Mirra

What Mirra does

Mirra Health Care LLC (formerly Access Health Care, LLC) is a privately held, Florida-licensed Third-Party Administrator that operates an integrated 'Medicare Advantage In a Box' software platform for U.S. Medicare Advantage health plans, Independent Physician Associations (IPAs), provider specialty groups, and hospice organizations. The company is headquartered in Brooksville, Florida, with product development centers in Bengaluru and Noida, India, and reports a workforce of 251-500 employees. Its platform consists of 12 proprietary modules — including Eligibility/Enrollment/Member Management, Premium Billing, Claims Adjudication (ClaimsLite for paper claims, ClaiMaster for EDI), Encounter Data Processing System (EDPS/RAPS), Utilization Management (Calypso/Calypso Lite), Provider Portal, Customer Service Management, Appeals and Grievances, Member House, Provider Villa, Full Stack Technology Solutions, and Healthcare Growth Marketing — that share data through internal APIs to provide end-to-end CMS- and HIPAA-compliant administration.

The platform is built on a cloud-hosted, CMS-aligned architecture with built-in editing libraries (over 40 million edits including NCCI), integrated CMS pricers for Inpatient, Outpatient, and PDPM, and EDI-based data exchange (834, 837, 278, TA1, 999, 277CA, MAO-002, MAO-004). AI/ML capabilities are positioned in the Full Stack Technology Solutions module around predictive modeling, behavior mapping, and optimization, with anomaly detection embedded in claims adjudication for fraud, waste, and abuse screening. Mirra monetizes through managed-services TPA contracts on a quote-based, per-member-per-month and per-claim basis sold via enterprise field sales; pricing is not publicly disclosed. As of the latest reporting, the company manages 123,777 TPA members and 65,358 IPA members across 7 health plans, 4 IPAs, 2 provider specialty groups, and 1 hospice, with named customers including Ultimate Health Plans and Liberty Medicare Advantage.

In March 2026, the Florida Office of Insurance Regulation suspended Mirra Health LLC's certificate of authority after finding the company impermissibly shared Medicare data of 23,119 Florida Medicare Advantage enrollees with four unlicensed overseas companies in India and the Philippines without the prior approval of the HMOs it served, and for failing to produce all overseas contracts in violation of section 626.884 of the Florida Insurance Code.

Name

Mirra

Legal name

Mirra Health Care LLC

Website

https://mirrahealthcare.com

Company type

Private

Founded year

2016

Operating status

Operating

Headcount range

251–500 employees

Short description

Mirra Health Care LLC is a Florida-licensed Third-Party Administrator that provides an integrated 'Medicare Advantage In a Box' software platform — spanning enrollment, claims, billing, utilization management, and appeals — for Medicare Advantage health plans, IPAs, specialty groups, and hospices, with product development in Florida and India.

Ownership category

akta.pro rank

Product category

Healthcare Third-Party Administration Software

NAICS

Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (518)

SIC

Hospital & Medical Service Plans (6324), Services-Computer Programming, Data Processing, Etc. (7370)

akta.pro primary industry

Medicare Advantage HMOs (HMO/HMO-POS) (HLAEAMAH)

akta.pro secondary industries

Medicare Quality, Risk Adjustment & Stars Analytics/Services (FSAIAGAJ), Medicare Provider Networks & Delegated Medical Groups (MA-focused) (FSAIAGAK)

Keywords

• Medicare Advantage administration
• Third-party administrator software
• Claims adjudication platform
• Healthcare revenue cycle management
• CMS compliance solutions

Headquarters

HQ city

Spring Hill

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, Marketing or Sales, Infrastructure, Supply Chain

Revenue model

1. TPA Services for Medicare Advantage Health Plans: As a licensed Third-Party Administrator, Mirra provides integrated products and services to Medicare Advantage Health Plans including eligibility management, claims adjudication, premium billing, utilization management, and provider portal solutions. Revenue is generated through service fees charged to health plans for processing their Medicare Advantage operations.

Go-to-market motion2 records

Distribution channels1 record

Marketing channels8 records

Core offering

Mirra Health Care is a licensed Third-Party Administrator that delivers the 'Medicare Advantage In a Box' platform — an integrated, modular suite of CMS- and HIPAA-compliant software products and services for Medicare Advantage Health Plans, IPAs, Provider Specialty Groups, and Hospice organizations. The platform spans eligibility/enrollment, premium billing, claims adjudication (ClaimsLite and ClaiMaster), encounter data processing (EDPS/RAPS), utilization management (Calypso), provider portal, customer service management, appeals and grievances, Member House, and Provider Villa, integrated through internal APIs, SFTP/EDI, and database linkages.

