Telligen
Telligen is a 100% employee-owned population health management company serving U.S. federal health agencies, state Medicaid agencies, health plans, and self-funded employers through its proprietary Qualitrac SaaS platform, clinical services, and data analytics, reaching approximately 36 million covered lives.
- Company typePrivate
- Founded1972
- HeadquartersWest Des Moines, United States
- Headcount501–1,000
- GTM typeB2B
- OfferingServices
What Telligen does
Telligen is a 100% employee-owned population health management company founded in 1972 as the Iowa Foundation for Medical Care (IFMC), headquartered in West Des Moines, Iowa, with 600+ employee-owners including 350 trained medical professionals and 200 health informaticists and technology experts. The company serves U.S. federal health agencies (notably CMS as a QIN-QIO contractor), state Medicaid agencies (including Oklahoma, Iowa, Mississippi, Massachusetts, Colorado, and others), self-funded employer and Taft-Hartley health plans, and managed care organizations, reaching approximately 36 million covered lives across Medicaid managed care, Medicare Advantage, Medicare fee-for-service, and commercial markets.
The core technology asset is Qualitrac, a proprietary cloud-based, multi-tenant, MITA-aligned SaaS population health management platform with four integrated modules (Case Management, Utilization Management, Quality Measurement & Reporting, and PASRR). The platform is FHIR-enabled for EHR integration, complies with the CMS Interoperability and Prior Authorization Rule, runs on AWS infrastructure, and is complemented by the Telligen Connect mobile app, the Spectrum of Health in-house analytics tool, and the Blue-Ribbon Prior Authorization Program built on MCG Health clinical intelligence. The company maintains URAC accreditations in Case Management, Disease Management, and Health Utilization Management (through 2028), NCQA Population Health Program Accreditation (2024), HITRUST, SOC, and CMMI Level 3 certifications.
Revenue is generated through multi-year managed services contracts with federal and state government agencies, subscription SaaS licensing of Qualitrac, professional services for self-funded employer health and well-being programs, and unit-priced training (NDPP Lifestyle Coach Training at $499 per person via CDC partnership). The company has not raised external funding since transitioning to 100% employee ownership in 2013, distributing services via direct enterprise sales, government contract vehicles (CMS MIDS, NQIIC, SPARC, GSA MAS as prime; CIO-SP3, OASIS+ as partner), and dedicated expert contact channels for each of its four primary segments: Federal, State, Health Plans, and Employers & Self-Funded Plans.
Telligen firmographics
Firmographics- Name
- Telligen
- Legal name
- Telligen
- Website
- https://telligen.com
- Company type
- Private
- Founded year
- 1972
- Operating status
- Operating
- Headcount range
- 501–1,000 employees
- Short description
- Telligen is a 100% employee-owned population health management company serving U.S. federal health agencies, state Medicaid agencies, health plans, and self-funded employers through its proprietary Qualitrac SaaS platform, clinical services, and data analytics, reaching approximately 36 million covered lives.
- Ownership category
- akta.pro rank
Telligen industry classification
Industry- Product category
- Population Health Management
- NAICS
- Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Health and Welfare Funds (525120), Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (518)
- SIC
- Hospital & Medical Service Plans (6324), Services-Computer Programming, Data Processing, Etc. (7370), Insurance Agents, Brokers & Service (6411)
- akta.pro primary industry
- Care Management & Population Health Program Administration (HLAEALAG)
- akta.pro secondary industries
- Compliance, Reporting & Regulatory Administration (ERISA/ACA/No Surprises) (HLAEALAJ), FHIR/HL7 Data Repositories & Canonical Data Models (HLACAIAI), Individual Health Insurance Administration (TPA/ASO) (FSAIAEAK), Large Group Health Insurance (Mid-Market & National Accounts) (FSAIAFAE)
Keywords
Where Telligen is headquartered
LocationHeadquarters
- HQ city
- West Des Moines
- HQ country
- United States
- HQ region
- North America
Offices7 records
Markets served
Telligen business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Technology or R&D, Operations, Marketing or Sales, Others
Revenue model
- Federal Government Contracts: Long-term contracts with federal health agencies including CMS for QIN-QIO work, CMS Innovation Center model support, HRSA rural health programs, and various IDIQ contract vehicles. Services include quality improvement, data analytics, quality measures, program management, and HIT solutions.
- State Medicaid Agency Contracts: Partnerships with state Medicaid agencies delivering utilization management, care management, assessments, quality measurement, and performance improvement. Proprietary Qualitrac technology backbone for all state solutions.
- Employer & Self-Funded Plan Services: Health and well-being programs for self-funded employers, unions, and Taft-Hartley health plans including at-risk coaching, diabetes prevention, case management, chronic conditions, utilization management, and wellness solutions.
