the Staff Sergeant Parker Fox Suicide Prevention Grant Program. Noridian and Verve are assisting grantees and VHA staff with implementation activities, developing resources to educate community agencies doing suicide prevention outreach to eligible Veterans and their families.
• HHS Technology Group (HTG)coreTechnology or Integration · 9 August 2022Collaboration to modernize solutions for states' Medicaid programs. Partnership combines Noridian's administrative services with HTG's technology software to develop transformative solutions for provider management and third-party liability services. HTG provides SaaS solutions for Medicaid modernization and interoperability strategies following CMS principles and standards.
• RELI GroupcoreImplementation/ SI/ Consulting Partner · 27 June 2022Partnership with management consulting firm RELI Group to assess and verify provider ownership information in Medicare programs. Noridian serves as subcontractor working to establish processes to ensure information is accurate and meets CMS approval requirements. Work covers all providers enrolled in Medicare Part A, Part B and DME insurance programs to prevent and detect abuse and fraud.
• EDI PartnerscoreTechnology or Integration · 19 March 2017Partnership with EDI Partners to offer EDI outsourcing services for healthcare payers. Services include data collection and communication between healthcare providers and payers supporting eligibility verification, claims collection, claims status, claims remittance and clinical information exchange. EDI Partners supports core X12 transactions established by HIPAA and focuses on working with trading partners to ensure controls are in place.
• Acorn CredentialingminorStrategic or Co-development PartnerPartnership to optimize provider credentialing. Collaboration aimed at enhancing provider enrollment processes for Medicaid programs.

Scale indicators14 records

Recent moves6 records

Expansion highlights6 records

Direct peers

• Palmetto GBA: Palmetto GBA is a fellow MAC contractor holding multiple Part A/B, DME, and Railroad Board jurisdictions for CMS, with a comparable suite of claims, medical review, and provider enrollment services.
• WPS Health Solutions: WPS is a MAC contractor for Part A/B Jurisdiction 5 and Jurisdiction J DME, with overlapping CMS claims administration and contact-center capabilities directly comparable to Noridian's MAC portfolio.
• CGS Administrators (Celerian Group): CGS is one of Noridian's closest direct competitors, serving as a Medicare Administrative Contractor for multiple Part A/B and DME jurisdictions and providing complementary home health/hospice and medical review services to CMS.
• National Government Services (NGS): NGS, an Anthem subsidiary, is a MAC contractor for Part A/B and DME jurisdictions and competes head-to-head with Noridian for federal Medicare administrative contracts.
• First Coast Service Options (FCSO): FCSO is a MAC for Part A/B Jurisdiction N, offering parallel Medicare claims administration and provider contact-center services that compete with Noridian's federal business.
• Novitas Solutions: Novitas is a MAC contractor for Part A/B Jurisdictions H and L, providing claims processing, medical review, and provider services similar to Noridian's MAC offerings.

Broad incumbents

• Optum (UnitedHealth Group): Optum is the largest scaled healthcare services and technology platform, providing claims administration, payment integrity, and care management for payers and government programs—directly competitive with Noridian's PXe suite and adjacent to its MAC work.
• Conduent: Conduent provides healthcare claims administration, utilization management, and contact-center services to government and commercial payers, competing with Noridian's PXe commercial health plan suite.
• Maximus: Maximus is a large diversified government services and BPO firm that operates in health program administration (e.g., appeals, eligibility, contact centers) and competes with Noridian on adjacent federal and state contracts.
• Gainwell Technologies: Gainwell is a major government healthcare technology and services vendor providing Medicaid MMIS, claims processing, and program integrity services, directly overlapping with Noridian's MXe state Medicaid offering.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks7 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/NoridianSolutions
• LinkedInlinkedin.com/company/noridian-healthcare-solutions-llc
• Instagraminstagram.com/noridian_health

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles23 records

Funding overview

Funding rounds

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 Noridian Healthcare Solutions