Provider Resources
Provider Resources, LLC (PRI) is a federal healthcare services contractor providing clinical review, program integrity, care management, health equity, and No Surprises Act IDRE services to U.S. federal agencies (CMS, VA, HRSA, CDC, FDA, HHS, NIH, AHRQ) via multiple IDIQ contract vehicles and a FISMA-authorized proprietary review system.
- Company typePrivate
- Founded2003
- HeadquartersErie, United States
- Headcount101–250
- GTM typeB2B
- OfferingServices
What Provider Resources does
Provider Resources, LLC (PRI) is a privately-held federal healthcare services contractor headquartered in Erie, Pennsylvania, founded in 2003 and operating with 51-100 employees. The company delivers clinical review, program integrity, care management, health equity, education and outreach, and data analytic services to U.S. federal healthcare agencies — primarily CMS, VA, HRSA, CDC, FDA, HHS, NIH, and AHRQ — exclusively through government-wide IDIQ contract vehicles including GSA OASIS+ (HUBZone and Small Business), BFCC IDIQ (75FCMC19D0071), and VA BPA (36C10X24A0013). PRI also operates as a certified Independent Dispute Resolution Entity (IDRE APP 141) under the No Surprises Act.
The company's core technical asset is PROS (PRI Review System), a FISMA-authorized proprietary review system that has maintained Authority to Operate from CMS for over 13 years, hosted in a CMS Federal Information Processing Standards High Availability Data Center with 24/7/365 Security Operations Center monitoring and multi-zone firewall architecture. PRI complements this with a HIPAA-approved telecommunications platform featuring IVR, auto-dialer, reporting, monitoring, and recording capabilities. Its Clinical Consortium aggregates over 500 board-certified physicians and 200+ healthcare professionals across specialties and subspecialties to support external peer reviews, VA reviews, and program integrity work. The company also maintains a Creative Solutions Group for federal multimedia and an Education & Outreach arm offering free CME webinars jointly sponsored with MedChi.
PRI's revenue model is contract-based, with pricing established through IDIQ task orders rather than publicly disclosed rates. Services are billed on multi-year contract terms. The company's market position is reinforced by URAC Independent Review Organization accreditation, ISO 9001:2015 registration, HUBZone certification (with a 35% HUBZone employee commitment), and a documented track record of measurable clinical outcomes — including a 9.18% reduction in 30-day hospital readmissions and 4.37% reduction in 30-day ER readmissions through its Beneficiary Care Management Program, and an 11% reduction in 30-day hospital readmissions and 11.74% reduction in ER readmissions in a separate national clinical program. Leadership, per the most recent first-party website, lists Shawn Keough-Hartz as CEO/President/Owner/Founder and Dennis Agostini as Chief Medical Officer; earlier corporate materials referenced Alex Ginsberg as CEO, suggesting a recent leadership transition.
Provider Resources firmographics
Firmographics- Name
- Provider Resources
- Legal name
- Provider Resources, LLC
- Website
- https://provider-resources.com
- Company type
- Private
- Founded year
- 2003
- Operating status
- Operating
- Headcount range
- 101–250 employees
- Short description
- Provider Resources, LLC (PRI) is a federal healthcare services contractor providing clinical review, program integrity, care management, health equity, and No Surprises Act IDRE services to U.S. federal agencies (CMS, VA, HRSA, CDC, FDA, HHS, NIH, AHRQ) via multiple IDIQ contract vehicles and a FISMA-authorized proprietary review system.