Product overview

Mirra Health Care operates as a licensed Third-Party Administrator offering the 'Medicare Advantage In a Box' platform — an integrated, modular suite of Medicare Advantage software solutions for health plans. The portfolio consists of 12 distinct products/modules: Eligibility, Enrollment and Member Management; Premium Billing; Claims Adjudication (encompassing ClaimsLite for paper claims and ClaiMaster for EDI adjudication); Encounter Data Processing System (EDPS/RAPS); Utilization Management (including Calypso and Calypso Lite portals); Provider Portal; Customer Service Management; Appeals, Grievances and Complaint Tracking Module; Member House; Provider Villa; Full Stack Technology Solutions; and Healthcare Growth Marketing. These products are designed to integrate Payer, Provider, and Patient across the healthcare ecosystem, sharing data via internal APIs and database linkages to form a cohesive TPA platform compliant with CMS standards and HIPAA.

Differentiator

Problem solved

Functional benefit

Brands

• ClaimsLite: Paper claims entry system for healthcare claims processing
• ClaiMaster
• Calypso
• Calypso Lite
• Medicare Advantage In a Box
• EDPS/RAPS
• Member House
• Provider Villa

Products and services

• Eligibility, Enrollment and Member Management End-to-end solution for onboarding and managing Medicare beneficiaries onto Medicare Advantage plans, supporting online, paper, 834 EDI, OEC, and custom format intake; real-time and batch eligibility checks via CMS BEQ; automated TRC processing; and compliant generation of ANOC, welcome kits, and ID cards. Designed for Medicare Advantage Health Plans and licensed as a HIPAA-compliant hosted solution.
• Premium Billing Member Billing module that automates generation of member invoices and payment posting, with seamless handling of CMS-imposed retroactivity. Fully integrated with Membership Management, supports LIS and SSA payments, generates member refund checks, and maintains extensive audit trails for Medicare Advantage Health Plans.
• Claims Adjudication (ClaimsLite / ClaiMaster) Claims adjudication solution with ClaimsLite for paper claim entry and ClaiMaster for EDI claims adjudication, featuring high auto-adjudication rates, flexible benefit configuration rules, and built-in editing software with over 40 million edits including CMS NCCI fraud/waste/abuse detection. Integrated pricers for Inpatient, Outpatient, and PDPM, designed for Medicare Advantage Health Plans.
• Encounter Data Processing System (EDPS/RAPS) EDPS/RAPS solution that receives, processes, and transmits CMS-compliant 837 data to CMS, applies responses automatically (TA1, 999, 277CA, MAO002, MAO004), performs HIPAA and CMS-specific edits, de-dups RAPS clusters, and reconciles discrepancy gaps between Claims, EDPS, RAPS, MAO-002, and MAO-004 for Medicare Advantage Health Plans.
• Utilization Management (Calypso / Calypso Lite) Cutting-edge, customizable utilization and prior authorization management system for Medicare Advantage Health Plans, including Calypso Lite (PCP portal for eligibility verification and authorization submission) and Calypso (approval/denials for Part A and Part B services with streamlined letter batching and fulfillment). Supports 278 EDI transactions and CMS/NCQA standards.
• Provider Portal Web portal providing participating providers with tools to support administrative needs including claim details, Explanation of Payments (EOP), member eligibility checks, prior authorization information, and self-registration with valid TIN and NPI combinations. HIPAA-compliant, ensuring providers see only their members' data.
• Customer Service Management Holistic solution for Medicare Advantage Health Plans to manage all customers, applicants, providers, agents, and prospects' service-related processes. Features web-based CSR interface, telephony integration, event management with routing, SLA tracking via color coding, RSVP tracking for webinars, and CMS scheduled reports.
• Appeals, Grievances and Complaint Tracking Module Comprehensive Medicare Advantage Appeals, Grievances and Complaint Tracking Module for managing all CMS case types including Part B drugs, Part C, Part D, and CTM. Features automatic due date calculation, centralized case database, CMS-required correspondence generation in English or Spanish, and escalation management to IRE.
• Member House Single source of truth for member-related information including demographics, plan mapping, and PCP mapping. Provides real-time and batch mode updates, historical data retrieval for regulatory needs, and integration via API, file extracts, and database linkages with enrollment, claims, utilization management, and customer service systems.
• Provider Villa Comprehensive provider data management solution serving as a central repository for provider and facility data. Supports vendor management with 1099 details, provider contracts with payclass/CPT/revenue code exceptions, NPI validation via NPI registry, address validation, and self-registration. Provides APIs to enrollment, claims, utilization management, and customer service systems.
• Full Stack Technology Solutions AI and ML-powered full-stack development services for health plans featuring behavior mapping, predictive modeling, optimization algorithms, and iterative enhancements to deliver 5X growth. Includes web app development, mobile app development (iOS/Android), user-centric UI/UX design, Section 508 accessibility services, product development, cloud solutions, DevOps, and security.
• Healthcare Growth Marketing Insights-driven digital marketing services for healthcare brands leveraging data and predictive analytics. Includes brand-centric end-to-end solutions, branding and brand asset creation, web and mobile development, digital marketing strategy and creation, content strategy, graphic design, video creation, social media management, SEO/ASO, performance marketing, email marketing, and e-commerce marketing. Uses AI and ML for hyper-personalized engagement.

