MediNcrease Health Plans

What MediNcrease Health Plans does

MediNcrease Health Plans, LLC is a privately held healthcare cost containment company founded in 2013 and headquartered in Gaithersburg, Maryland, with a secondary office in St. Petersburg, Florida. The company operates a national multi-specialty provider network spanning 230,000+ providers in Commercial Health, 215,000+ in Auto Medical, and 220,000+ in Workers' Compensation, covering 15+ million lives across the United States and Puerto Rico. Since 2021 it has operated as a subsidiary of Exponent Health (formerly HRGi). The founding leadership team brings over 150 collective years in the provider network business, having previously built and sold a national PPO network in 2011.

The company's core products fall into four categories: (1) Provider Network Services — primary, complementary/travel, and specialty network access sold on a subscription basis to payers; (2) Claim Negotiation Services — out-of-network and in-network claim negotiations with provider sign-off targeted within 3–5 days, priced as transaction fees; (3) Medical Bill Audit Services — using proprietary and public benchmark criteria to identify billing errors, duplicate charges, unbundled services, and unreasonable charges, priced as transaction fees; and (4) No Surprises Act (NSA) Compliance Services — the NSA Navigator solution that identifies NSA-covered claims, calculates the Qualified Payment Amount, and provides post-payment management. Underlying technology includes EDI 837 5010 processing, custom XML web services, secure FTP, web-based claim repricing, and a 24-hour online entry tool. The company is HIPAA-compliant with annual employee training and encrypted hardware.

The go-to-market is enterprise B2B sales targeting insurance companies, regional health plans, government payers, TPAs, self-insured employer groups, reinsurance/stop-loss carriers, and bill review companies. MediNcrease has contracted access to 1,000+ payers and processes billions in annual medical claims. Revenue is generated primarily through access fees (subscription) for network usage and transaction fees on negotiated and audited claims. The sales motion is relationship-based: prospects enter through a formal Request for Information process with 24–48 hour response times, and post-sale clients receive dedicated account managers, weekly touchpoint calls, monthly value management reporting, and quarterly stewardship meetings. Marketing channels include the company website, industry conferences (AAPANN, National Workers' Comp, RIMS, SIIA, HCAA), and direct/inside sales.

Name

MediNcrease Health Plans

Legal name

MediNcrease Health Plans, LLC

Website

https://medincrease.com

Company type

Private

Founded year

2013

Operating status

Operating

Headcount range

11–50 employees

Short description

MediNcrease Health Plans is a privately held healthcare cost containment company that operates a national multi-specialty provider network of 230,000+ providers, serving insurance companies, TPAs, employers, and bill review firms across Commercial Health, Workers' Compensation, and Auto Medical markets.

Ownership category

akta.pro rank

Product category

Healthcare Cost Containment

NAICS

Direct Health and Medical Insurance Carriers (524114)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Medigap Plan Administration (Enrollment, Billing & Member Services) (HLAEADAC)

akta.pro secondary industries

Medigap Provider Network & Contracting Support (as applicable) (HLAEADAK), Integrated Physical-Behavioral-Social Care (Whole-Person) Medicaid Plans (HLAEAEAI)

Keywords

• Provider network services
• Medical cost containment
• Claim negotiation services
• Workers compensation networks
• Healthcare cost reduction

Headquarters

HQ city

St. Petersburg

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Provider Network Services: Access fees charged to payers for use of contracted provider network for Commercial Health, Workers' Compensation, and Auto Medical markets. Includes primary network, national complementary and travel network, and specialty networks.
2. Claim Negotiation Services: Negotiation services for in-network and out-of-network claims resulting in meaningful savings with provider sign-off within 3-5 day timeframe.
3. Medical Bill Audit Services: Audit services using proprietary and public benchmark criteria to identify billing errors and reduce billed charges before provider contractual discounts are applied.
4. No Surprises Act (NSA) Compliance Services: NSA Navigator solution for identifying NSA-covered claims, calculating QPA, and post-payment management services.

Go-to-market motion1 record

Distribution channels2 records

Marketing channels4 records

Core offering

MediNcrease Health Plans operates a national multi-specialty provider network (230,000+ providers) and delivers medical cost-containment services to insurance payers across Commercial Health, Workers' Compensation, and Auto Medical markets. Its core services include Provider Network Access, Claim Negotiation (with provider sign-off in 3–5 days), Medical Bill Audit, and No Surprises Act (NSA) Compliance via its NSA Navigator solution.

Product overview

MediNcrease Health Plans is a cost containment company offering a suite of integrated services for Commercial Health, Workers' Compensation, and Auto Medical insurance markets. The core product portfolio consists of Provider Network Services (Primary Network, National Complementary and Travel Network, and Specialty Networks), Claim Negotiation Services, Medical Bill Audit Services, and No Surprises Act (NSA) Compliance Services. These services work together to reduce medical expenditures through contracted provider networks, bill auditing, and claims negotiation for payers including insurance companies, TPAs, self-insured employers, and government healthcare payers.

Differentiator

Problem solved

Functional benefit

Products and services

• Provider Network Services A national multi-specialty provider network with 230,000+ Commercial Health providers, 215,000+ Auto Medical providers, and 220,000+ Workers' Compensation providers, accessed by payers to deliver care at contracted rates.
• Claim Negotiation Services Negotiation services for in-network and out-of-network medical claims, incorporating medical bill audit programs to deliver savings with provider sign-off within a 3–5 day timeframe.
• Medical Bill Audit Services Audit services that use proprietary and public benchmark criteria to identify billing errors, atypical charges, duplicate charges, unbundled services, and charges exceeding reasonable and customary pricing.
• No Surprises Act (NSA) Navigator Compliance solution that identifies claims covered under the No Surprises Act, calculates the Qualified Payment Amount (QPA), and provides post-payment management services.
• Commercial Health Solutions Medical cost-saving solutions for insurers, employers, TPAs, medical management companies, and reinsurance/stop-loss carriers in the Commercial Health market.
• Auto Medical Network Casualty-specific medical savings network for auto insurers and bill review companies covering motor vehicle injuries, with providers contracted to deliver care at significant discounts.
• Workers' Compensation Network Industry-leading cost reduction solutions for insurers, TPAs, employers, non-subscribers, and medical management/bill review companies, with 220,000+ participating providers.