- Ownership category
- akta.pro rank
Provider Resources industry classification
Industry- Product category
- Healthcare Quality and Program Integrity Services
- NAICS
- Administration of Public Health Programs (923120), Services for the Elderly and Persons with Disabilities (624120)
- SIC
- Services-Health Services (8000), Services-Misc Health & Allied Services, Nec (8090)
- akta.pro primary industry
- Benefits, Insurance & Entitlement Navigation (Medicare/Medicaid/VA/LTC) (HSABAIAG)
- akta.pro secondary industries
- Benefits, Insurance & Long-Term Care Planning Navigation (Medicare/Medicaid/LTC) (HLADALAI), Health Information Management (EHR) & Medical Office Administration (EDAOAJAF)
Keywords
Where Provider Resources is headquartered
LocationHeadquarters
- HQ city
- Erie
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Provider Resources business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure
Revenue model
- Government Healthcare Contracts: PRI generates revenue through multiple federal government contract vehicles including GSA OASIS+, BFCC IDIQ, and VA BPA. Services include clinical review, program integrity, care management, health equity initiatives, and education programs for federal healthcare agencies.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Other | Multi-year contract | Government contract services - pricing established via IDIQ contracts |
Go-to-market motion1 record
Distribution channels4 records
Marketing channels5 records
Provider Resources product offering
Product offeringCore offering
Provider Resources, LLC (PRI) is a government contractor that delivers clinical review, program integrity, care management, health equity, and education/outreach services to federal healthcare agencies. Services are delivered through multiple IDIQ contract vehicles (GSA OASIS+, BFCC IDIQ, VA BPA) and supported by a proprietary FISMA-authorized PROS review system and a Clinical Consortium of over 500 board-certified physicians. The company focuses on healthcare quality oversight, fraud prevention, and health disparities reduction for agencies such as CMS, VA, HRSA, and CDC.
Product overview
Provider Resources operates a unified healthcare services platform with multiple interconnected solution areas rather than a single software product. The core offerings include Clinical Solutions (with a Physician Consortium of 500+ board-certified physicians), Education & Outreach Solutions, Data Analytic Solutions, Creative Solutions Group, and System Solutions (encompassing the proprietary PROS review system and telecommunications infrastructure). These services are delivered alongside specialized programs including VA Reviews (URAC-accredited IRO), No Surprises Act IDRE Services, Health Equity Solutions, the Clinical Consortium, CME Courses, and PRI Community. The portfolio centers on program integrity, clinical quality, care management, and health equity for federal healthcare programs.
Differentiator
Problem solved
Functional benefit
Brands
- PROS (PRI Review System): Federal Information Security Modernization Act (FISMA) authorized system for clinical and program review, with Authority to Operate granted by CMS in 2021.
- CSG (Creative Solutions Group)
- Clinical Consortium
Products and services
- Clinical Solutions
Quantifiable outcome
- 9.18% reduction in 30-day hospital readmissions and 4.37% reduction in 30-day emergency room readmissions through Beneficiary Care Management Program
- +1 more outcomes
Companies that use Provider Resources
Customer profileNamed customers8 records
Segments3 records
Ideal customer profiles2 records
Provider Resources technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Feature3 records
Provider Resources partnerships and signals
Strategic signalPartnerships
Three partnerships are on record, tiered core.
- The Maryland State Medical Society (MedChi)coreMedChi jointly sponsors PRI's Continuing Medical Education (CME) courses, allowing physicians and healthcare providers to earn CME credits. PRI develops and offers training opportunities for physicians on best practices in engaging patients at the community level. Courses are offered at no charge to providers and delivered via PRI Training website.
- URACcoreURAC is the independent accrediting organization that has accredited Provider Resources as an Independent Review Organization (IRO). Accreditation number IRC010009. URAC accreditation demonstrates compliance with quality standards for healthcare utilization management and review services.
- GSA (General Services Administration)coreGSA provides government-wide acquisition contract vehicles that PRI utilizes for delivering professional services to federal agencies. PRI holds multiple OASIS+ and GSA MAS contract vehicles enabling direct engagement with government customers.
Scale indicators6 records
Recent moves7 records
Expansion highlights6 records
Provider Resources competitors and assessment
Company assessmentBroad incumbents
- Maximus: Large federal services contractor operating BFCC-QIO contracts and a wide range of clinical review, eligibility, and program integrity services for CMS and other federal agencies — directly comparable to PRI's federal healthcare quality work.