Quantifiable outcome

• Reduces operational costs by 25-30%
• +5 more outcomes

Named customers2 records

Segments4 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration6 records

AI capability8 records

Feature10 records

Scale indicators7 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• HealthEdge Software: HealthEdge provides a commercial health plan core platform (HealthRules) with deep Medicare Advantage functionality including claims, enrollment, and provider management. Directly comparable to Mirra as a tech-platform vendor serving MA health plans with integrated, modular offerings.
• Edifecs: Edifecs specializes in healthcare data interoperability, EDI processing, and CMS compliance — overlapping directly with Mirra's encounter data processing (EDPS/RAPS), 837/834 EDI handling, and CMS regulatory compliance capabilities for MA plans.
• Conduent Incorporated: Conduent provides healthcare claims administration and customer service solutions to health plans and payers. Directly competes with Mirra's claims adjudication and customer service management offerings for MA plan business, with global delivery scale.
• SS&C Technologies (SS&C Health): SS&C Health is a major third-party administrator serving health plans with claims processing, eligibility, and member management solutions. A direct competitor in the MA TPA space, though at significantly larger scale with broader product breadth across commercial and government programs.

Broad incumbents

• Change Healthcare (Optum): Change Healthcare, now part of Optum/UnitedHealth Group, provides claims processing, payment integrity, and healthcare data analytics. A broad incumbent in the same claims processing and revenue cycle space, but serving the entire healthcare ecosystem rather than specializing in MA TPA.
• HMS Holdings (Gainwell Technologies): Gainwell Technologies, the successor to HMS Holdings, provides Medicaid and Medicare claims processing, care management, and analytics for government health programs. Comparable to Mirra's MA TPA focus but at much larger scale and with broader government health program coverage.
• TriZetto (Cognizant): TriZetto, now part of Cognizant, is a broad healthcare IT services and platform provider for health plans, offering claims processing, care management, and member engagement. Competes with Mirra as part of a much wider portfolio including consulting and large-scale system integration.

Emerging players

• ZeOmega: ZeOmega offers the Jiva population health management platform used by MA plans for care management, utilization management, and member engagement. Partial overlap with Mirra's Calypso utilization management and care management offerings, with stronger analytics focus.
• Mphasis: Mphasis is an India-headquartered IT services company with a healthcare payer practice providing claims administration, member services, and digital transformation. Mirrors Mirra's offshore delivery model and TPA service positioning, but as a much larger generalist services firm.
• VirtualHealth: VirtualHealth provides HELIOS, a care management and utilization management platform for health plans including MA populations. Comparable to Mirra's Calypso utilization management and care management modules, focused specifically on value-based care workflows.

Market position

Strengths4 records

Weaknesses5 records

Competitive moat4 records

Key risks5 records

Key highlights6 records

Customer concentration

• Xx.com/mirrahealthcare
• YouTubeyoutube.com/channel/UCAfsrhBs3rSbOXGmQeNFVpA
• Facebookfacebook.com/mirrahealthcare
• LinkedInlinkedin.com/company/mirra-health-care

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

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 Mirra