What Sagamore Health Network does

Sagamore Health Network is a wholly-owned subsidiary of Cigna Health Corporation operating a regional Preferred Provider Organization (PPO) healthcare provider network in Indiana. Founded in 1985 and headquartered at 11595 N Meridian St #600 in Carmel, Indiana, the company serves two primary B2B customer segments: health insurance payors, which access the network for claims re-pricing and provider verification, and healthcare providers (physicians, allied health professionals, hospitals, and ancillary facilities), which participate in the network via a CAQH-based credentialing process. Sagamore offers four branded product tiers — Sagamore Plus (PPO), Sagamore Select (Indiana-focused PPO), Sagamore Ambassador Care (Point of Service with PCP gatekeeping), and Sagamore Select St. Mary's Evansville Employees (employer-specific plan) — and operates a dedicated Select Health South Bend line serving Marshall and St. Joseph counties.

The company's core platform is a web-based portal hosting eight functional tools: Web Re-Pricing, Customized Provider Directory, Web Provider Extract (biweekly fixed-field text files delivered via FTP), Route Code Lookup, Provider Verification, Claims Lookup, Provider Manual & Forms, and Machine Readable Files for federal Transparency in Coverage compliance. The portal is secured by Okta multifactor authentication and supported operationally by Evernorth (Cigna's health services arm) via [email protected]. The provider directory is refreshed daily, extract files are regenerated every two weeks, and credentialing is standardized through the CAQH uniform application, with a $50 one-time non-refundable midlevel provider application fee covering credentialing, administration, and directory printing costs.

Sagamore's revenue model combines enterprise managed services — network access fees and claims processing services paid by health insurance payors under quote-based enterprise contracts — with a minor transactional revenue stream from provider credentialing application fees. Go-to-market is relationship-based enterprise B2B sales through a Network Development team, with no public pricing, self-service channel, or independent sales motion. Geographic scope is limited to Indiana. As a Cigna subsidiary, the company does not pursue independent capital raises, M&A, or geographic expansion beyond its Indiana footprint, and its financials are consolidated into Cigna's U.S. payer solutions segment rather than reported separately.

Name

Sagamore Health Network

Legal name

Sagamore Health Network, Inc.

Website

https://sagamorehn.com

Company type

Private

Founded year

1985

Operating status

Operating

Headcount range

51–100 employees

Short description

Sagamore Health Network is a Cigna-owned Indiana PPO provider network offering claims re-pricing, provider credentialing, and web-based network management tools to health insurance payors and healthcare providers across the state.

Ownership category

akta.pro rank

Headquarters

HQ city

Carmel

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. Network Management Services: Provides PPO network management services to health insurance payors including claims re-pricing, provider network access, and administrative tools. Revenue derived from network access fees and claims processing services paid by payors.
2. Provider Credentialing: Midlevel providers pay a one-time non-refundable application fee of $50.00 for credentialing, administration, and directory printing costs.

Pricing tiers

Go-to-market motion1 record

Distribution channels1 record

Marketing channels3 records

Core offering

Sagamore Health Network operates a PPO provider network in Indiana as a wholly owned subsidiary of Cigna, offering claims re-pricing, provider directory, provider verification, and network management services to health insurance payors and healthcare providers through a web-based portal. Its offerings include multiple network product tiers (Sagamore Plus, Sagamore Select, Sagamore Ambassador Care) and credentialing/onboarding services for physicians, hospitals, and ancillary facilities.

Product overview

Sagamore Health Network is a wholly owned subsidiary of Cigna that operates a healthcare provider network platform. The platform consists of web-based administrative tools including Web Re-Pricing, Customized Provider Directory, Web Provider Extract, Route Code Lookup, Provider Verification, Claims Lookup, and Machine Readable Files for Transparency in Coverage compliance. The company offers four network products: Sagamore Plus (PPO), Sagamore Select (PPO focused on Indiana), Sagamore Ambassador Care (Point of Service with PCP referrals), and Sagamore Select St. Mary's Evansville Employees (employer-specific plan).

