Telligen

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.

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

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

• Population health management
• Utilization management services
• Care management software
• Medicaid quality improvement
• Healthcare data analytics

Headquarters

HQ city

West Des Moines

HQ country

United States

HQ region

North America

Offices7 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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

Go-to-market motion2 records

Distribution channels5 records

Marketing channels8 records

Core 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

Named customers7 records

Segments4 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration2 records

AI capability5 records

Feature6 records

Partnerships

Six partnerships are on record, tiered core and supporting.

• MCG HealthcoreTechnology or Integration · 10 June 2026Partnership 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)coreOthersCMS-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)coreOthersNational 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)coreStrategic or Co-development PartnerCDC 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)supportingTechnology or IntegrationAWS certified partner providing cloud services, generative AI implementation, disaster recovery and business continuity solutions. Experienced with FedRAMP environments and obtaining ATO credentials.
• Hearst Health NetworkcoreStrategic or Co-development PartnerMCG 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

Direct 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

• Xx.com/telligen
• Facebookfacebook.com/telligen
• LinkedInlinkedin.com/company/telligen

Compliance8 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles8 records

Subsidiaries4 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 Telligen