Sanus Health

What Sanus Health does

Sanus Health Corporation is a privately held Third Party Administrator (TPA) headquartered in Doral, Florida, providing healthcare claims administration and provider network management services to insurance carriers, self-funded employer plans (private and government), third-party administrators, assistance and referral entities, and re-insurance carriers. Founded in 2000, the company has grown from supporting a single carrier group to approximately 620 employer groups under administration, and operates a provider network spanning all 50 U.S. states plus the District of Columbia, the Caribbean, Canada, Europe, and Asia, with access to over 700,000+ provider locations including approximately 4,700 hospitals and 500,000 doctors.

The company's core technology is a modular healthcare claims administration and network management platform with capabilities spanning utilization management (pre-admission review, concurrent review, discharge planning, retrospective review), case management with registered nurse-led price negotiation, medical bill auditing (identifying overcharges, up-coding, unbundling, double billing), care network repricing, eligibility verification via 1-800 number with electronic call records, and a Modular Reporting System capable of generating 200+ custom reports. Underlying the platform is a 24-hour claims notification and customer service operation with ACS-designated staff, plus an Advanced Transplant network of 80+ participating facilities and Centers of Excellence credentialing infrastructure. Provider retention rates of 95%+ for doctors and 98%+ for hospitals indicate operational stability.

Sanus Health generates revenue through three primary streams: managed services fees for third-party administration of self-insured health plans, transaction-based fees for care network repricing, and professional services fees for medical bill auditing and insurance consulting. Pricing is not publicly disclosed and follows flexible structures that can be hourly, project-based, or incentive-based, tailored to client needs. The go-to-market model is sales-led, with direct enterprise engagement and relationship management across multiple customer segments. Geographic reach extends across the United States, Canada, the Caribbean, Latin America, Europe, and Asia, with the company positioning itself as the largest TPA in the Northern Caribbean.

Name

Sanus Health

Legal name

Sanus Health Corporation

Website

https://sanushealth.com

Company type

Private

Founded year

2000

Operating status

Operating

Headcount range

11–50 employees

Short description

Sanus Health Corporation is a privately held Third Party Administrator (TPA) that provides healthcare claims administration, provider network management, and medical bill auditing services to insurance carriers, self-funded employer plans, third-party administrators, and re-insurers across the Americas, Caribbean, Europe, and Asia.

Ownership category

akta.pro rank

Product category

Healthcare Third Party Administration

NAICS

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

SIC

Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321)

akta.pro primary industry

Self-Funded Employer Plan TPA (ASO Administration) (HLAEALAA)

akta.pro secondary industries

Care Management & Population Health Program Administration (HLAEALAG), Government Program Administrative Services (Medicare/Medicaid ASO/TPA) (HLAEALAO), Compliance, Reporting & Regulatory Administration (ERISA/ACA/No Surprises) (HLAEALAJ)

Keywords

• Health claims administration
• Third party administration
• Utilization management services
• Medical bill auditing
• Provider network management

Headquarters

HQ city

Doral

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. Third Party Administration Services: Professional services fees for administering self-insured health plans, including claims processing, utilization management, case management, and network access.
2. Care Network Repricing: Decades of operational experience in US and International claims arena providing repricing services with expert technical support, fast provider management and reporting, and 24-hour service following notification of claim.
3. Auditing Services: Medical bill auditing services with flexible fee schedules including hourly, project, or incentive-based fee structures.
4. Insurance Consulting: Consulting services with over 170 years of combined experience providing cost reduction strategies, plan design, pricing, and managed care education.

Pricing tiers

Go-to-market motion2 records

Distribution channels3 records

Marketing channels5 records

Core offering

Sanus Health Corporation is a Third Party Administrator (TPA) that provides healthcare claims administration, care network repricing, utilization management, case management, medical bill auditing, eligibility verification, specialized modular reporting, and insurance consulting services. It serves insurance carriers, assistance and referral entities, employer self-funded plans (both private and government), third party administrators, and re-insurers across the U.S., the Caribbean, Canada, Europe, and Asia.

Product overview

Sanus Health is an insurance service provider offering a comprehensive suite of healthcare administration products and services. The company operates a modular platform comprised of Client Services (claims processing, care network repricing, utilization management, case management, auditing services, specialized reporting, insurance consulting, and eligibility verification), Health Claims Administrator Services, and Centers of Excellence. These offerings are designed for insurance carriers, assistance and referral entities, employer self-funded plans (both private and government), third party administrators, and re-insurers. The company maintains an extensive provider network spanning all 50 states, Canada, the Caribbean, Latin America, and select international regions.

Differentiator

Problem solved

Functional benefit

Products and services

• Client Services Comprehensive suite of insurance service offerings for insurance carriers, assistance and referral entities, employer self-funded plans (private and government), third party administrators, and re-insurers, including claims processing, care network repricing, utilization management, case management, auditing services, specialized reporting, and insurance consulting.
• Health Claims Administrator Services

Quantifiable outcome

• 98% of U.S. population has access to a provider in the network
• +2 more outcomes

Named customers5 records

Segments5 records

Ideal customer profiles5 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Scale indicators14 records

Recent moves6 records

Expansion highlights5 records

Broad incumbents

• Cotiviti: Cotiviti provides payment accuracy and analytics-driven healthcare solutions to payers and retailers, operating a broader portfolio of claims editing and audit services that overlap with Sanus's auditing and repricing modules.
• Change Healthcare (Optum): Change Healthcare (now part of Optum/UnitedHealth Group) is a broad incumbent in healthcare claims processing, network management, and revenue cycle solutions, offering overlapping capabilities with Sanus's claims administration and network services at significantly greater scale.
• Cigna Healthcare (Evernorth): Evernorth/Cigna offers large-scale TPA and care management services through its health services division, including claims administration and utilization management that overlap with Sanus's core service lines.

Emerging players

• Lyric (formerly ClaimsXten): Lyric (formerly ClaimsXten) is a technology-focused payment integrity and claims accuracy platform serving health plans and TPAs, representing an emerging, technology-led peer in the space where Sanus competes.
• Vālenz Health: Valenz Health provides integrated cost-containment and care management solutions to self-funded employers and TPAs, an emerging player directly competing in the same self-funded plan and repricing niche.

Direct peers

• Zelis: Zelis provides healthcare claims cost management, network solutions, and integrated analytics to payers, TPAs, and employers, directly competing with Sanus in repricing, network management, and payment integrity services.
• The Rawlings Group: Rawlings is a specialized TPA focused on healthcare claims recovery, subrogation, and cost containment for insurance carriers and self-funded plans—an adjacent peer in the TPA ecosystem serving overlapping customer segments.
• Health Management Solutions (HMS): HMS provides payment integrity and population health management solutions to health plans, government agencies, and employers, with overlapping capabilities in claims auditing, cost containment, and care management analogous to Sanus's offerings.
• MultiPlan: MultiPlan is a leading independent cost-management and network-based solutions provider for healthcare, offering repricing, network access, and claims administration services to insurers, TPAs, and self-funded plans—closely aligned with Sanus Health's core service portfolio.
• Paramount Health Solutions: Paramount Health Solutions is a TPA and claims repricing provider serving carriers, self-funded plans, and other TPAs with network access and cost-containment services closely analogous to Sanus Health's offering.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/SanusHealth
• Facebookfacebook.com/sanushealthcorp
• LinkedInlinkedin.com/company/sanushealth

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 Sanus Health