- Health Plan Solutions: Solutions for Medicare Advantage, Medicaid managed care, and marketplace health plans including assessments, case management, value-based reimbursement models, utilization management, and population health programs.
- Qualitrac Software Licensing: Commercial-off-the-shelf (COTS) SaaS solution offered as cloud-based multi-tenant platform. Four defined modules can function independently or as comprehensive solution when combined.
- NDPP Lifestyle Coach Training: CDC-partnered training program for National Diabetes Prevention Program lifestyle coaches. Two-day intensive training using Prevent T2 curriculum at $499 per person.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Unit Pricing | Pay-as-you-go | NDPP Lifestyle Coaching Training - $499 per person |
| Other | Multi-year contract | Enterprise healthcare solutions - Quote-based |
Go-to-market motion2 records
Distribution channels5 records
Marketing channels8 records
Telligen product offering
Product offeringCore offering
Telligen provides population health management solutions to U.S. government health agencies, state Medicaid agencies, self-funded employer and Taft-Hartley health plans, and managed care organizations. Its offering centers on the proprietary Qualitrac SaaS platform, combined with managed services for utilization management, care management, quality improvement, quality measurement, data analytics, prior authorization, and health equity consulting.
Product overview
Telligen offers a platform-plus-modules architecture centered on Qualitrac, a proprietary population health management SaaS application. Qualitrac consists of four integrated modules: Case Management, Utilization Management, Assessment Management (PASRR), and Quality Measurement & Reporting. The platform is complemented by member-facing mobile applications (Connect Mobile App and Telligen Connect App), the Blue-Ribbon Prior Authorization Program, NDPP Lifestyle Coaching Training Program, Health Equity Solutions, and Spectrum of Health analytics tool. Services include care management, utilization management, quality improvement, data analytics & validation, software development, and learning & dissemination across federal, state, and employer/health plan markets.
Differentiator
Problem solved
Functional benefit
Brands
- Qualitrac: Proprietary, population health management application - web-based, mobile friendly, MITA-aligned system with modules for Case Management, Utilization Management, Quality Measurement & Reporting, and PASRR
- Telligen Connect Mobile App
- Telligen Connect App
- Blue-Ribbon Program
- CircleTalk
Products and services
- Qualitrac Platform
- Qualitrac Case Management Module
- Qualitrac Utilization Management Module
- Qualitrac Quality Measurement & Reporting Module
- Qualitrac PASRR Module
- NDPP Lifestyle Coaching Training Program
- Blue-Ribbon Prior Authorization Program
- Health Equity Solutions
- Telligen Connect Mobile App
Quantifiable outcome
- 500% provider participation expansion and 180% auto-authorization volume increase for Blue-Ribbon Prior Authorization Program
- +7 more outcomes
Companies that use Telligen
Customer profileNamed customers7 records
Segments4 records
Ideal customer profiles4 records
Telligen technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- Yes
- API docs
- API detail
Core technology
AI maturity
App detail
Integration2 records
AI capability5 records
Feature6 records
Telligen partnerships and signals
Strategic signalPartnerships
Six partnerships are on record, tiered core and supporting.
- MCG HealthcorePartnership for clinical intelligence and automation technology. MCG provides evidence-based care guidelines and automation technology integrated into Telligen's authorization workflow through the Blue-Ribbon Program. Achieved 500% provider participation expansion and 180% auto-authorization volume increase. Co-presenting at AHIP26 on AI for utilization management modernization for an organization serving 36 million members.
- Centers for Medicare & Medicaid Services (CMS)coreCMS-designated Quality Innovation Network-Quality Improvement Organization (QIN-QIO). Supports multiple CMS programs including Quality Payment Program, Medicare Drug Price Negotiation Program, and various CMS Innovation Center models (KCC, EOM, ACO SSP, ACO PC Flex, ACO REACH, AHEAD, FCHIP). Also supports Data Validation and Administrative Contractor (DVAC) and Partnership to Advance Tribal Health (PATH).
- Health Resources and Services Administration (HRSA)coreNational Rural Quality Improvement Technical Assistance (RQITA) center for HRSA, providing specialized resources and data for rural healthcare transformation.
- Centers for Disease Control and Prevention (CDC)coreCDC partnership for National Diabetes Prevention Program (NDPP). Telligen is a preferred training provider offering Lifestyle Coach Training Courses using CDC-approved Prevent T2 curriculum. Training helps organizations become CDC-recognized programs for diabetes prevention.
- Amazon Web Services (AWS)supportingAWS certified partner providing cloud services, generative AI implementation, disaster recovery and business continuity solutions. Experienced with FedRAMP environments and obtaining ATO credentials.
- Hearst Health NetworkcoreMCG Health is part of Hearst Health network. Telligen's Blue-Ribbon Program recognized with Doyle Award by MCG Health/Hearst Health for innovation in evidence-based care guidelines and automation.
