Cypress Care

What Cypress Care does

Cypress Care, Inc. operates as a subsidiary of Optum, Inc., a wholly-owned subsidiary of UnitedHealth Group (NYSE: UNH), doing business as "Optum Workers' Compensation Services of Georgia." The company is one of five legal entities (alongside PMSI, Progressive Medical, Healthcare Solutions, and Procura Management) that collectively form the Optum Workers' Compensation and Auto No-Fault division. Cypress Care delivers pharmacy benefit management (PBM), medical bill review, utilization management, clinical oversight, ancillary services coordination, and state-certified Managed Care Organization (MCO) services to insurance carriers, third-party administrators (TPAs), and self-insured employers managing workers' compensation and auto no-fault claims. Headquartered within Optum's Eden Prairie, Minnesota campus, with operational correspondence routed through Huntingdon Valley, Pennsylvania, the company operates in the 101-250 employee range and is supported by 50+ years of legacy industry experience across the division.

The technology stack centers on three proprietary platforms: VitalPoint (the primary pharmacy and claims management portal), TruCase (case management system), and P2P Link (provider peer-to-peer connectivity platform). Underlying infrastructure includes the Tmesys pharmacy network (nearly 60,000 retail, home delivery, and specialty pharmacies), the Procura PPO network (provider access for auto no-fault), MicroStrategy-powered reporting within VitalPoint, One Healthcare ID (OHID) authentication, and a patent-pending clinical data analytics model developed by the Chief Clinical Officer that drives utilization management and fraud/waste/abuse detection. The VitalPoint portal underwent a major redesign in 2025. Certifications include URAC Gold accreditation, HIPAA compliance, NY 21 NYCRR 500 compliance, and state MCO certifications in California, Connecticut, Georgia, Illinois, Kentucky, New Jersey, New York, and West Virginia, with MAC disclosure processes across 20+ states.

Revenue is generated through transaction-fee PBM pricing on pharmacy claims, managed-care-services contracts for MCO functions, and ancillary service fees, all structured as multi-year enterprise B2B agreements with insurance carriers, TPAs, self-insured employers, and government entities. Go-to-market is enterprise field sales targeting large insurance carriers and national TPAs, supported by content marketing through the Policy Talk Podcast, CE-accredited continuing education webinars, a resource library, and active public policy and regulatory affairs engagement. The division serves 500,000+ injured persons annually with a reported 92% customer satisfaction rate and 15+ years of average industry experience among team members.

Name

Cypress Care

Legal name

Cypress Care, Inc.

Website

https://workcompauto.optum.com

Company type

Private

Founded year

2001

Operating status

Operating

Headcount range

101–250 employees

Short description

Cypress Care, a subsidiary of Optum (UnitedHealth Group), delivers pharmacy benefit management, medical bill review, and state-certified managed care organization services for workers' compensation and auto no-fault claims, serving insurance carriers, TPAs, and self-insured employers through the VitalPoint portal and Tmesys 60,000-pharmacy network.

Ownership category

akta.pro rank

Product category

Workers' Compensation and Auto No-Fault Managed Care Services

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Agencies, Brokerages, and Other Insurance Related Activities (5242)

SIC

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

akta.pro primary industry

Pharmacy Benefit Analytics, Reporting & Employer Consulting (HLAEAKAK)

akta.pro secondary industries

Pharmacy Benefit/Channel Services (PSAO, 340B Admin, Chargebacks/Rebates Ops) (CRAOAHAK), Pharmacy Liaison & Prior Authorization/Insurance Coordination (HSABALAD), Injectables & Specialty Medication Support (e.g., insulin, biologics) (HSABALAG)

Keywords

• Pharmacy benefit management
• Workers compensation services
• Auto no-fault claims
• Managed care organization
• Medical bill review

Headquarters

HQ city

Eden Prairie

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Pharmacy Benefit Management Services: PBM services for workers' compensation and auto no-fault claims including pharmacy network access, claims adjudication, drug formulary management, and utilization review. Revenue generated through transaction fees, per-claim processing, and contracted pricing arrangements with insurance carriers and TPAs.
2. Managed Care Organization Services: State-certified managed care organization (MCO) services providing medical provider networks, utilization review, case management, and medical bill review. Revenue derived from contracted arrangements with employers, insurers, and TPAs.
3. Ancillary Services: Clinical services, ancillary referrals, home delivery pharmacy, and specialized medical equipment coordination for injured workers and auto accident claimants.

