Automated Health Systems

What Automated Health Systems does

Automated Health Systems, Inc. (AHS) is a privately held business process outsourcing and contract expertise firm founded in 1979 in Pittsburgh, Pennsylvania, specializing in the administration of public healthcare programs for state and local government agencies. The company delivers call center operations, mail fulfillment, field outreach, document management, payment processing, and self-service technology for Medicaid, CHIP, and state-based health insurance exchange programs. AHS also provides enrollment brokering, eligibility determination, provider enrollment and credentialing, and Primary Care Case Management (PCCM) services, serving populations ranging from 250,000 to over 4 million across nearly half of US states.

The company's underlying technology platform is a proprietary Customer Relationship Management (CRM) system integrated with IVR telephony, document imaging and indexing, eligibility processing including MAGI-in-the-Cloud integration, and a Provider Network Verification portal. Mobile applications include a HIPAA-compliant field outreach app for capturing applicant documents and a Florida Medicaid Member Portal available on Apple Store and Google Play. Supporting modules include a Task Tracking System with workflow routing, data transfer interfaces supporting HIPAA-compliant formats and EDI, and a Managed Care Prison Transition program. AHS holds URAC Health Call Center Accreditation Version 5.0 (Tennessee) and maintains HIPAA-compliant document handling across operations.

AHS generates revenue exclusively through multi-year government contracts procured via competitive bidding, structured as managed services and professional services engagements. The company employs nearly 3,000 professionals per its Careers page across operations offices in at least 11 states. Customer segments are vertical: state Medicaid agencies, Departments of Health, Departments of Human Services, and state-based health insurance exchanges. The go-to-market motion is enterprise field sales led by a Senior Vice President of Strategic Business Development & Sales with 30+ years of government contracting experience, targeting RFPs from state agencies; pricing is not publicly disclosed. Notable clients include Florida AHCA, Ohio Department of Medicaid, Massachusetts EOHHS, Maryland Department of Human Services, Tennessee TennCare, and Wyoming Department of Health.

Name

Automated Health Systems

Legal name

Automated Health Systems, Inc.

Website

https://automated-health.com

Company type

Private

Founded year

1979

Operating status

Operating

Headcount range

501–1,000 employees

Short description

Automated Health Systems is a privately held government healthcare BPO firm that administers Medicaid, CHIP, and health insurance exchange programs for state agencies across nearly half of US states, delivering call center, enrollment brokering, eligibility, and provider services through a proprietary CRM platform since 1979.

Ownership category

akta.pro rank

Product category

Healthcare BPO Services

NAICS

Administration of Public Health Programs (923120), Office Administrative Services (5611), Office Administrative Services (56111)

SIC

Services-Health Services (8000), Hospital & Medical Service Plans (6324), Services-Computer Programming, Data Processing, Etc. (7370)

akta.pro primary industry

Workflow & Case Management (Human-Centric BPM) (HDAEAHAA)

akta.pro secondary industries

Patient Access, Registration & Intake (Front-End RCM) (HLACACAE), Provider Network, Credentialing & Contracting Support (BPAAAFAI), Insurance Claims Intake & FNOL Support (BPAAAFAA)

Keywords

• Medicaid administration services
• Healthcare BPO services
• Enrollment broker services
• Government health programs
• Call center operations

Headquarters

HQ city

Pittsburgh

HQ country

United States

HQ region

North America

Offices11 records

Markets served

GTM type

B2B

Offering type

Services

Revenue model

1. BPO Services Contracts: AHS generates revenue through government contracts for business process outsourcing services including call center operations, mail fulfillment, field operations, document management, payment processing, and self-service technology. Contracts are multi-year engagements with state and federal government agencies for healthcare program administration.
2. Contract Expertise Services: Revenue from specialized contract administration services including enrollment brokering, health insurance exchange operations, eligibility operations, provider services, and alternatives to managed care programs for state Medicaid agencies.

Go-to-market motion1 record

Distribution channels1 record

Marketing channels10 records

Core offering

Automated Health Systems provides business process outsourcing (BPO) services and contract expertise for state and federal government health programs, including call center operations, enrollment brokering, eligibility determination, provider services, mail fulfillment, document management, payment processing, and field outreach. The company administers Medicaid, CHIP, and health insurance exchange programs across nearly half of U.S. states, leveraging a proprietary CRM platform integrated with telephony, IVR, mobile applications, and provider network verification systems.