Scale indicators15 records
Recent moves9 records
Expansion highlights5 records
Telligen competitors and assessment
Company assessmentDirect peers
- Acentra Health (formerly KEPRO): Direct peer as a fellow QIN-QIO and government health services contractor. Both organizations serve as CMS-designated Quality Improvement Organizations and provide utilization management, care management, and quality measurement to state Medicaid and federal agencies.
- Health Management Associates (HMA): Direct peer in Medicaid population health management consulting and technical assistance for state agencies, managed care plans, and providers. Both serve similar state Medicaid clients with utilization management, care coordination, and quality improvement services.
- Gainwell Technologies: Direct peer as a major Medicaid fiscal agent and TPA serving state Medicaid programs. Both administer state Medicaid operations including care management, UM, and assessments under state government contracts.
- AxisPoint Health: Care management and population health services company serving health plans and employers with chronic condition management and UM. Both target commercial health plan and self-funded employer segments with similar service offerings.
Broad incumbents
- Maximus: Broader government health services incumbent that runs state and federal health programs including Medicaid enrollment, eligibility, and clinical assessments. Overlap with Telligen in state Medicaid assessment and case management services.
- Optum (UnitedHealth Group): Large incumbent serving health plans and employers with utilization management, care management, and population health analytics. Direct overlap with Telligen's commercial health plan segment and adjacent competition on federal/state programs.
- Conduent: Broad incumbent serving state and federal government health programs with eligibility, case management, and quality measurement services. Competes with Telligen for state Medicaid and federal contract vehicles.
- Change Healthcare (now Optum): Broad incumbent providing prior authorization, utilization management, and value-based care analytics to health plans. Competes with Telligen's Qualitrac platform in the commercial health plan segment.
- ICF International: Federal health consulting and IT services contractor providing quality improvement, data analytics, and program support to HHS, CMS, and state agencies. Direct overlap with Telligen's federal health solutions and CMS contract work.
- eviCore (Evernorth/Cigna): Large-scale prior authorization, utilization management, and clinical decision support provider for health plans. Competes with Telligen's Qualitrac UM module and Blue-Ribbon Program in commercial and Medicare Advantage markets.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat5 records
Key risks5 records
Key highlights7 records
Customer concentration
Telligen social profiles
Digital presenceTelligen compliance and trust
Trust signalCompliance8 records
Telligen financial estimates
Financial estimateRevenue estimate
Valuation estimate
Telligen leadership team
Management profileNumber of profiles
Profiles8 records
Telligen subsidiaries and ownership
Company hierarchySubsidiaries4 records
Telligen funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Telligen 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 Telligen
What does Telligen do?
Telligen provides population health management solutions to U.S. government health agencies, state Medicaid agencies, self-funded employer and Taft-Hartley health plans, and managed care organizations. Its offering centers on the proprietary Qualitrac SaaS platform, combined with managed services for utilization management, care management, quality improvement, quality measurement, data analytics, prior authorization, and health equity consulting.
Is Telligen a public or private company?
Telligen is a private company. It is classified as management employee owned and is currently operating.
When was Telligen founded?
Telligen was founded in 1972. It employs 501 to 1,000 people.
Where is Telligen based?
Telligen is headquartered in West Des Moines, United States, in the North America region.
How does Telligen make money?
Six revenue lines are on record. Federal Government Contracts are the primary driver. The others are state Medicaid Agency Contracts, employer & Self-Funded Plan Services, health Plan Solutions, qualitrac Software Licensing and NDPP Lifestyle Coach Training.
Who are Telligen's main competitors?
Direct peers on record are Acentra Health (formerly KEPRO), Health Management Associates (HMA), Gainwell Technologies and AxisPoint Health. Broad incumbents are Maximus, Optum (UnitedHealth Group), Conduent, Change Healthcare (now Optum), ICF International and eviCore (Evernorth/Cigna).
Does Telligen have an API?
Yes. Telligen offers several API endpoints for integration purposes. The Qualitrac platform includes: (1) Medical/Eligibility Coverage Check API - checks member medical and eligibility coverage in real-time for smoother authorization experiences and FHIR integration preparation; (2) CRD Provider Search/Lookup API - enables provider search and lookup for efficient workflows; (3) FHIR-enabled batch and real-time data interfaces for healthcare interoperability. The platform supports EHR integration via FHIR-based API data standards in compliance with CMS Interoperability and Prior Authorization Rule.
What industry is Telligen in?
Telligen's product category is Population Health Management. Its primary akta.pro industry code is HLAEALAG, Care Management & Population Health Program Administration, with a secondary code of HLAEALAJ, Compliance, Reporting & Regulatory Administration (ERISA/ACA/No Surprises). Its NAICS code is 524292 and its SIC code is 6324.