Pricing tiers

Go-to-market motion1 record

Distribution channels5 records

Marketing channels7 records

Core offering

Cypress Care, Inc. provides pharmacy benefit management and state-certified managed care organization services for the U.S. workers' compensation and auto no-fault insurance markets. Core services include pharmacy claims adjudication and drug utilization review through the Tmesys pharmacy network (nearly 60,000 retail, home delivery, and specialty pharmacies), medical bill review, PPO provider network access via the Procura network, ancillary services coordination (home health, DME, transportation, diagnostic imaging), clinical oversight programs, and utilization management. The company contracts directly with insurance carriers, third-party administrators, self-insured employers, and government entities.

Product overview

Optum Workers' Comp and Auto No-Fault (which includes Cypress Care, Inc., dba Optum Workers' Compensation Services of Georgia) is a comprehensive platform providing integrated solutions for workers' compensation and auto no-fault insurance. The portfolio centers on three core components: pharmacy benefit management through the VitalPoint portal and Tmesys pharmacy network (nearly 60,000 pharmacies nationwide); medical and pharmacy bill review services; and a PPO network through the Procura Network for provider access. Ancillary services including home health, DME, transportation, and diagnostic imaging support injured persons. Clinical services encompass medication management, utilization review, and physician outreach. The offering also includes client-facing tools (VitalPoint, TruCase, P2P Link), continuing education programs, and policy insights through the Policy Talk Podcast. Cypress Care operates as part of this Optum division serving Georgia workers' compensation clients.

Differentiator

Problem solved

Functional benefit

Products and services

• Workers' Compensation Pharmacy Services End-to-end pharmacy benefit management for workers' compensation claims, including prescription processing, pharmacy locator, home delivery, and specialty pharmacy services for injured workers.
• Auto No-Fault Pharmacy Services Pharmacy benefit management for automobile no-fault claims, including prescription processing, pharmacy locator, and home delivery for policyholders in no-fault states.
• Tmesys Pharmacy Network National workers' compensation-specific pharmacy network of nearly 60,000 retail pharmacies plus home delivery and specialty pharmacies providing nationwide online claims submission and approval/processing for state and federal workers' compensation claims and select automobile no-fault / PIP claims.
• Procura Network Non-risk Preferred Provider Organization (PPO) network offering injured persons easy access to quality healthcare nationwide, available for both workers' compensation and auto no-fault lines of business through contracted providers.
• State-Certified Managed Care Organization (MCO) Services State-certified Managed Care Organization (MCO) services in California, Connecticut, Georgia, Illinois, Kentucky, New Jersey, New York, and West Virginia, providing compliant provider networks, utilization review, and case management for workers' compensation.
• Medical Bill Review Medical bill review services providing approval, repricing, and processing for workers' compensation and auto no-fault claims, including pharmacy bill review and broader medical bill review through the ProviderHub portal.
• Ancillary Services Comprehensive ancillary services including home health, durable medical equipment (DME), transportation, and diagnostic imaging referrals and management for injured workers and auto no-fault claimants.
• Clinical Services Clinical programs including medication plans, formularies, utilization reviews, physician outreach, clinical interventions, and pharmacist and nursing support to help manage medical costs and improve outcomes for injured workers and claimants.
• VitalPoint Portal Primary pharmacy portal providing online access for claims management, pharmacy transactions, reporting, and client services for workers' compensation and auto no-fault; available to claims professionals, providers, and clients.
• TruCase Case Management System Case management system for claims professionals providing integrated case handling, documentation, and workflow management for workers' compensation and auto no-fault claims.
• PPO Network Services Preferred Provider Organization network providing access to contracted healthcare providers with negotiated rates for workers' compensation and auto no-fault claims.

Quantifiable outcome

• 500,000+ injured persons currently served
• +3 more outcomes

Named customers3 records

Segments4 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration7 records

AI capability2 records

Feature4 records

Partnerships

Seven partnerships are on record, tiered core, regional and minor.