Differentiator

Problem solved

Functional benefit

Brands

• Sagamore Plus: Provider network product offering comprehensive healthcare coverage with broad provider access.
• Sagamore Select
• Sagamore Ambassador Care

Products and services

• Web Re-Pricing A web-based tool that allows payors or providers to submit claims that have been directed to their locations prior to being handled by Sagamore Health Network, providing efficient and cost-effective claim re-pricing as an alternative to mailing. Requires unique ID and password.
• Customized Provider Directory A searchable directory of currently active Sagamore Network providers with daily-updated data and the ability to print personalized provider directories. Used by payors and members to locate in-network providers.
• Web Provider Extract A tool that retrieves provider data and writes it to fixed-field text files that are zipped and FTP'd to specified locations; new files created every two weeks with archived versions retained. Requires unique ID and password.
• Route Code Lookup A tool that assists in tying a group number to a route code, essential for proper routing and re-pricing of claims within the Sagamore Health Network.
• Provider Verification A tool that allows payors to enter a provider's tax identification number, name, and/or facility name to verify the provider's network effective date. Requires unique ID and password.
• Provider Manual & Forms A downloadable manual containing the Administrative Guidelines, rules and procedures for Sagamore products, information on how to join the network, credentialed provider types, provider data sheets, ancillary questionnaire, and the provider action request form.
• Claims Lookup A web-based tool for looking up claims information within the Sagamore Health Network portal.
• Machine Readable Files (Transparency in Coverage) Machine Readable Files required for compliance with the Federal Transparency in Coverage Rule, providing healthcare price information in machine-readable format on a public website (effective July 1, 2022).
• Sagamore Plus A PPO product offering within the Sagamore Health Network providing access to a broad network of providers with the option to see out-of-network providers at higher costs.
• Sagamore Select A PPO product offering with a focus on Indiana providers, particularly in the Indianapolis area.
• Sagamore Ambassador Care A Point of Service (POS) product that limits specialty care to Primary Care Physician referrals within the Sagamore network, with coverage limited to Primary Care specialties unless referred.
• Sagamore Select St. Mary's Evansville Employees A specialized product tailored for St. Mary's Evansville employees, providing network access specific to that employer group.

Named customers2 records

Segments6 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration2 records

Feature6 records

Scale indicators1 record

Recent moves6 records

Expansion highlights5 records

Direct peers

• First Health Network: First Health is a national PPO network acquired by Aetna/CVS, offering provider access, claims re-pricing, and network management services. Direct competitor in PPO network infrastructure and claims routing.
• MultiPlan: MultiPlan is the largest independent PPO network management company in the US, offering network access, claims re-pricing, and cost containment services. It is the most direct competitor to Sagamore's claims re-pricing and provider network administration model.
• Zelis: Zelis provides healthcare cost management including network access, claims editing, and price transparency solutions. It competes with Sagamore in claims re-pricing and payor-provider network analytics.
• PHCS (Private Healthcare Systems): PHCS operates a national PPO network offering provider access and claims re-pricing similar to Sagamore. Now part of the Mutual of Omaha family, it is a direct comparable in PPO network administration.

Regional players

• HealthLink: HealthLink operates a regional PPO network, originally based in the Midwest. It is comparable to Sagamore as a regional PPO network administrator serving employer and payor clients with claims re-pricing and provider directory services.

Emerging players

• USA Managed Care Organization (USAMCO): USAMCO specializes in PPO network management, claims re-pricing, and provider network access for payors. It is an emerging competitor in the same niche that Sagamore occupies, with overlapping B2B payor contract models.

Broad incumbents

• UnitedHealthcare: UnitedHealthcare is the largest US health insurer with its own national PPO network and network management operations. As a broad incumbent, it competes with regional PPOs like Sagamore in employer/plan-sponsor contracts across Indiana.
• Cigna Healthcare: Cigna Healthcare, the parent company of Sagamore Health Network, operates national PPO and HMO networks. Relevant as the parent context and as an incumbent network operator whose strategy determines Sagamore's positioning.
• Anthem Blue Cross Blue Shield (Indiana): Anthem operates the dominant regional Blue Cross Blue Shield plan in Indiana with its own provider network and PPO products. As a broad incumbent in the same Indiana geography, it is Sagamore's primary in-region competitor.

Others

• CAQH (Council for Affordable Quality Healthcare): CAQH is the credentialing and provider data utility that Sagamore integrates with for uniform provider applications. It is an ecosystem enabler rather than a competitor, but is part of Sagamore's operational backbone.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks5 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/sagamore-health-network

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 Sagamore Health Network