NFP Health

What NFP Health does

NFP Health, founded in late 2012 and headquartered in Norwell, Massachusetts, designs, builds, and operates a proprietary multi-carrier, multi-product health insurance exchange platform purpose-built for Affordable Care Act (ACA) state-based marketplaces. The modular platform comprises five core product lines — Financial Management (premium billing, aggregation, and carrier remittance), Reconciliation Services (carrier-to-exchange discrepancy detection), Enrollment (quoting, plan display, EDI 834 transactions), Shopping Experience (WCAG 2.1 Level AA-compliant portal with dynamic rating and decision support), and Third-Party Integrations (CMS, Salesforce, Vonage, and banking/payment partners including Bank of America, Wells Fargo, and Webster Bank). The company also offers an Individual Coverage Health Reimbursement Arrangement (ICHRA) module and operates a Customer Engagement Center for inbound consumer support.

The company's business model is managed services B2G (business-to-government): revenue derives from multi-year contracts with state and District agencies to deliver, run, and maintain exchange technology and call-center operations. Engagements are won primarily through state RFPs and direct agency outreach, with implementation partners such as Deloitte (HealthSource RI, 2013) and Optum (beWellnm individual exchange, 2021) used selectively. The firm currently runs five SHOP public exchanges (Covered California for Small Business, HealthSource RI, Massachusetts Health Connector, beWellnm SHOP, DC Health Link), two individual public exchanges (HealthSource RI, beWellnm), and operates New England's largest private exchange. Pricing is quote-based and not publicly disclosed; contract economics scale with the number of covered lives, bill runs, and bundled call-center seats.

NFP Health is a wholly owned subsidiary of NFP, a national insurance broker and consulting firm, operating with a 51-100 employee headcount across offices in Norwell, MA (headquarters), Rumford, RI, and Albuquerque, NM (Customer Engagement Center). Compliance credentials include ongoing SOC1 audits since 2014 on the Rhode Island engagement, MARS-E conformance for the New Mexico deployment, and PCI-DSS alignment for the Pay-by-IVR functionality. Leadership is concentrated in the C-suite and VP ranks, with deep institutional tenure in state and federal exchange programs and health IT operations.

Name

NFP Health

Legal name

NFP Health

Website

https://nfphealth.com

Company type

Private

Founded year

2012

Operating status

Operating

Headcount range

51–100 employees

Short description

NFP Health is a private, NFP-owned health insurance exchange technology provider founded in 2012, serving U.S. state-based marketplaces with a modular platform spanning premium billing, enrollment, reconciliation, shopping, and integrations. It operates five SHOP public exchanges, two individual public exchanges, and a customer engagement center.

Ownership category

akta.pro rank

Product category

Health Insurance Exchange Technology

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Agencies, Brokerages, and Other Insurance Related Activities (5242)

SIC

Hospital & Medical Service Plans (6324), Insurance Agents, Brokers & Service (6411)

akta.pro primary industry

Digital Distribution & Comparison Platforms (Aggregators/Marketplaces) (FSAGAGAA)

akta.pro secondary industries

ACA Marketplace (On-Exchange) Individual Plans (FSAIAEAA), Embedded Insurance & Affinity Distribution Platforms (FSAGAGAL)

Keywords

• Health insurance exchange
• Premium billing platform
• Enrollment management systems
• SHOP marketplace technology
• ACA exchange solutions

Headquarters

HQ city

Braintree

HQ country

United States

HQ region

North America

Offices3 records

Markets served

GTM type

B2B

Offering type

Software

Cost components

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

Revenue model

1. Government Exchange Technology & Services: Revenue generated from contracts with state governments to build, operate, and maintain health insurance exchange technology platforms. Services include premium billing systems, enrollment portals, reconciliation services, call center operations, and financial management. Engagements are typically multi-year government contracts with states such as California, Rhode Island, Massachusetts, New Mexico, and the District of Columbia.

Go-to-market motion1 record

Distribution channels1 record

Marketing channels3 records

Core offering

NFP Health designs, builds, and operates proprietary multi-carrier, multi-product health insurance exchange platforms for state-based marketplaces under the Affordable Care Act. Its core offering includes premium billing and aggregation systems, enrollment portals, reconciliation services, and online shopping experiences for SHOP and Individual marketplace models, sold primarily to state government agencies through multi-year managed services contracts.

Product overview

NFP Health operates as a healthcare exchange technology provider offering a modular platform with distinct products: Financial Management (premium billing and aggregation), Reconciliation Services (enrollment data reconciliation), Enrollment (plan quoting and enrollment system), Shopping Experience (online shopping portal), and Third-Party Integrations. The company also operates multiple state-based exchange sub-brands including HealthSource RI, Covered California for Small Business, beWellnm, DC Health Link, and Massachusetts Health Connector. These solutions are offered both as standalone systems and as integrated end-to-end exchange solutions. NFP Health serves state-based marketplaces, health and dental carriers, and private exchanges, and operates New England's largest private exchange.