Product overview

Automated Health Systems provides a unified BPO and health program management platform combining multiple service modules for government Medicaid and healthcare programs. The core offering integrates call center operations, mail fulfillment, field outreach, document management, payment processing, and self-service technology through a proprietary CRM platform. Contract Expertise services include Enrollment Broker, Health Insurance Exchange, Eligibility Operations, and Provider Services. Innovation modules include Provider Network Verification portal, Data Transfer Expertise, Managed Care Prison Transition, Task Tracking, and Mobile Applications. The company operates primarily in the government healthcare sector, administering programs for underserved populations across multiple states since 1979.

Differentiator

Problem solved

Functional benefit

Products and services

• Business Process Outsourcing (BPO) Services Comprehensive health program management through BPO services including call center operations, mail fulfillment, field outreach, document management, payment processing, and self-service technology platforms for state Medicaid agencies.
• Call Center Operations Call center solutions with advanced telephony, IVR, email and texting capabilities, proprietary CRM integration, and quality assurance programs for Medicaid and government health programs.
• Mail Fulfillment Operations Complex outbound mail operations handling populations from 20,000 to 4 million, with state-of-the-art mailrooms, equipment, and tools for transparency, reporting, and tracking.
• Field Operations and Outreach Face-to-face outreach and relationship building with mobile technology and apps to educate and engage consumers, providers, and community-based organizations.

Quantifiable outcome

• 3+ million Medicaid eligibles transitioned to managed care without missing a single SLA
• +5 more outcomes

Named customers20 records

Segments5 records

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature6 records

Partnerships

One partnership is on record.

• McKesson Health SolutionscoreStrategic or Co-development PartnerMcKesson Health Solutions and AHS jointly administered the ACCESS Plus Enhanced PCCM (Primary Care Case Management) program in Pennsylvania. This partnership was recognized as a top 15 finalist for the Innovations for American Government Award through Harvard Kennedy School Ash Institute. The program achieved documented cost savings of $62.9 million in its first two years.

Scale indicators10 records

Recent moves8 records

Expansion highlights6 records

Direct peers

• Kepro: Healthcare management and quality oversight company serving state Medicaid agencies and managed care plans with utilization review, prior authorization, and provider services. Overlaps with AHS's provider services and managed care program administration offerings.
• Gainwell Technologies: Healthcare technology and services company serving state Medicaid agencies, managed care organizations, and providers with claims processing, member management, and program integrity solutions. Gainwell is a direct competitor in the Medicaid technology and operations services market where AHS operates.
• Cognosante: Health IT and government services company providing eligibility, enrollment, and contact center solutions to state Medicaid and federal health agencies. Competes with AHS in the same state procurement landscape, particularly in MAGI-based eligibility modernization.
• Public Consulting Group: Management consulting firm focused on public-sector health and human services, providing BPO, technology, and consulting services to state Medicaid and human-services agencies. Competes with AHS on similar RFPs, particularly in eligibility, enrollment broker, and case management services.
• Maximus: Large publicly traded government health and human services BPO provider that competes head-to-head with AHS on state Medicaid, CHIP, and health-exchange contracts. Maximus is the most direct comparable in scale, services portfolio (call centers, eligibility, enrollment brokering), and customer base. Notably, AHS President Dr. Moses Haregewoyn previously worked at Maximus.

Broad incumbents

• Conduent: Major business process services company with a large government healthcare BPO practice serving Medicaid agencies, health plans, and exchanges. Conduent offers overlapping capabilities in eligibility, enrollment, and member engagement as part of a much broader transportation, commercial, and government portfolio.
• ICF International: Professional services and digital solutions firm with a substantial public health practice serving federal, state, and local health agencies on program modernization, analytics, and BPO. Overlaps with AHS on health and human services contract opportunities.
• Optum (UnitedHealth Group): Diversified health services and technology business within UnitedHealth Group that serves state Medicaid agencies with claims administration, analytics, and population health services. A much larger incumbent offering overlapping capabilities as part of a broader payer-services portfolio.
• DXC Technology: Global IT services company with a government healthcare practice that delivers systems integration, application management, and BPO services to state health agencies. Adjacent competitor with broader enterprise IT scale and federal contracting depth.

Emerging players

• CSG Government Solutions: Government healthcare consultancy and BPO provider focused on Medicaid Management Information Systems (MMIS) and eligibility modernization projects for state agencies. Smaller than AHS but competes on similar specialized procurements.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/pages/Automated-Health-Systems/106868452703067
• LinkedInlinkedin.com/company/automated-health-systems
• Xx.com/HealthAutomated

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

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 Automated Health Systems