Nova Healthcare Administrators

What Nova Healthcare Administrators does

Nova Healthcare Administrators is a Third-Party Administrator (TPA) specializing in self-funded employee health benefits administration. Founded in 1980 and headquartered in Buffalo, New York, Nova operates as a subsidiary of Independent Health and provides claims administration, in-house medical management (case, disease, and utilization management), stop-loss reporting, PBM coordination, and reporting and analytics to employers nationwide. The company targets small and mid-sized employers (often via level-funded plans), large employers with 200-plus employees, and insurance brokers and consultants serving as distribution partners. It also offers white-label/BPO services to health plan start-ups, unions, municipalities, hospital systems, TPAs, medical practices, and direct primary care providers.

The core technology platform centers on claims processing, an in-house clinical team, and partnership integrations with a broad ecosystem of network partners (Nova Medicalcare, Independent Health, Cigna, First Health, MultiPlan, PHCS, HealthCare Highways Plus, HealthSmart, Emblem Health/GHI, Alchemy Health, Cofinity), stop-loss carriers, and twelve-plus PBM vendors (Prime Therapeutics, Express Scripts, Liviniti, Cigna, Southern Scripts, TrueScripts, VeracityRx, US-Rx Care, WellDyne, Meritain, DisclosedRx, Drexi). In July 2021 Nova partnered with HealthJoy to extend into mobile on-demand care navigation. Additional product modules include Reference-Based Pricing, Direct Primary Care, HSA/FSA/HRA administration, dental and vision ancillary benefits, the Innovations Lifestyle Spending Account (launched September 2023), and the Pet Care Reimbursement Benefit (launched May 2026). Quality is anchored by URAC accreditations for Case Management and Health Utilization Management and Validation Institute revalidation for chronic condition management with a $25,000 Credibility Guarantee.

Commercially, Nova generates revenue primarily through recurring administrative fees (PEPM-style subscription billing) for self-funded plan administration, managed-services fees for white-label BPO, and ancillary revenue from stop-loss reporting, lifestyle benefits, and referral/affiliate arrangements with PBM and network partners. Pricing is custom-quoted per plan based on demographics, industry, group size, claims experience, plan design, and risk tolerance, with monthly billing cadence. Go-to-market is enterprise field sales to employers combined with a broker/consultant channel that includes dedicated sales and service teams, RFP support tools, and content marketing through the Under the Coverage podcast and the annual Employee Benefits Benchmarking Report. The company has 101-250 employees and reports nationwide US operations with no disclosed geographic restrictions.

Name

Nova Healthcare Administrators

Legal name

Nova Healthcare Administrators, Inc.

Website

https://novahealthcare.com

Company type

Private

Founded year

1980

Operating status

Operating

Headcount range

101–250 employees

Short description

Nova Healthcare Administrators is a Buffalo, NY-based Third-Party Administrator providing self-funded and level-funded employee health benefits administration, including claims processing, in-house medical management, stop-loss reporting, and care navigation via its HealthJoy partnership, serving employers, brokers, and white-label clients nationwide.

Ownership category

akta.pro rank

Product category

Health Benefits Third-Party Administration

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Care Management & Population Health Program Administration (HLAEALAG)

Keywords

• Third-party administration
• Self-funded benefits
• Claims administration
• Medical management services
• Employee benefits administration

Headquarters

HQ city

Buffalo

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. TPA Administrative Services Fees: Nova charges administrative fees for processing self-funded employee benefit plans, including claims administration, customer service, and plan management.
2. Stop-Loss Insurance Management: Nova manages stop-loss reporting for specific and aggregate stop-loss policies, working with industry-leading stop-loss carriers. May serve as stop-loss broker of record or provide reporting to the designated broker.
3. White-Label / BPO Services: Nova provides white-label administrative services to health plan start-ups, unions, municipalities, TPAs, hospital systems, and medical practices, enabling them to build their own brand while outsourcing staffing and support.
4. Network Partnerships and PBM Commissions: Nova works with network partners and PBMs, recommending the best network strategy for organizations and partnering with best-in-class pharmacy benefit management vendors.
5. Lifestyle Benefits (Pet Care Reimbursement): Nova launched a Pet Care Reimbursement Benefit as a taxable lifestyle spending account structure, providing employers a flexible fringe benefit.

