MedHOK

What MedHOK does

MedHOK, Inc. (operating as MHK) is a Tampa, Florida-based enterprise healthcare technology company, founded in 2010 and operating as a subsidiary within the Hearst Health network. The company sells an integrated SaaS platform — organized under the CareProminence and MarketProminence suites — that supports US health plans, pharmacy benefit managers (PBMs) and managed care organizations across utilization management, care management, complaints/appeals/grievances, population health, pharmacy management, enrollment, premium billing, financial reconciliation and web portals.

The platform is anchored by SmartProminence Orchestrator, an AI-driven workflow orchestration layer that the company describes as combining enterprise workflow technology with artificial intelligence, and by DataVisor, an analytics module that consolidates disparate payer data sources. A FHIR-based Interoperability suite provides real-time data exchange across systems, and the entire stack carries HITRUST CSF, ISO 27001, NCQA Health Plan Accreditation and Population Health Prevalidation, PQA, and AICPA SOC 2 certifications — credentials that materially shorten procurement cycles in regulated payer environments. Client outcomes disclosed by MHK include reductions in call handle time from 15 minutes to 6 minutes after CareProminence implementation, daily time savings of 30 minutes to 2 hours per associate, and a four-month deployment timeline for a national managed care plan.

MHК distributes exclusively through direct enterprise field sales, with consultative "Schedule a Demo" and "Request Information" engagement paths and quote-based pricing. Revenue is generated through subscription/enterprise licensing arrangements with large payers; the company does not publish pricing. MHК is wholly owned by Hearst Health (no public ticker, no recent disclosed funding round since a 2014 $77.5 million round involving Bain Capital Ventures, Spectrum Equity and Growth Capital Fund) and operates with 51–100 employees from Tampa.

Name

MedHOK

Legal name

MedHOK, Inc.

Website

https://medhok.com

Company type

Private

Founded year

2010

Operating status

Operating

Headcount range

51–100 employees

Short description

MedHOK (MHK) is a Hearst Health subsidiary that sells an AI-enabled care, quality and compliance SaaS platform — CareProminence and MarketProminence suites — to US health plans, PBMs and managed care organizations, covering the full member lifecycle from enrollment through care delivery.

Ownership category

akta.pro rank

Product category

Healthcare Payer Software

NAICS

Computer Systems Design and Related Services (54151), Computer Systems Design and Related Services (5415), Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Other Computer Related Services (541519)

SIC

Services-Prepackaged Software (7372), Services-Health Services (8000), Hospital & Medical Service Plans (6324)

akta.pro primary industry

Pharmacy Interoperability, Standards & Integration (FHIR/NCPDP) (HLACAKAO)

Keywords

• Healthcare payer software
• Care management platform
• Utilization management software
• Pharmacy benefit management
• Healthcare compliance software

Headquarters

HQ city

Tampa

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Software

Cost components

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

Revenue model

1. Enterprise Software Licensing/Subscription: Software solutions sold to health plans, PBMs, and managed care organizations through enterprise licensing agreements. Solutions include CareProminence and MarketProminence suites covering utilization management, care management, pharmacy management, enrollment, billing, and analytics.

Go-to-market motion1 record

Distribution channels1 record

Marketing channels12 records

Core offering

MedHOK (MHK) sells an integrated enterprise software platform that combines AI-driven workflow orchestration with clinical, administrative, and compliance modules for U.S. health plans, pharmacy benefit managers, and managed care organizations. The platform is delivered through two suites — CareProminence for utilization, care, population health, pharmacy, and complaints management, and MarketProminence for enrollment, premium billing, financial reconciliation, and member/provider web portals. Core differentiators include the SmartProminence Orchestrator, DataVisor analytics, FHIR-based interoperability, and a certified compliance foundation (HITRUST, NCQA, ISO 27001).

Product overview

MedHOK (MHK) offers an enterprise healthcare technology platform with two primary sub-brands: CareProminence and MarketProminence. CareProminence provides AI-driven workflow orchestration for care management, utilization management, population health, pharmacy management, and compliance (complaints, appeals, grievances). MarketProminence handles enrollment, premium billing, financial reconciliation, and web portals. Core products include SmartProminence Orchestrator (AI-powered orchestration engine) and DataVisor (analytics), supported by an Interoperability suite with FHIR-based APIs. The modular architecture allows health plans and pharmacy benefit managers to consolidate systems and automate workflows from member enrollment through ongoing care delivery.