Quantifiable outcome

• Provider sign-off on claim negotiations within 3-5 day timeframe
• +1 more outcomes

Named customers4 records

Segments3 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature7 records

Partnerships

Twelve partnerships are on record, tiered core.

• SleepWorks (MedBridge Healthcare Company)coreStrategic or Co-development Partner · 28 October 2022SleepWorks, a MedBridge Healthcare Company, joined MediNcrease's national provider network. SleepWorks provides mail order home sleep apnea testing and southeastern-based network of sleep diagnostic centers offering in-center and home diagnostic options for patients with sleep-related disorders.
• Rosetta GenomicscoreStrategic or Co-development Partner · 12 October 2017Provider agreement making RosettaGX Reveal thyroid microRNA classifier and other testing services accessible through MediNcrease's client base of regional and national health plans, insurance companies, employers, TPAs, and other companies managing medical claims.
• BioceptcoreStrategic or Co-development Partner · 20 June 2017Provider agreement making Biocept's Target Selector liquid biopsy tests accessible through MediNcrease's client base. Biocept provides molecular diagnostics for lung, breast, gastric, colorectal and prostate cancers, and melanoma.
• MDxHealthcoreStrategic or Co-development Partner · 2 May 2017Contract to make ConfirmMDx for Prostate Cancer and SelectMDx for Prostate Cancer available to 5.5 million covered lives through MediNcrease's clients and payers.
• Next Day AccesscoreStrategic or Co-development PartnerNext Day Access provides home accessibility and mobility products including wheelchair ramps, scooters, grab bars, and automatic door openers through locations throughout the United States.
• Newport HealthcarecoreStrategic or Co-development PartnerNewport Healthcare operates residential teen and young adult treatment centers, outpatient treatment centers, and Newport Academy Day Schools throughout the US, providing behavioral health care including mental health, eating disorders, and substance abuse treatment.
• BioventuscoreStrategic or Co-development PartnerProvider agreement making Bioventus's EXOGEN Ultrasound Bone Healing System available through MediNcrease network. Bioventus is a global leader in active orthopaedic healing with clinically proven, cost-effective orthobiologics products.
• Athletico Physical TherapycoreStrategic or Co-development PartnerProvider agreement with Athletico's network of 330+ clinics in 9 states providing orthopedic rehabilitation, physical and occupational therapy, industrial rehabilitation, women's health, and athletic training services.
• Myriad Genetics and Crescendo BiosciencecoreStrategic or Co-development PartnerProvider agreement adding Myriad Genetics (personalized medicine and molecular diagnostics) and Crescendo Bioscience (quantitative blood tests for rheumatoid arthritis) to MediNcrease's specialty laboratories network.
• Vibra HealthcarecoreStrategic or Co-development PartnerProvider agreement with Vibra Healthcare's network of specialty hospitals covering 18 states. Vibra operates Acute Medical Rehabilitation Hospitals (IRF) and Long Term Acute Care (LTAC) hospitals.
• Meridian Health ServicescoreStrategic or Co-development PartnerProvider agreement with Meridian Health Services offering behavioral health and primary care services in 39 counties throughout Indiana. Meridian integrates physical, mental, and social well-being.
• ConcentracoreStrategic or Co-development PartnerProvider agreement with Concentra's network of 300+ medical centers in 38 states providing occupational medicine, urgent care, physical therapy, and wellness services.

Scale indicators8 records

Recent moves7 records

Expansion highlights5 records

Direct peers

• MCMC LLC: Independent medical cost management firm offering claim review, negotiation, and bill audit services to insurance carriers, TPAs, and self-insured employers. Overlapping claim negotiation and medical bill audit services make this a direct peer.
• HealthSmart: PPO network and healthcare cost management company serving self-funded employers, TPAs, and insurers with network leasing, repricing, and care management services. Operates in the same provider network and cost containment space as MediNcrease.
• MultiPlan: Largest independent PPO network in the US, offering provider network access, claim cost management, and analytics services to insurers, TPAs, and self-funded plans. Most direct competitor to MediNcrease's network-based cost containment model.
• Lyric: Payment integrity and claims analytics platform (formerly ClaimsXten) used by health plans to ensure accurate claim payments. Comparable to MediNcrease's claim audit and cost containment services, with overlapping payer customer base.
• Zelis Healthcare: Healthcare cost management platform offering payment integrity, network access, and claim cost containment. Directly comparable to MediNcrease in serving payers with claim repricing, negotiation, and network services.
• Valenz: Healthcare cost containment and payment integrity company offering claim review, network solutions, and care management to payers and self-funded employers. Comparable in product set and customer base to MediNcrease.

Broad incumbents

• Optum: Diversified health services platform owned by UnitedHealth Group offering network services, claims processing, and care delivery. Overlaps with MediNcrease on payer services but operates at vastly greater scale across the entire healthcare value chain.
• Carelon: Health services arm of Elevance Health (formerly Anthem), offering care management, behavioral health, and payment integrity services. Comparable in payment integrity and payer services but operates as a much broader, integrated platform.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/Medincrease-LLC-580782425325354
• Xx.com/MediNcrease
• LinkedInlinkedin.com/company/medincrease-llc

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles3 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 MediNcrease Health Plans