Pricing tiers

Go-to-market motion2 records

Distribution channels5 records

Marketing channels7 records

Core offering

Nova Healthcare Administrators is a Third-Party Administrator (TPA) providing self-funded employee health benefits administration for employers. Its core offering includes claims administration, medical management (case, disease, and utilization management), network partnerships, stop-loss management, PBM partnerships, and reporting and analytics. The company also provides level-funded plans, white-label BPO services, HSA/FSA/HRA administration, and ancillary dental/vision benefits.

Product overview

Nova Healthcare Administrators is a Third-Party Administrator (TPA) offering a comprehensive suite of self-funded and level-funded employee benefits administration services. The core product is Self-Funded Employee Benefits Administration, which integrates Medical Management, Claims Administration, Network Partnerships, Stop-Loss Management, Reporting & Analytics, and PBM Partnerships. Nova x HealthJoy provides on-demand care navigation as a mobile platform add-on. Additional add-on modules include HSA/FSA/HRA administration, dental and vision ancillary benefits, Reference-Based Pricing, Direct Primary Care solutions, Pet Care Reimbursement, and Innovations Lifestyle Benefits. White Label/BPO services allow partners to private-label Nova's administration capabilities. An educational resource, Under the Coverage Podcast, complements the service portfolio.

Differentiator

Problem solved

Functional benefit

Brands

• Under the Coverage: A podcast about employee benefits that helps consumers understand health care and benefits terminology through interviews with industry insiders.

Products and services

• Self-Funded Employee Benefits Administration
• Level-Funded Health Plans
• Nova x HealthJoy (Care Navigation)
• Business Process Outsourcing (BPO) / White Label Services
• Medical Management Services
• HSA, FSA, and HRA Benefits Administration
• Self-Funded Dental and Vision Insurance
• Reference-Based Pricing (RBP)
• Direct Primary Care (DPC) Solutions
• Pet Care Reimbursement
• Innovations Lifestyle Benefits (Lifestyle Spending Account)

Quantifiable outcome

• 21% lower costs for high-cost claimants
• +6 more outcomes

Named customers2 records

Segments4 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration7 records

Feature4 records

Partnerships

Eight partnerships are on record, tiered core and minor.

