Novitas Solutions
Novitas Solutions is a Medicare Administrative Contractor that processes and adjudicates Medicare claims for healthcare providers under three CMS contracts (Jurisdictions L, H, and NPEAST DMEPOS), operating as a subsidiary of GuideWell Source with 2,000+ employees across six U.S. offices.
- Company typePrivate
- Founded1965
- HeadquartersCamp Hill, United States
- Headcount1,001–5,000
- GTM typeB2B
- OfferingServices
What Novitas Solutions does
Novitas Solutions, Inc. is a Medicare Administrative Contractor (MAC) that processes and adjudicates Medicare claims under contracts with the U.S. Centers for Medicare & Medicaid Services (CMS). It operates three concurrent MAC contracts: Jurisdiction L (covering Pennsylvania, West Virginia, Virginia, and surrounding areas for Parts A and B), Jurisdiction H (covering Texas, Arkansas, Colorado, Louisiana, Mississippi, New Mexico, and Oklahoma for Parts A and B), and NPEAST DMEPOS (durable medical equipment across a multi-state eastern footprint). The company is a subsidiary of GuideWell Source, with First Coast Service Options operating as a sister MAC.
The company serves healthcare providers — principally hospitals, physicians, and DMEPOS suppliers — operating within its assigned jurisdictions. Its core products are provider-facing portals (Novitasphere and jurisdiction-specific sites), claims processing and adjudication systems, medical review and appeals workflows, and educational/provider outreach services. It is also participating in CMS's WISeR (Wasteful and Inappropriate Service Reduction) prior authorization model in partnership with Genzeon, which expands its scope from traditional post-payment review toward pre-payment utilization management. The company is ISO 9001:2015 certified, indicating a formalized quality management system across operations.
Novitas employs more than 2,000 people, with roughly half at its Mechanicsburg, Pennsylvania headquarters and the remainder distributed across field offices in Pittsburgh, Williamsport, Dallas, Milwaukee, and Jacksonville. The business model is contract-based: revenue flows from CMS under MAC fee-for-service pricing, with compensation tied to claims processed, medical reviews performed, and provider services delivered under the contract scope. There is no public financial disclosure; the company is privately held within GuideWell, a mutual insurance holding company.
Novitas Solutions firmographics
Firmographics- Name
- Novitas Solutions
- Legal name
- Novitas Solutions, Inc.
- Website
- https://novitas-solutions.com
- Company type
- Private
- Founded year
- 1965
- Operating status
- Operating
- Headcount range
- 1,001–5,000 employees
- Short description
- Novitas Solutions is a Medicare Administrative Contractor that processes and adjudicates Medicare claims for healthcare providers under three CMS contracts (Jurisdictions L, H, and NPEAST DMEPOS), operating as a subsidiary of GuideWell Source with 2,000+ employees across six U.S. offices.
- Ownership category
- akta.pro rank
Novitas Solutions industry classification
Industry- Product category
- Medicare Administrative Services
- NAICS
- Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Administration of Public Health Programs (923120)
- SIC
- Hospital & Medical Service Plans (6324), Services-Computer Programming, Data Processing, Etc. (7370)
- akta.pro primary industry
- Medicare Plan Administration & Third-Party Services (TPA/BPO, Enrollment, Billing) (FSAIAGAI)
- akta.pro secondary industry
- Government Program Administrative Services (Medicare/Medicaid ASO/TPA) (HLAEALAO)
Keywords
Where Novitas Solutions is headquartered
LocationHeadquarters
- HQ city
- Camp Hill
- HQ country
- United States
- HQ region
- North America
Offices6 records
Markets served
Novitas Solutions business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Infrastructure, Marketing or Sales
Revenue model
- Medicare Administrative Contractor Services: Administrative services processing for government-sponsored healthcare programs under contract with the Centers for Medicare & Medicaid Services (CMS). Revenue is derived from government contracts to process Medicare claims, manage provider enrollment, and perform compliance oversight for designated jurisdictions.
Go-to-market motion1 record
Distribution channels4 records
Marketing channels6 records
Novitas Solutions product offering
Product offeringCore offering
Novitas Solutions serves as a Medicare Administrative Contractor (MAC) for the Centers for Medicare & Medicaid Services (CMS), administering three government contracts: Jurisdiction L (Delaware, DC, Maryland, New Jersey, Pennsylvania, and parts of Virginia), Jurisdiction H (Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas, plus IHS and VA nationally), and the NPEAST DMEPOS provider enrollment contract spanning 28 states/territories. The company processes Medicare Part A and Part B claims, handles provider enrollment and oversight, conducts medical review, manages appeals and redeterminations, and administers prior authorization (including the WISeR model) for physicians, hospitals, skilled nursing facilities, DMEPOS suppliers, and other healthcare providers.
Product overview
Novitas Solutions operates as a Medicare Administrative Contractor (MAC) administering three primary government contracts: Medicare Jurisdiction L (JL) covering Mid-Atlantic states, Medicare Jurisdiction H (JH) covering South-Central states, and the NPEAST DMEPOS national provider enrollment contract. The company provides claims processing, provider enrollment, medical review, and appeals administration services through its Novitasphere online portal. Providers access these services through dedicated websites for each contract jurisdiction.