Differentiator

Problem solved

Functional benefit

Brands

• CareProminence: Enterprise workflow platform for health plans and managed care organizations; includes SmartProminence Orchestrator, DataVisor, Utilization Management, Complaints/Appeals/Grievances, Care Management, Population Health & Quality Management, and Pharmacy Management solutions.
• MarketProminence
• SmartProminence
• DataVisor

Products and services

• SmartProminence Orchestrator AI-powered workflow orchestration platform that streamlines complex healthcare operations by connecting workflows, data, and decisions across health plans and pharmacy benefit managers, leveraging agentic AI for utilization management and care coordination.
• DataVisor Insights and analytics platform for payers providing data consolidation, unified reporting, and actionable intelligence from disparate healthcare data sources.
• Interoperability FHIR-based interoperability suite enabling real-time healthcare information exchange across systems with certified, standards-compliant connectivity for payer-provider data sharing.
• Utilization Management Comprehensive suite for managing utilization review, prior authorization processing, and medical necessity determinations with workflow automation for health plans and managed care organizations.
• Complaints, Appeals & Grievances (CAG) Workflow suite for managing member complaints, appeals, and grievances with automated tracking, reporting, and compliance documentation for health plan compliance teams.
• Care Management Comprehensive care management suite supporting member care coordination from enrollment through ongoing engagement across the care journey for health plan care managers.
• Population Health & Quality Management Platform for managing population health initiatives, quality measure tracking, and NCQA prevalidated reporting for health plan performance and quality program compliance.
• Pharmacy Management Comprehensive pharmacy management solution supporting pharmacy benefit manager operations, medication therapy management, and pharmacy quality measures for PBM and health plan customers.
• Financial Reconciliation Module for reconciling financial transactions, claims data, and payments across health plan operations with automated reconciliation workflows.
• Premium Billing Module for managing premium billing, payment collection, and member financial transactions for health plan revenue operations.
• Enrollment & Member Maintenance System for managing member enrollment, eligibility verification, and ongoing member information maintenance from point of enrollment for health plans.
• Web Portals Web-based portal solutions providing member and provider access to health plan information, claims, and care management tools.
• CareProminence HITRUST-certified enterprise workflow platform for health plans covering care management, utilization management, population health, pharmacy management, complaints/appeals/grievances, and care coordination with AI-driven orchestration.
• MarketProminence Enterprise platform for enrollment, premium billing, financial reconciliation, and member-facing web portals serving health plan administrative and financial operations.

Quantifiable outcome

• Handle time reduced from 15 minutes to approximately 6 minutes after implementing CareProminence
• +3 more outcomes

Named customers4 records

Segments3 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability5 records

Feature5 records

Partnerships

One partnership is on record.

• Hearst HealthcoreOthersMHK is a proud part of the Hearst Health network, a major healthcare information company. Each Hearst Health company shares a vision to elevate care across the health journey with a focus on delivering essential intelligence and software that improves the quality, safety and efficiency of care. MHK serves as a technology partner within this network, guiding health plan and PBM clients to excel in compliance, improve health outcomes and deliver operational efficiencies.

Scale indicators2 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• HealthEdge: HealthEdge provides a core administrative and care management software platform for health plans, directly competing with MedHOK's CareProminence suite in utilization management, care management, and population health for commercial, Medicare, and Medicaid payers.
• Availity: Availity operates one of the largest healthcare information networks with FHIR-based interoperability, payer-provider data exchange, and workflow tools, overlapping directly with MedHOK's Interoperability suite and CareProminence workflows for health plans and PBMs.
• ZeOmega: ZeOmega's Jiva platform delivers population health, care management, and utilization management workflows to health plans, addressing the same pain points (siloed systems, manual processes, compliance) that MedHOK's CareProminence targets.
• Cotiviti: Cotiviti provides payment integrity, risk adjustment, and quality analytics for health plans and PBMs, with a strong DataVisor-like analytics and quality-measurement offering that competes with MedHOK's DataVisor and population health modules.
• Inovalon: Inovalon offers a payer-focused data analytics, quality reporting, and care management platform powered by the INovalon ONE ecosystem, directly comparable to MedHOK's DataVisor analytics and population health/quality management suite.
• Edifecs: Edifecs provides healthcare data interoperability, FHIR-based integration, and value-based care workflow tools, making it a direct competitor to MedHOK's Interoperability suite and to parts of the SmartProminence orchestration offering.
• Health Catalyst: Health Catalyst provides data and analytics-driven population health and quality management technology for payers and providers, overlapping with MedHOK's DataVisor, Population Health & Quality Management, and care management capabilities.

Broad incumbents

• Optum (UnitedHealth Group): Optum operates an extensive portfolio of payer services, analytics, and interoperability (including the former Change Healthcare assets) that competes with MedHOK across care management, utilization management, financial reconciliation, and pharmacy workflows at very large scale.

Emerging players

• Casenet (Centene): Casenet, originally an independent care management software vendor and now operating inside Centene, competes with MedHOK's Care Management and Utilization Management suites for managed care plan buyers.
• RLDatix: RLDatix provides healthcare governance, risk, and compliance workflow software, including payer-facing modules, making it an adjacent competitor to MedHOK's complaints, appeals, and grievances and compliance-driven offerings.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/MedHOK360
• YouTubeyoutube.com/@MHKhealth
• Facebookfacebook.com/MedHOK
• LinkedInlinkedin.com/company/medhok-healthcare-solutions
• TikToktiktok.com/@mhk.health

Compliance8 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles8 records

Funding overview

Funding rounds1 record

Investors3 records

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 MedHOK