Western Sky Community Care
Western Sky Community Care is a New Mexico Medicaid, Medicare Advantage, and ACA Marketplace health plan operated as a wholly owned subsidiary of Centene Corporation, serving state-funded beneficiaries through a contracted provider network in a single state.
- Company typePrivate
- Founded2019
- HeadquartersAlbuquerque, United States
- Headcount251–500
- GTM typeB2C
- OfferingServices
What Western Sky Community Care does
Western Sky Community Care is a New Mexico-based managed care organization that administers Medicaid, Medicare Advantage, and ACA Marketplace health plans for state residents, headquartered in Albuquerque and operating exclusively within New Mexico. The company is a wholly owned subsidiary of Centene Corporation, sharing the parent company's enterprise EDI transaction infrastructure, credentialing systems, UM decision frameworks (InterQual/MCG), and NCQA HEDIS quality reporting, while distributing those capabilities via its own regional brand and provider network.
Its core products are health plan offerings rather than discrete software products; supporting the products is an operational technology stack that includes the AuthentiCare (First Data) Electronic Visit Verification system for tracking personal care and community benefit visits, the PaySpan Health web-based EFT/ERA platform for provider payments and remittances, a secure Provider Portal for eligibility, claims, and authorization workflows, telemedicine delivery, and a clinical and payment policy library built on InterQual evidence-based criteria. HEDIS performance measurement and a Quality Assurance Program Improvement (QAPI) framework provide standardized quality accountability.
Western Sky Community Care generates revenue primarily through capitation payments and fee-for-service arrangements under government contracts with the New Mexico Human Services Department (Centennial Care/Turquoise Care) and through Medicare Advantage and ACA Marketplace premiums. Member acquisition is non-commercial, driven instead by state Medicaid enrollment, Medicare enrollment channels, and Marketplace selection, with the contracted provider network serving as the primary delivery channel for care and downstream engagement.
Western Sky Community Care firmographics
Firmographics- Name
- Western Sky Community Care
- Legal name
- Centene Corporation
- Website
- https://westernskycommunitycare.com
- Company type
- Private
- Founded year
- 2019
- Operating status
- Operating
- Headcount range
- 251–500 employees
- Short description
- Western Sky Community Care is a New Mexico Medicaid, Medicare Advantage, and ACA Marketplace health plan operated as a wholly owned subsidiary of Centene Corporation, serving state-funded beneficiaries through a contracted provider network in a single state.
- Ownership category
- akta.pro rank
Where Western Sky Community Care is headquartered
LocationHeadquarters
- HQ city
- Albuquerque
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Western Sky Community Care business model
Business model- GTM type
- B2C
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Infrastructure, Marketing or Sales
Revenue model
- Government Healthcare Contracts: Western Sky Community Care generates revenue primarily through capitation payments and fee-for-service arrangements under government contracts with the State of New Mexico Human Services Department for Medicaid (Centennial Care/Turquoise Care) and Medicare programs. Revenue is driven by enrolled member counts and healthcare services rendered.
- Marketplace/Commercial Plans: Revenue from ACA Marketplace health insurance plan premiums paid by enrolled members and potentially subsidized through government premium tax credits.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | Medicaid Managed Care Plan |
| Subscription | Monthly | Medicare Advantage Plan |
| Subscription | Monthly | Marketplace/ACA Plan |
Go-to-market motion1 record
Distribution channels4 records
Marketing channels4 records
Western Sky Community Care product offering
Product offeringCore offering
Western Sky Community Care is a New Mexico-based managed care organization that provides government-sponsored and commercial health insurance plans, including Medicaid (Centennial Care, with contract ended June 30, 2024, transitioning to Turquoise Care), Medicare Advantage, and ACA Marketplace plans. The company sells coverage directly to individual members and delivers healthcare services through a contracted network of providers, supported by care coordination, behavioral health, pharmacy benefits, telemedicine, and quality improvement programs.