Differentiator
Problem solved
Functional benefit
Products and services
- Medicare Administrative Contract Jurisdiction L (JL)
Companies that use Novitas Solutions
Customer profileNamed customers6 records
Segments3 records
Ideal customer profiles4 records
Novitas Solutions technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Feature4 records
Novitas Solutions partnerships and signals
Strategic signalPartnerships
Four partnerships are on record, tiered core and minor.
- GuideWell SourcecoreParent company of Novitas Solutions. GuideWell Source is part of the GuideWell family of companies, which includes Florida Blue and other health insurance and healthcare services organizations.
- First Coast Service OptionsminorSister company operating under GuideWell Source. Also a Medicare Administrative Contractor serving different jurisdictions.
- Centers for Medicare & Medicaid Services (CMS)coreFederal agency that contracts Novitas Solutions as a Medicare Administrative Contractor (MAC) to process Medicare claims and administer health care programs in designated jurisdictions. Relationship governed by government contracting.
- GenzeoncoreWISeR (Wasteful and Inappropriate Service Reduction) model participant responsible for reviewing prior authorization requests for New Jersey providers under the CMS innovation program.
Scale indicators4 records
Recent moves4 records
Expansion highlights3 records
Novitas Solutions competitors and assessment
Company assessmentBroad incumbents
- Maximus: Government services contractor with a large health segment including eligibility, appeals, and CMS operations support. Provides adjacent administrative services to federal healthcare programs.
- Conduent: Public company providing healthcare claims administration, eligibility, and provider services for government payers. Operates at greater scale than Novitas across multiple government health programs.
- Gainwell Technologies: Large government healthcare IT and services vendor serving state Medicaid and federal programs. Broader in scope than Novitas but competes for adjacent CMS technology and administration contracts.
- GuideWell Source (Parent): Novitas' parent operating company within the GuideWell/Florida Blue family. Holds the corporate umbrella for Novitas and sister MAC First Coast, providing shared services, IT, and strategic direction.
Direct peers
- National Government Services: An Anthem subsidiary operating as a MAC for multiple jurisdictions (J6, JK, J5). Directly competes with Novitas on government contracts and serves overlapping provider types.
- First Coast Service Options: Sister company under GuideWell Source and fellow Medicare Administrative Contractor. Operates adjacent MAC jurisdictions with the same operating model, contract structure, and provider-facing services, making it the most directly comparable peer.
- Noridian Healthcare Solutions: MAC contractor serving Jurisdictions JE, JF, and JH successor. Competes head-to-head with Novitas on MAC procurements and delivers the same Part A/Part B claims administration services.
- Wisconsin Physicians Service Insurance: MAC contractor administering Jurisdictions J5 and J8. Comparable MAC services portfolio with similar claims processing, provider enrollment, and audit responsibilities.
- Palmetto GBA: A division of BlueCross BlueShield of South Carolina operating multiple MAC jurisdictions (JJ, JM, JI). Directly competes with Novitas for CMS administrative contracts and serves similar provider populations.
- CGS Administrators: A Cigna-owned MAC administering Jurisdictions J15 and J6 for Part A and Part B. Comparable in scope, contract structure, and provider-facing Medicare services.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat3 records
Key risks6 records
Key highlights7 records
Customer concentration
Novitas Solutions social profiles
Digital presenceNovitas Solutions compliance and trust
Trust signalCompliance1 record
Novitas Solutions financial estimates
Financial estimateRevenue estimate
Valuation estimate
Novitas Solutions leadership team
Management profileNumber of profiles
Novitas Solutions funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Novitas Solutions 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 Novitas Solutions
What does Novitas Solutions do?
Novitas Solutions serves as a Medicare Administrative Contractor (MAC) for the Centers for Medicare & Medicaid Services (CMS), administering three government contracts: Jurisdiction L (Delaware, DC, Maryland, New Jersey, Pennsylvania, and parts of Virginia), Jurisdiction H (Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas, plus IHS and VA nationally), and the NPEAST DMEPOS provider enrollment contract spanning 28 states/territories. The company processes Medicare Part A and Part B claims, handles provider enrollment and oversight, conducts medical review, manages appeals and redeterminations, and administers prior authorization (including the WISeR model) for physicians, hospitals, skilled nursing facilities, DMEPOS suppliers, and other healthcare providers.
Is Novitas Solutions a public or private company?
Novitas Solutions is a private company. It is classified as corporate owned and is currently operating.
When was Novitas Solutions founded?
Novitas Solutions was founded in 1965. It employs 1,001 to 5,000 people.
Where is Novitas Solutions based?
Novitas Solutions is headquartered in Camp Hill, United States, in the North America region.
How does Novitas Solutions make money?
One revenue line is on record: medicare Administrative Contractor Services.
Who are Novitas Solutions's main competitors?
Broad incumbents on record are Maximus, Conduent, Gainwell Technologies and GuideWell Source (Parent). Direct peers are National Government Services, First Coast Service Options, Noridian Healthcare Solutions, Wisconsin Physicians Service Insurance, Palmetto GBA and CGS Administrators.
Does Novitas Solutions have an API?
No public API is recorded for Novitas Solutions.
What industry is Novitas Solutions in?
Novitas Solutions's product category is Medicare Administrative Services. Its primary akta.pro industry code is FSAIAGAI, Medicare Plan Administration & Third-Party Services (TPA/BPO, Enrollment, Billing), with a secondary code of HLAEALAO, Government Program Administrative Services (Medicare/Medicaid ASO/TPA). Its NAICS code is 524292 and its SIC code is 6324.