What Midlands Choice does

Midlands Choice, Inc. is a privately-held healthcare provider network organization founded in 2001 and headquartered in Omaha, Nebraska. The company operates as the largest independent PPO network serving Iowa, Nebraska, and South Dakota, contracting with thousands of physicians, hospitals, and ancillary healthcare facilities across urban and rural communities, including a partnership extending into Mayo Health System. Its core offering is provider network access sold to insurance payers, third-party administrators, brokers, and self-funded employer groups, supplemented by credentialing services (via the CredSolutions platform), claims processing and repricing through its proprietary Provider Matching Logic (PML), and a secure online portal for administrative functions.

The company's technology stack centers on a healthcare network management platform with claims processing, provider credentialing, and electronic data interchange (EDI) capabilities. PML applies automated rules and decisions during claim repricing to determine provider participation and reimbursement terms, and has been updated to use 5010-compliant 9-digit zip codes and NPI numbers for interoperability. Secure web-based tools enable providers and payers to access claims status, group lookups, payer listings, reimbursement schedules, and administrative functions, while EDI clearinghouse connections (including Change Healthcare and Availity) support electronic claims submission and prior authorization workflows. The platform is HIPAA compliant and the company maintains structured patient-privacy protocols.

Midlands Choice generates revenue through managed-services contracts: it sells network access and administrative services to payers (Cigna, Medica, HealthPartners, Oscar Health, Meritain Health, Cerner HealthPlan Services, Health Alliance), TPAs, and self-funded employer groups, while concurrently building a network of contracted providers through credentialing and network-participation applications. Distribution is primarily direct enterprise field sales supported by a self-serve secure online portal, with payer partnerships supplemented by an E-newsletter and provider news archive. The company does not disclose pricing publicly, operating on contract-based negotiated rates between providers and payers.

Name

Midlands Choice

Legal name

Midlands Choice, Inc.

Website

https://midlandschoice.com

Company type

Private

Founded year

2001

Operating status

Operating

Headcount range

51–100 employees

Short description

Midlands Choice is a privately-held, independent PPO healthcare provider network serving thousands of physicians, hospitals, and ancillary facilities across Iowa, Nebraska, and South Dakota, contracting with payers (Cigna, Medica, HealthPartners, Oscar Health), TPAs, brokers, and self-funded employers for network access and administrative services.

Ownership category

akta.pro rank

Product category

Healthcare Provider Network

NAICS

Agencies, Brokerages, and Other Insurance Related Activities (5242)

SIC

Insurance Agents, Brokers & Service (6411)

akta.pro primary industry

Regional & Local PPO Networks (HLAEANAB)

akta.pro secondary industries

Provider Network Administration & Contracting (PPO Network Management) (HLAEALAE), Multi-Specialty PPO Provider Networks (HLAEANAC)

Keywords

• PPO provider network
• Healthcare network management
• Provider credentialing services
• Claims administration services
• Preferred provider organization

Headquarters

HQ city

Omaha

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

Revenue model

1. Network Access and Administrative Services: Midlands Choice generates revenue by providing a network of contracted healthcare providers to payers (insurance companies, self-funded employers, TPAs) and charging for administrative services including claims processing, credentialing, and provider management.

Go-to-market motion1 record

Distribution channels3 records

Marketing channels3 records

Core offering

Midlands Choice operates a Preferred Provider Organization (PPO) network across Iowa, Nebraska, and South Dakota, contracting with thousands of physicians, hospitals, and ancillary providers. The company delivers credentialing, claims processing and repricing, eligibility verification, and secure online administrative tools that connect contracted providers with insurance payers, third-party administrators, and self-funded employer groups.

Product overview

Midlands Choice is a healthcare provider network organization offering a PPO network serving Iowa, Nebraska, and South Dakota. The company provides a suite of interconnected services including a provider network with thousands of physicians and hospitals, Secure Tools Portal for claims and administrative management, credentialing services with CredSolutions platform, payer resources for multiple carriers (Cigna, Medica, Oscar Health, HealthPartners), provider search functionality, and network participation tools. The product portfolio centers on connecting healthcare providers with payers and patients through electronic claims processing, credentialing, and administrative portals.

Differentiator

Problem solved

Functional benefit

Products and services

• Provider Network Services PPO network offering contracted access to physicians, hospitals, and ancillary providers across Iowa, Nebraska, and South Dakota, sold to insurance payers, TPAs, brokers, and self-funded employer groups.
• Secure Tools Portal Online portal allowing registered healthcare providers and payers to view claims status, perform group and payer lookups, access reimbursement schedules, and complete account administration.
• Provider Credentialing Credentialing services for network applicants, including initial participation applications, recredentialing, demographic updates, and use of the CredSolutions credentialing platform.
• Payer Resources and Group Administration Administrative resources for contracted payers including Cigna, Medica, Oscar Health, and HealthPartners, offering eligibility and benefits verification, ID card and EOB requirements, and group enrollment and termination forms.
• Mayo Health System Network Product Add-on network product providing access to Mayo Health System services, distributed to payers, brokers, and employer groups seeking expanded coverage options.

