Health Payer Consortium
Health Payer Consortium is a privately held US B2B provider of healthcare claims cost containment services, offering medical bill review, claim editing, out-of-network, referenced-based pricing, and post-pay recovery solutions to TPAs, health plans, stop-loss carriers, reinsurers, and brokers.
- Company typePrivate
- Founded2011
- HeadquartersSt Louis, United States
- Headcount51–100
- GTM typeB2B
- OfferingServices
What Health Payer Consortium does
Health Payer Consortium (HPC) is a privately held, US-based B2B cost containment services provider for the healthcare payer industry, founded in 2011 and headquartered in St. Louis, Missouri. The company targets Third Party Administrators, Health Plans, Managing General Underwriters, Stop Loss Companies, Reinsurers, and Brokers, with a six-product portfolio covering Medical Bill Review, HPC Advantage (the proprietary orchestration solution), Claim Editing, Out-of-Network Services, Referenced-Based Pricing, and Post-Pay Recovery. Its stated value proposition is identifying savings on healthcare claims that other vendors may have overlooked, achieved through a blend of automation technology and hands-on claims review.
Health Payer Consortium firmographics
Firmographics- Name
- Health Payer Consortium
- Legal name
- Health Payer Consortium
- Website
- https://healthpayerconsortium.com
- Company type
- Private
- Founded year
- 2011
- Operating status
- Operating
- Headcount range
- 51–100 employees
- Short description
- Health Payer Consortium is a privately held US B2B provider of healthcare claims cost containment services, offering medical bill review, claim editing, out-of-network, referenced-based pricing, and post-pay recovery solutions to TPAs, health plans, stop-loss carriers, reinsurers, and brokers.
- Ownership category
- akta.pro rank
Health Payer Consortium industry classification
Industry- Product category
- Healthcare Claims Cost Containment
- 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
- Payer-Provider Data Exchange (X12, prior auth, claims/clinical attachment) (HLACABAK)
Keywords
Where Health Payer Consortium is headquartered
LocationHeadquarters
- HQ city
- St Louis
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Health Payer Consortium business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure
Revenue model
- Claims Cost Containment Services: Revenue generated from providing cost containment solutions for healthcare claims, including medical bill review, claim editing, out-of-network services, referenced-based pricing, and post-pay recovery services for TPAs, health plans, and other payers.
Go-to-market motion1 record
Distribution channels1 record
Marketing channels5 records
Health Payer Consortium product offering
Product offeringCore offering
Health Payer Consortium provides cost containment solutions for healthcare claims, lowering annual claims expense by applying the appropriate cost management solution for each claim type. The company delivers a blend of automation and hands-on review across six core service lines: Medical Bill Review, HPC Advantage, Claim Editing, Out-of-Network Services, Referenced-Based Pricing, and Post-Pay Recovery, serving Third Party Administrators, Health Plans, Managing General Underwriters, Stop Loss Companies, Reinsurers, and Brokers.
Product overview
Health Payer Consortium offers a suite of cost containment solutions for healthcare claims management. The company's portfolio consists of six core service products: Medical Bill Review (for identifying billing errors and savings opportunities), HPC Advantage (the proprietary core platform applying cost management solutions), Claim Editing (automated pre-processing accuracy checks), Out-of-Network Services (specialized handling for non-network providers), Referenced-Based Pricing (benchmark-based pricing model), and Post-Pay Recovery (overpayment recovery services). The company serves Third Party Administrators, Health Plans, Managing General Underwriters, Stop Loss Companies, Reinsurers, and Brokers, utilizing a blend of automation and hands-on claims review to increase profitability and ensure claims integrity.
Differentiator
Problem solved
Functional benefit
Brands
- HPC Advantage: A specific service offering within the HPC portfolio of cost containment solutions.
- HPC ROCKS
Products and services
- Medical Bill Review
Quantifiable outcome
- Lowers annual claims expense through appropriate cost management solution application
Companies that use Health Payer Consortium
Customer profileNamed customers7 records
Segments3 records
Ideal customer profiles3 records
Health Payer Consortium technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Feature6 records
Health Payer Consortium partnerships and signals
Strategic signalScale indicators2 records
Recent moves5 records
Expansion highlights4 records
Health Payer Consortium competitors and assessment
Company assessmentDirect peers
- Zelis: Zelis is the largest healthcare cost management/payment integrity platform, directly competing with HPC's medical bill review, claim editing, OON, RBP, and post-pay recovery services to TPAs, health plans, and reinsurers. Both combine automation with expert review and serve overlapping enterprise payers.