Product overview
Western Sky Community Care is a health insurance plan offering Medicare, Medicaid, and Marketplace health plans in New Mexico. The company provides a coordinated portfolio of products including core insurance coverage and integrated provider tools: a secure Provider Portal for administrative functions, Telemedicine for virtual care delivery, Electronic Visit Verification (EVV) for personal care services tracking, PaySpan for electronic payment processing, Care Management for coordinated member support, HEDIS quality measurement for performance tracking, and Clinical & Payment Policies using InterQual criteria. Language assistance services complement the offering. The product ecosystem is built on Centene Corporation's infrastructure and supports electronic transactions via EDI and the PaySpan platform.
Differentiator
Problem solved
Functional benefit
Quantifiable outcome
- Quality of care assessed through annual HEDIS performance measures across 90+ measures covering preventive care, chronic disease management, behavioral health, and member experience
Companies that use Western Sky Community Care
Customer profileNamed customers3 records
Segments4 records
Ideal customer profiles4 records
Western Sky Community Care technology and API
TechnologyAPI detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Integration2 records
Feature3 records
Western Sky Community Care partnerships and signals
Strategic signalPartnerships
Six partnerships are on record, tiered core, flagship and minor.
- PaySpan HealthcoreWestern Sky Community Care partners with PaySpan Health to provide a web-based solution for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs) to providers. This service is provided at no cost to providers and allows online enrollment. Benefits include elimination of paper checks, electronic remittance advices, HIPAA 835 file downloads, reduced accounting expenses, and improved cash flow for providers.
- First Data (AuthentiCare)coreFirst Data provides the AuthentiCare Electronic Visit Verification (EVV) system mandated by the State of New Mexico Human Services Department - Centennial Care Program. The system tracks visits related to Community Benefits using landlines and GPS-enabled mobile devices. It is web-based, paperless, and generates claims automatically. Services tracked include Personal Care (Consumer Delegated, Consumer Directed, Consumer Directed Administrative Fee, Consumer Directed Training, Consumer Directed Advertisement Reimbursement) and EPSDT Personal Care.
- Centene CorporationflagshipWestern Sky Community Care is a wholly owned subsidiary of Centene Corporation. Centene provides enterprise-level EDI transaction support, HIPAA transaction processing, clinical and payment policy frameworks, quality improvement programs (HEDIS, CAHPS), provider credentialing systems, and corporate governance. Centene owns the copyright in the website content and all proprietary materials. The parent company also facilitates behavioral health HEDIS training programs and coordinates COVID-19 response guidance.
- NCQA (National Committee for Quality Assurance)coreWestern Sky Community Care participates in HEDIS (Healthcare Effectiveness Data and Information Set) reporting managed by NCQA. HEDIS measures allow comparison across health plans and hold the organization accountable for timeliness and quality of healthcare services delivered to members. The company also participates in NCQA's Quality Assurance Program Improvement (QAPI).
- InterQual (McKesson)coreWestern Sky Community Care utilizes InterQual criteria for medical technologies, procedures, or pharmaceutical treatments where no Western Sky Community Care clinical policy exists. InterQual is a nationally recognized evidence-based decision support tool. Providers can access InterQual SmartSheets through the secure provider portal or by calling the health plan.
- National Council on Independent LivingminorCentene, in partnership with the National Council on Independent Living, provides the Provider Accessibility Initiative COVID-19 Web Series with timely recommendations from disability experts on how the national provider network can deliver disability-competent care during the COVID-19 epidemic.
Scale indicators2 records
Recent moves6 records
Expansion highlights5 records
Western Sky Community Care competitors and assessment
Company assessmentBroad incumbents
- Centene Corporation: Centene is the parent company of Western Sky Community Care and operates Medicaid, Medicare, and Marketplace health plans across 30+ states, providing the enterprise platform, technology, and capital that WSCC relies on.