Named customers8 records

Segments3 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

Feature3 records

Partnerships

Nine partnerships are on record, tiered core and minor.

• Health AlliancecoreStrategic or Co-development Partner · 1 November 2012Midlands Choice formed a relationship with Health Alliance, a large provider-sponsored health insurer located in Urbana, Illinois. Health Alliance administers health plans for more than 335,000 members in Illinois and Iowa. The partnership allows Health Alliance to offer broader coverage to their PPO members residing in Iowa as well as those traveling for care, giving them access to the Midlands Choice network.
• CignacoreChannel Partner/ Reseller/ DistributorCigna is a major payer partner whose members access the Midlands Choice provider network. Cigna provides network access for their health plan members in the Midlands Choice service area.
• MedicacoreChannel Partner/ Reseller/ DistributorMedica is a payer partner providing health insurance coverage whose members access Midlands Choice providers in-network.
• HealthPartnerscoreChannel Partner/ Reseller/ DistributorHealthPartners is a payer partner whose provider newsletter (Fast Facts) is distributed through the Midlands Choice platform to network providers.
• Oscar HealthcoreChannel Partner/ Reseller/ DistributorOscar Health is a payer partner whose members access the Midlands Choice provider network for healthcare services.
• Meritain HealthminorChannel Partner/ Reseller/ DistributorMeritain Health is an Aetna-owned company. Meritain members have access to physicians and hospitals in the Midlands Choice Aetna network and began accessing the Aetna Choice POS II product in January 2013.
• First Administrators, Inc.minorChannel Partner/ Reseller/ DistributorFirst Administrators is a payer contracted with Midlands Choice, providing administrative services for employer groups such as Bomgaars Supply employees in Nebraska.
• Mayo Health SystemminorChannel Partner/ Reseller/ DistributorMayo Health System is offered as an additional network product through Midlands Choice, expanding coverage options for payers and employer groups.
• CoOportunity HealthminorChannel Partner/ Reseller/ DistributorCoOportunity Health was a nonprofit CO-OP health insurance company that partnered with Midlands Choice for provider network access in Iowa and Nebraska. The company entered liquidation in early 2015.

Scale indicators3 records

Recent moves6 records

Expansion highlights4 records

Broad incumbents

• MultiPlan: MultiPlan is the largest independent national PPO and complementary network manager in the U.S., offering repricing, network access, and analytics services to payers and TPAs. It directly overlaps Midlands Choice's core business of providing leased PPO networks and claim cost containment.
• Zelis: Zelis provides healthcare cost management, network solutions, claims integrity, and payments to insurers and TPAs. Its network and repricing offerings compete with Midlands Choice's PPO access and EDI-based claim processing model.
• Aetna (CVS Health) Network Services: Aetna operates one of the largest national PPO networks and rents network access to third parties, including TPAs and self-funded employers. It is both a competitor for network leases and a channel partner for Midlands Choice via Meritain Health.
• Cigna Healthcare Network: Cigna runs a national PPO network and offers network rental to other payers and TPAs. Midlands Choice is a regional complement to Cigna's network in IA/NE/SD, and Cigna is simultaneously a customer and a broad competitor.

Regional players

• HealthLink: HealthLink operates a regional PPO network serving the Midwest and other states, providing provider access, claims administration, and utilization management to payers and employers. Its regional network model and payer-facing services mirror Midlands Choice's positioning.
• PreferredOne: PreferredOne is a Minnesota-based health plan and PPO network operator serving the upper Midwest, contracting with regional providers and employers. Its geographic and product overlap with Midlands Choice's IA/NE/SD footprint makes it a regional comparable.

Direct peers

• Stratose: Stratose is an independent preferred provider organization offering multi-state leased networks, repricing, and medical claims management to payers, TPAs, and self-funded employers. Its product set closely mirrors Midlands Choice's PPO and administrative services.
• Cofinity: Cofinity (formerly PPOM/First Health) operates a national PPO network and provides network access, utilization review, and care management to payers and employer groups. It competes directly with Midlands Choice for payer network-lease contracts.
• USA Managed Care Organizations: USA Managed Care Organizations runs a national PPO network and provides network leasing, repricing, and claims services to TPAs, insurers, and self-funded plans. It is a comparable independent network competitor to Midlands Choice.

Emerging players

• Lucent Health: Lucent Health is a TPA and network solutions provider offering self-funded employer plans with provider network access and care management. Its payer/broker channel and network-rental model overlap with Midlands Choice's payer services.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks5 records

Key highlights6 records

Customer concentration

• LinkedInlinkedin.com/company/midlands-choice

Compliance1 record

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 Midlands Choice