• Tmesys (Affiliate of Optum Rx)coreTechnology or IntegrationTmesys is a national, wholly-owned workers' compensation-specific network consisting of nearly 60,000 retail pharmacies, home delivery, and specialty pharmacies. It provides nationwide online claims submission and approval/processing for state and federal workers' compensation claims and certain automobile no-fault/personal injury protection claims in select states. Tmesys is an affiliate of Optum Rx, part of the Optum/UnitedHealth Group enterprise.
• Procura NetworkcoreTechnology or IntegrationThe Procura Network is a non-risk, PPO network for auto no-fault services that offers injured persons easy access to quality healthcare nationwide. The network includes providers dedicated to clinically appropriate care for injured persons.
• Anthem (California MPN Services)regionalTechnology or IntegrationOptum offers Medical Provider Network (MPN) services in California through affiliate partner Anthem, in alignment with Administrative Rules §9767.1-19. The MPN includes access to a comprehensive network of providers specializing in workers' compensation treatment.
• Networks by Design (California MPN Services)regionalTechnology or IntegrationOptum offers Medical Provider Network (MPN) services in California through affiliate partner Networks by Design, providing additional options for MPN coverage in alignment with California administrative rules.
• MagnaCare (New York Certified PPO Services)regionalTechnology or IntegrationOptum provides Certified Preferred Provider Organization (Certified PPO) services in New York through affiliate partner MagnaCare, in alignment with Administrative Regulations §325-8. Services include care coordination, utilization review, medical bill review, and dispute resolution.
• CEU InstituteminorStrategic or Co-development PartnerCE credits for continuing education courses are administered by the CEU Institute, which handles accreditation and course completion reporting for Optum's CE webinar programs.
• Optum Health EducationminorStrategic or Co-development PartnerOptum Health Education offers additional free online webinars and CE courses beyond the core Optum Workers' Comp and Auto No-Fault offerings, providing expanded continuing education opportunities.

Scale indicators6 records

Recent moves5 records

Expansion highlights4 records

Broad incumbents

• Express Scripts (Evernorth): Express Scripts, part of Cigna's Evernorth, is one of the largest U.S. PBMs serving commercial, government, and workers' compensation populations. It competes with Cypress Care for workers' comp PBM contracts at large carriers and TPAs.
• Enlyte (Coventry Workers' Comp Services): Enlyte (parent of Coventry, Mitchell, and myMatrixx) provides integrated workers' compensation managed care, PBM, and bill review services. As the consolidated owner of Mitchell and myMatrixx, Enlyte is one of the most directly competitive scaled platforms to Cypress Care.
• Magellan Rx Management: Magellan Rx Management, part of Centene, provides PBM, specialty pharmacy, and managed care services including utilization management and clinical programs — comparable to Cypress Care's clinical oversight and PBM service lines.
• MedImpact Healthcare Systems: MedImpact is an independent PBM providing pharmacy benefit management across commercial, Medicaid, and workers' compensation populations. It competes for workers' comp PBM contracts and offers comparable clinical oversight and formulary management capabilities.
• Optum Rx: Optum Rx is the broader PBM arm of Optum/UnitedHealth Group, providing commercial, Medicare, and specialty pharmacy benefit management. While Cypress Care sits within Optum, Optum Rx is the incumbent pharmacy platform against which all specialty/workers' comp PBMs compete for formulary, pricing, and network leverage.

Direct peers

• Helios (PBM): Helios is a specialty PBM focused on workers' compensation claims processing, clinical management, and pharmacy network services — directly comparable to Cypress Care's specialty workers' comp PBM offering for insurance carriers and TPAs.
• myMatrixx: myMatrixx by Enlyte is a pharmacy benefit manager purpose-built for workers' compensation and auto liability claims, offering claims processing, clinical management, and a national pharmacy network — competing head-to-head with Cypress Care/Tmesys.
• Healthesystems: Healthesystems is a specialty PBM and managed care services provider focused on workers' compensation, offering clinical programs, pharmacy network management, and claims processing — a directly comparable specialty workers' comp PBM peer.
• Mitchell International: Mitchell International provides claims management, pharmacy benefit management, and medical bill review solutions for workers' compensation and auto liability markets — directly competing with Cypress Care across PBM, bill review, and managed care services for carriers and TPAs.

Emerging players

• Sav-Rx: Sav-Rx is an independent PBM providing pharmacy benefit management services with a focus on cost containment and clinical programs. As a smaller PBM, it competes for workers' comp and commercial PBM contracts at a regional/tier-2 scale comparable to some Cypress Care customer segments.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/workcompauto.optum
• Xx.com/OptumWorkComp

Compliance5 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 Cypress Care