- Humana: Humana is a major Medicare Advantage operator with growing Medicaid presence; comparable to WSCC in government-program focus and care management orientation, though at materially larger national scale.
- Anthem (Elevance Health): Anthem is one of the largest US health insurers operating Medicaid, Medicare, and Marketplace plans across multiple states, serving as a broad incumbent comparable in scale, product mix, and government-program orientation.
- Ambetter Health: Ambetter is Centene's ACA Marketplace brand operating across multiple states, including New Mexico; it shares WSCC's parent infrastructure and overlaps in Marketplace product offering, though it is not a Medicaid MCO.
Direct peers
- Blue Cross and Blue Shield of New Mexico: BCBSNM is a contracted Medicaid MCO in New Mexico and a major multi-line health plan serving Medicaid, Medicare, and commercial members, competing head-to-head with WSCC for state contracts, provider participation, and member enrollment.
- Sunflower Health Plan: Sunflower Health Plan is another wholly-owned Centene Corporation subsidiary providing Medicaid managed care in Kansas, structurally identical to Western Sky Community Care in operating model, technology stack, and parent backing.
- Presbyterian Health Plan: Presbyterian Health Plan is one of the largest New Mexico Medicaid managed care organizations and the most direct competitor to Western Sky Community Care, serving Medicaid, Medicare, and commercial members in the same geography with overlapping provider networks.
- Molina Healthcare of New Mexico: Molina Healthcare operates a Medicaid managed care plan in New Mexico as one of the contracted MCOs under Turquoise Care, with comparable government-program focus and member demographics to WSCC.
- UnitedHealthcare Community Plan of New Mexico: UnitedHealthcare Community Plan operates a Medicaid MCO in New Mexico and is one of the contracted Turquoise Care plans, directly competing with WSCC for Medicaid members and provider network access in the same state.
Emerging players
- CareSource: CareSource is a nonprofit managed care plan focused primarily on Medicaid and Marketplace products across several states, with a comparable mission-driven, government-program orientation and member-services approach to WSCC.
Market position
Strengths4 records
Weaknesses5 records
Competitive moat4 records
Key risks6 records
Key highlights6 records
Customer concentration
Western Sky Community Care social profiles
Digital presenceWestern Sky Community Care compliance and trust
Trust signalCompliance1 record
Western Sky Community Care financial estimates
Financial estimateRevenue estimate
Valuation estimate
Western Sky Community Care leadership team
Management profileNumber of profiles
Western Sky Community Care funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Western Sky Community Care M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Western Sky Community Care
What does Western Sky Community Care do?
Western Sky Community Care is a New Mexico-based managed care organization that provides government-sponsored and commercial health insurance plans, including Medicaid (Centennial Care, with contract ended June 30, 2024, transitioning to Turquoise Care), Medicare Advantage, and ACA Marketplace plans. The company sells coverage directly to individual members and delivers healthcare services through a contracted network of providers, supported by care coordination, behavioral health, pharmacy benefits, telemedicine, and quality improvement programs.
Is Western Sky Community Care a public or private company?
Western Sky Community Care is a private company. It is currently operating.
When was Western Sky Community Care founded?
Western Sky Community Care was founded in 2019. It employs 251 to 500 people.
Where is Western Sky Community Care based?
Western Sky Community Care is headquartered in Albuquerque, United States, in the North America region.
How does Western Sky Community Care make money?
Two revenue lines are on record. Government Healthcare Contracts are the primary driver. The others are marketplace/Commercial Plans.
Who are Western Sky Community Care's main competitors?
Broad incumbents on record are Centene Corporation, Humana, Anthem (Elevance Health) and Ambetter Health. Direct peers are Blue Cross and Blue Shield of New Mexico, Sunflower Health Plan, Presbyterian Health Plan, Molina Healthcare of New Mexico and UnitedHealthcare Community Plan of New Mexico. CareSource is listed as an emerging player.
Does Western Sky Community Care have an API?
No public API is recorded for Western Sky Community Care.