Differentiator

Problem solved

Functional benefit

Products and services

• Financial Management Premium billing and aggregation platform for multi-carrier, multi-product health insurance exchanges. Consolidates billing and premium collection onto a single bill across many carriers and products, then aggregates collected payments to the correct insurer. Includes broker and general agent commissioning tools, state treasuries and accounting systems integration, and large group payroll system support. Designed for state-based marketplace operators.
• Enrollment Full-featured enrollment system that quotes plans, displays plan rates and benefits, and enables enrollment. Includes EDI 834 transaction support and account management capabilities for individuals, groups, brokers, and administrators. Used by state exchange operators to process health plan enrollments.
• Reconciliation Services Reconciliation product that reconciles enrollment data between carriers and exchanges. Produces discrepancy lists with suggestions for resolution, backed by decades of reconciliation experience. Designed for state exchange operators and insurance carriers to maintain data integrity across exchange systems.
• Shopping Experience Online portal helping employers and individuals shop for health plans. Features plan comparison, benefits information, dynamic rating engine, real-time quoting, XML transfers, decision support, carrier branding, special enrollment period management, renewal and delinquency management, and agent/general agent features. WCAG 2.1 Level AA compliant.
• Customer Engagement Center (CEC) State-of-the-art call center in Albuquerque, NM handling customer communication for exchanges including phone, email, and web chat. Includes Pay-by-IVR functionality for unattended phone-based credit card payments (PCI-compliant). Operates for state exchange clients including beWellnm.
• HealthSource RI Exchange State-based health insurance exchange serving Rhode Island, providing both Individual and SHOP exchange functionality including premium billing, call center, and reconciliation services. Replaced the State's legacy SHOP enrollment portal and carrier interfaces in 2019. Has executed clean yearly SOC audits since 2014.
• Covered California for Small Business SHOP exchange for the State of California featuring front-end eligibility and enrollment portal and back-end premium billing. Includes WCAG 2.1 Level AA compliance and decision support for plan selection. California's primary SHOP marketplace serving small businesses.
• beWellnm Exchange New Mexico health insurance exchange supporting both Individual and SHOP exchanges with eligibility/enrollment portal, financial management, and Customer Engagement Center. Built complete end-to-end SHOP solution in three months in 2018. SHOP financial operations have perfect track record for billing, invoicing, and premium aggregation.
• DC Health Link Premium billing solution for the District of Columbia's SHOP exchange, the largest SHOP exchange in the country. Built and deployed replacement solution in six weeks in 2013.
• Massachusetts Health Connector SHOP exchange for the State of Massachusetts featuring technology sharing with DC Health Link and a custom Broker Commissions module. Expanded to include dental plans and ancillary benefits in 2019. Designed loan program during Covid-19 pandemic to prevent group terminations due to delinquent premiums. Continually meets accuracy standards for billing and invoicing.

Named customers5 records

Segments3 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration12 records

Feature6 records

Partnerships

Six partnerships are on record, tiered major and core.

• OptummajorStrategic or Co-development Partner · 1 January 2021In fall 2021, NFP Health teamed with Optum to build the first individual exchange for the State of New Mexico (beWellnm). NFP Health built the State's financial management solution and Customer Engagement Center while partnering on the overall exchange implementation.
• DeloittemajorImplementation/ SI/ Consulting Partner · 1 January 2013NFP Health partnered with Deloitte in 2013 to build the State of Rhode Island's individual health insurance exchange, HealthSource RI. Deloitte provided consulting and implementation services with NFP Health delivering the technology platform.
• Bank of AmericacoreTechnology or IntegrationBank of America is integrated with NFP Health's exchange platforms for banking and payment processing functions, including ACH and lockbox processing for premium aggregation and carrier remittance.
• SalesforcecoreTechnology or IntegrationSalesforce CRM is integrated with NFP Health's exchange platforms for case management and customer relationship management, specifically implemented for beWellnm's Customer Engagement Center operations.
• Vonage Contact CentercoreTechnology or IntegrationVonage Contact Center platform is integrated with NFP Health's exchange platforms for call center operations, including IVR and CRM solutions for customer engagement centers.
• CMS (Centers for Medicare & Medicaid Services)coreTechnology or IntegrationCMS integration enables APTC (Advance Premium Tax Credit) processing and 1095 tax form reporting for individual exchange operations, supporting ACA compliance requirements.

Scale indicators3 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• GetInsured: Builds and operates state-based health insurance exchange platforms (SHOP and Individual) for state agencies. Directly comparable to NFP Health in serving the same ACA state-based marketplace RFP channel.
• hCentive (byInfosys): Health insurance exchange technology provider offering enrollment, eligibility, and shopping portal solutions to state marketplaces and insurers. Direct overlap with NFP Health's core product suite.
• Connecture (now part of RxBenefits / HealthPlanOne): Health insurance shopping, enrollment, and administration technology serving carriers, brokers, and exchanges. Comparable product surface (shopping, enrollment, billing) and overlap in exchange-adjacent buyer base.
• Softheon: Health insurance exchange and ACA marketplace technology provider serving states, carriers, and brokers. Direct overlap in state-based exchange platform capabilities and ACA-focused customer base.

Broad incumbents

• Optum (UnitedHealth Group): Large-scale health IT and services business that partnered with NFP Health on New Mexico's individual exchange. Competes broadly in state health-tech procurements and has the scale to bid as a prime exchange vendor.
• Deloitte: Consulting and systems integrator that partnered with NFP Health on Rhode Island's exchange. Frequently competes as a prime contractor on state health IT procurements and can substitute for or acquire exchange technology capability.
• MAXIMUS: Government health services and IT vendor operating large-scale state and federal health programs (Medicaid, CHIP, exchanges). Competes with NFP Health in state-government health IT procurements as a broader-services incumbent.
• Accenture Federal Services: Federal and state health IT systems integrator with broad exchange and Medicaid modernization practices. Competes for state-based marketplace and benefits-administration contracts at a much larger scale than NFP Health.

Regional players

• Noridian Healthcare Solutions: Government health services contractor with Medicare and state-level health IT work. Comparable in operating government health programs but typically serves different contract vehicles and geographies.

Emerging players

• Benefitalign (formerly Array Health): Private health insurance exchange and benefits decision-support platform for employers and consumers. Comparable shopping/decision-support product surface, focused on private rather than state exchange markets.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/nfp-health?original_referer=https%3A%2F%2F0by.bbb.mwp.accessdomain.com%2F

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles9 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 NFP Health