• HealthJoycoreStrategic or Co-development Partner · 25 July 2021Nova partnered with HealthJoy in July 2021 to bring the HealthJoy TPA+ platform to current clients and new prospects. The partnership delivers on-demand, personalized healthcare navigation including a digital benefits wallet, 24/7 healthcare concierge, rx savings review, bill review, provider recommendations, appointment booking, integrated telemedicine, and nurse case managers. Nova x HealthJoy claims 21% lower costs for high-cost claimants, 94% average member satisfaction, and 20% HR time saved per year.
• Network Partners (Nova Medicalcare, Independent Health, Cigna, First Health, MultiPlan, PHCS, HealthCare Highways Plus, HealthSmart, Emblem Health/GHI, Alchemy Health, Cofinity, First Health Complementary)coreTechnology or IntegrationNova works closely with network partners to understand business goals and develop affordable access-to-care solutions. The company's solutions analysts recommend the best network strategy for any organization. Nova supports multiple provider networks including its own Nova Medicalcare, Independent Health, Cigna, First Health, PHCS, MultiPlan, HealthCare Highways Plus, HealthSmart, Emblem Health/GHI, Alchemy Health, Cofinity, and First Health Complementary.
• Stop-Loss CarrierscoreStrategic or Co-development PartnerNova works with some of the industry's leading stop-loss carriers. It manages reporting for specific and aggregate stop-loss policies, including filing claims for reimbursement or advance funding. Nova can serve as the stop-loss broker of record or provide reporting to the broker of record designated by the client.
• PBM Partners (Prime Therapeutics, Express Scripts, Liviniti, Cigna, Southern Scripts, TrueScripts, VeracityRx, US-Rx Care, WellDyne, Meritain, DisclosedRx, Drexi)coreTechnology or IntegrationNova partners with best-in-class pharmacy benefit management (PBM) vendors including Prime Therapeutics, Express Scripts, Liviniti, Cigna, Southern Scripts, TrueScripts, VeracityRx, US-Rx Care, WellDyne, Meritain, DisclosedRx, and Drexi. Nova provides flexibility for clients to work with their vendor of choice and offers preferred partner integrations.
• Direct Primary Care (DPC) ProvidersminorStrategic or Co-development PartnerNova partners with DPC providers and plan sponsors to help round out the full picture of care with comprehensive data and support for optimal care and cost outcomes. DPC arrangements offer an alternative to traditional network solutions with a flat monthly fee for provider access and concierge care.
• Dental Networks (Nova Dentalcare, Nova Premium Dentalcare, Cigna Dental, DenteMax)coreTechnology or IntegrationNova provides dental network access through its own Nova Dentalcare and Nova Premium Dentalcare networks, as well as through Cigna Dental and DenteMax partnerships.
• Vision Networks (VSP, EyeMed, Davis Vision)coreTechnology or IntegrationNova provides vision network access through VSP, EyeMed, and Davis Vision, allowing members to find in-network vision care providers.
• Independent HealthcoreStrategic or Co-development PartnerNova Healthcare Administrators is an affiliate company of Independent Health. The companies share infrastructure, provider networks (Nova Medicalcare and Independent Health), and operational resources. Nova also handles customer service teams that cover both Nova and Independent Health Self-Funded Services.

Scale indicators5 records

Recent moves6 records

Expansion highlights6 records

Direct peers

• UMR: UnitedHealth Group's TPA subsidiary — the largest US third-party administrator of self-funded health plans; directly overlaps with Nova on claims administration, medical management, and stop-loss coordination.
• WebTPA: Independent TPA serving self-funded employer plans with claims administration, care management, and network strategies — comparable go-to-market through consultants and brokers.
• Auxiant: Mid-sized TPA focused on self-funded plans for employers and Taft-Hartley funds, offering claims, medical management, and stop-loss support — directly comparable offering profile.
• Allied Benefit Systems: Mid-market TPA offering self-funded plan administration, medical management, and ancillary benefits — directly comparable scope and customer profile to Nova.
• Key Benefit Administrators: National TPA administering self-funded medical, dental, disability and COBRA benefits with a similar consultant/broker distribution approach to Nova.
• Meritain Health: A CVS Health-owned TPA providing self-funded medical, pharmacy, and specialty benefit administration — closely comparable to Nova's core offering to employers and brokers.
• HealthEZ: TPA focused on self-funded plans for small and mid-sized employers, with integrated care management and level-funded options — directly overlapping with Nova's SME segment and product set.
• HealthComp Holdings: Independent third-party administrator of self-funded health plans offering integrated medical management, PBM, and COBRA administration — same product mix and broker-distribution model as Nova.

Broad incumbents

• Cigna Healthcare: National health services company whose TPA segment competes in the same self-funded, stop-loss, and care-navigation categories as Nova — operates at significantly larger scale across the same broker channel.

Regional players

• Excellus BlueCross BlueShield: Upstate New York-based health plan that also administers self-funded accounts in Nova's home market — competes on overlapping employer accounts in the Buffalo/NY region.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/NovaTrendMgmt
• YouTubeyoutube.com/channel/UCIHB3QdPIR9LSSDeR1hJWNA
• Facebookfacebook.com/novahealthcare
• LinkedInlinkedin.com/company/nova-healthcare-administrators-inc-

Compliance12 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles6 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 Nova Healthcare Administrators