- ICF International: Large federal health and human services consultancy providing program support, evaluation, and quality improvement for HHS, CMS, and CDC — broader incumbent competing for the same federal health contracts.
- Booz Allen Hamilton: Major federal contractor with a large HHS/CMS health portfolio including clinical review, health analytics, and program integrity — a broader incumbent that competes for many of the same opportunities.
- Acentia (now part of Maximus): Former federal health IT and program integrity contractor, now part of Maximus — provides relevant precedent for the type of federal health services PRI delivers.
Direct peers
- Livanta: BFCC-QIO contractor and URAC-accredited Independent Review Organization providing clinical review and quality improvement services for Medicare beneficiaries — directly overlaps with PRI's federal clinical review and VA work.
- Qlarant (formerly Delmarva Foundation): Federal healthcare quality improvement organization providing program integrity, utilization review, and quality oversight services to CMS — comparable peer in the federal healthcare review space.
- Keystone Peer Review Organization (KePRO): Quality improvement and care management organization serving federal healthcare programs including CMS BFCC-QIO contracts — direct peer in clinical review and Medicare beneficiary services.
- Westat: Federal health services research and quality improvement contractor supporting CMS, AHRQ, and CDC on health outcomes and program evaluation — comparable peer in federal healthcare quality work.
- HealthCare Dynamics International: Federal healthcare contractor providing clinical review, utilization management, and quality improvement services — comparable small/mid-sized peer in federal clinical review.
Emerging players
- PerformCare: Care management and quality oversight organization serving government health programs — adjacent peer in the federal care management and clinical oversight space.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat5 records
Key risks6 records
Key highlights7 records
Customer concentration
Provider Resources social profiles
Digital presenceProvider Resources compliance and trust
Trust signalCompliance4 records
Provider Resources financial estimates
Financial estimateRevenue estimate
Valuation estimate
Provider Resources leadership team
Management profileNumber of profiles
Profiles4 records
Provider Resources funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Provider Resources 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 Provider Resources
What does Provider Resources do?
Provider Resources, LLC (PRI) is a government contractor that delivers clinical review, program integrity, care management, health equity, and education/outreach services to federal healthcare agencies. Services are delivered through multiple IDIQ contract vehicles (GSA OASIS+, BFCC IDIQ, VA BPA) and supported by a proprietary FISMA-authorized PROS review system and a Clinical Consortium of over 500 board-certified physicians. The company focuses on healthcare quality oversight, fraud prevention, and health disparities reduction for agencies such as CMS, VA, HRSA, and CDC.
Is Provider Resources a public or private company?
Provider Resources is a private company. It is classified as founder individual operated bootstrapped and is currently operating.
When was Provider Resources founded?
Provider Resources was founded in 2003. It employs 101 to 250 people.
Where is Provider Resources based?
Provider Resources is headquartered in Erie, United States, in the North America region.
How does Provider Resources make money?
One revenue line is on record: government Healthcare Contracts.
Who are Provider Resources's main competitors?
Broad incumbents on record are Maximus, ICF International, Booz Allen Hamilton and Acentia (now part of Maximus). Direct peers are Livanta, Qlarant (formerly Delmarva Foundation), Keystone Peer Review Organization (KePRO), Westat and HealthCare Dynamics International. PerformCare is listed as an emerging player.
Does Provider Resources have an API?
No public API is recorded for Provider Resources.
What industry is Provider Resources in?
Provider Resources's product category is Healthcare Quality and Program Integrity Services. Its primary akta.pro industry code is HSABAIAG, Benefits, Insurance & Entitlement Navigation (Medicare/Medicaid/VA/LTC), with a secondary code of HLADALAI, Benefits, Insurance & Long-Term Care Planning Navigation (Medicare/Medicaid/LTC). Its NAICS code is 923120 and its SIC code is 8000.