- MultiPlan: MultiPlan is a long-standing direct competitor in healthcare cost containment, offering PPO networks, repricing, claim editing, and subrogation/recovery. Its products (e.g. PHCS, MultiPlan Network, Discovery) compete head-to-head with HPC's OON, RBP, and post-pay recovery lines for the same payer clients.
- Pareto Intelligence: Pareto Intelligence (acquired by Zelis) provided analytics-driven payment integrity and cost containment for payers and TPAs, overlapping HPC's data-driven claim review and RBP offerings. It illustrates the consolidation direction HPC faces from well-funded rivals.
- Cotiviti: Cotiviti provides payment integrity, claim editing (ClaimSpotter/Cotiviti), and recovery solutions to health plans and managed care organizations. Its focus on audit/recovery and editing overlaps directly with HPC Advantage, Claim Editing, and Post-Pay Recovery.
- Lyric (formerly ClaimsXten / Change Healthcare): Lyric is a leading claim editing and clinical code validation platform originally built by Optum/Change Healthcare. Its content-driven editing software is the benchmark for automated claim editing that HPC's hybrid model blends with manual review.
Emerging players
- HGS Healthcare: HGS Healthcare delivers technology-led revenue cycle and cost containment services including claim editing, clinical/coding, and payment integrity to US payers and providers. It is a comparable B2B services peer with overlapping lines to HPC Advantage and Post-Pay Recovery.
- MRO Corp: MRO is a health information management and disclosure management vendor that handles release-of-information and clinical record retrieval — services that intersect with HPC's claim review and post-pay recovery workflows at the clinical attachment layer.
Broad incumbents
- Change Healthcare (now Optum): Change Healthcare's claim editing, X12 clearinghouse, and payment integrity products (now part of Optum) compete with HPC across the entire pre-to-post-pay claims lifecycle, offering enterprise payers an integrated stack rather than HPC's best-of-breed services.
- Optum: Optum (a UnitedHealth Group company) is the broadest incumbent in healthcare cost management, with claim editing, payment integrity, and post-pay recovery via Change Healthcare. It dwarfs HPC on scale and competes through bundled enterprise offerings rather than stand-alone cost containment.
Others
- Datavant: Datavant is a healthcare data networking/routing company that exchanges clinical and claims data between payers and providers. It is adjacent enabling infrastructure for the X12/clinical attachment flows HPC operates within, but does not directly compete on cost containment services.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat4 records
Key risks6 records
Key highlights6 records
Customer concentration
Health Payer Consortium social profiles
Digital presenceHealth Payer Consortium financial estimates
Financial estimateRevenue estimate
Valuation estimate
Health Payer Consortium leadership team
Management profileNumber of profiles
Profiles1 record
Health Payer Consortium funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Health Payer Consortium 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 Health Payer Consortium
What does Health Payer Consortium do?
Health Payer Consortium provides cost containment solutions for healthcare claims, lowering annual claims expense by applying the appropriate cost management solution for each claim type. The company delivers a blend of automation and hands-on review across six core service lines: Medical Bill Review, HPC Advantage, Claim Editing, Out-of-Network Services, Referenced-Based Pricing, and Post-Pay Recovery, serving Third Party Administrators, Health Plans, Managing General Underwriters, Stop Loss Companies, Reinsurers, and Brokers.
Is Health Payer Consortium a public or private company?
Health Payer Consortium is a private company. It is classified as founder individual operated bootstrapped and is currently operating.
When was Health Payer Consortium founded?
Health Payer Consortium was founded in 2011. It employs 51 to 100 people.
Where is Health Payer Consortium based?
Health Payer Consortium is headquartered in St Louis, United States, in the North America region.
How does Health Payer Consortium make money?
One revenue line is on record: claims Cost Containment Services.
Who are Health Payer Consortium's main competitors?
Direct peers on record are Zelis, MultiPlan, Pareto Intelligence, Cotiviti and Lyric (formerly ClaimsXten / Change Healthcare). Emerging players are HGS Healthcare and MRO Corp. Broad incumbents are Change Healthcare (now Optum) and Optum. Datavant is listed as an others.
Does Health Payer Consortium have an API?
No public API is recorded for Health Payer Consortium.
What industry is Health Payer Consortium in?
Health Payer Consortium's product category is Healthcare Claims Cost Containment. Its primary akta.pro industry code is HLACABAK, Payer-Provider Data Exchange (X12, prior auth, claims/clinical attachment). Its NAICS code is 524292 and its SIC code is 6324.