NAHGA Claim Services

What NAHGA Claim Services does

NAHGA Claim Services (legal name: NAHGA Claim Services; DBA: NAHGA / National Accident Health General Agency) is a privately held, family-owned third-party administrator founded in 1991 by brothers Bill and Bruce Chalmers in Bridgton, Maine. The company was created to process secondary accident insurance claims for boys and girls summer camps when incumbent carriers declined to administer such claims directly; over 30+ years the client base has expanded to include hundreds of NCAA Division I/II/III athletic programs, K-12 schools, youth sport leagues, motocross and short-track racing organizations, film and television productions, and more than 11 top-rated health and accident insurance companies that outsource specialty claims processing to NAHGA.

The operating stack is anchored by the proprietary NAHGA All Access Portal, a 24/7 claims administration system with real-time status visibility, customizable reporting, and paperless submission, supported by annual unqualified SOC1 audits, HIPAA-compliant operations, and a documented disaster recovery program. NAHGA ingests claims electronically via Optum's iEDI clearinghouse under Payer ID 67788 (succeeding Change Healthcare), pays providers through Zelis Payments (ACH and virtual credit card with fraud monitoring), and is natively integrated with dominant injury tracking platforms — ATS, SportsWare, and HealthyRoster — so that athletic trainer incident reports auto-generate claims. Modular service lines include Cost Containment (repricing network discounts), Risk Management (provider network customization and fee negotiation), Primary Insurance Verification, and Section 111 Medicare Secondary Payer reporting delivered through a Verisk – ISO Claims Partners partnership.

NAHGA earns managed-services revenue from claims administration fees paid by insurance carriers, self-insured organizations, schools, and athletic programs, with quote-based pricing tailored to client program requirements. Go-to-market is enterprise-led, executed through direct sales, a US-based customer service team available M-F 8am-4:30pm EST, and online channels including a Request a Demo CTA. Leadership is family-led: Marney Chalmers (President/CEO), Tom Chalmers (Quality Assurance & Licensing Specialist), and an operating team spanning compliance, information security, claim operations, and finance. The company has no disclosed external funding, parent company, or acquisition activity, and remains a 30+-year profitable niche specialist in secondary accident claims administration for the youth, education, and amateur athletics ecosystem.

Name

NAHGA Claim Services

Legal name

NAHGA Claim Services

Website

https://nahgaclaimservices.com

Company type

Private

Founded year

1991

Operating status

Operating

Headcount range

11–50 employees

Short description

NAHGA Claim Services is a privately held, family-owned third-party administrator that processes secondary accident and health insurance claims for NCAA athletic programs, K-12 schools, youth camps, racing and film/TV organizations, and top-rated insurance carriers across the United States.

Ownership category

akta.pro rank

Headquarters

HQ city

Bridgton

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. Third Party Administration Fees: NAHGA earns fees for administering health and accident insurance claims on behalf of self-insured organizations, schools, colleges, and insurance companies. Revenue is generated through claims processing services, cost containment, and administrative services for secondary accident insurance claims.

Go-to-market motion1 record

Distribution channels3 records

Marketing channels3 records

Core offering

NAHGA Claim Services is a third-party administrator (TPA) that processes secondary accident and health insurance claims on behalf of insurance companies, schools, colleges, camps, athletic programs, and self-insured organizations. Its core offering centers on claims administration, cost containment, and regulatory compliance (including Section 111 Medicare Secondary Payer reporting), delivered through a proprietary claims portal with electronic submission and payment capabilities.

Product overview

NAHGA Claim Services operates as a Third Party Administrator (TPA) providing a unified claims processing platform centered on the NAHGA Portal (All Access Portal). The core offering is comprehensive claims administration services augmented by modular add-ons including Cost Containment, Risk Management, Primary Insurance Verification, and Section 111 Reporting. Technology features include Online Claims Management with integrations to third-party injury tracking software (ATS, SportsWare, HealthyRoster), Electronic Payments via Zelis Payments, and Bill Us Digitally for electronic claims submissions. The company specializes in secondary accident insurance claims for educational institutions, athletic programs, camps, and specialty organizations.

Differentiator

Problem solved

Functional benefit

Brands

• NAHGA Portal: All Access Portal providing 24/7 real-time access to claims status, reporting, and claims submission functionality.

Products and services

• Third Party Administrator (TPA) Services
• Cost Containment
• Risk Management
• Primary Insurance Verification
• Section 111 Reporting
• NAHGA Portal (All Access Portal)
• Electronic Payments (E-Pay)
• Bill Us Digitally (Electronic Claims Submission)

Quantifiable outcome

• Real-time 24/7 claims status access
• +2 more outcomes

Named customers7 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

Integration5 records

Feature5 records

Partnerships

Six partnerships are on record, tiered core.

• Zelis PaymentscoreTechnology or IntegrationNAHGA has partnered with Zelis Payments to provide robust e-payment functionality including ACH and virtual credit card options. The partnership simplifies accounting, speeds payments, and includes fraud monitoring, full traceability, and encryption for security.
• Athletic Trainer System (ATS)coreTechnology or IntegrationIntegration partner allowing athletic trainers to create injury reports that automatically generate claims within NAHGA's system. Reduces manual data entry and processing time.
• SportsWarecoreTechnology or IntegrationIntegration partner enabling injury tracking data to automatically trigger claims in NAHGA's system, allowing trainers to focus on treatment rather than administrative tasks.
• HealthyRostercoreTechnology or IntegrationIntegration partner that connects injury reports directly to NAHGA claims processing, maintaining full transparency throughout the claims process.
• OptumcoreTechnology or IntegrationOptum's clearinghouse (iEDI) is used for electronic claims submissions via NAHGA's Payer ID 67788. This replaced Change Healthcare clearinghouse for electronic claim processing.
• Verisk - ISO Claims PartnerscoreTechnology or IntegrationPartnership for Section 111 Reporting Platform for reporting workers' compensation, liability, and no-fault claims to CMS. Includes conditional payment and lien resolution via Verisk's CP Link process for Medicare Secondary Payer compliance.

Scale indicators4 records

Recent moves6 records

Expansion highlights4 records

Broad incumbents

• Sedgwick: Sedgwick is a large global claims management and TPA provider handling health, workers' comp, disability, and property claims. Comparable to NAHGA as a TPA servicing self-insured and carrier-outsourced claims, but operates at vastly greater scale across many lines of business versus NAHGA's niche focus on secondary accident insurance.
• CorVel Corporation: CorVel is a national TPA and managed care services firm providing claims administration, medical case management, and cost containment for workers' comp and group health. Comparable to NAHGA in administering health/accident claims with cost containment focus, but serves a broader employer base rather than NAHGA's school/athletic niche.
• Crawford & Company (Broadspire): Crawford & Company's Broadspire division is a major third-party claims administrator offering medical, workers' comp, and disability claims management. Directly comparable claims-administration services to NAHGA, with overlap in TPA model and carrier-outsourced processing, but at much larger scale and broader line-of-business coverage.
• ESIS (Chubb): ESIS is Chubb's third-party claims administration and risk services arm, providing claims management across workers' comp, liability, and accident/health lines. Comparable to NAHGA's TPA function and accident/health claims specialization, but operates as part of a global insurance carrier platform.
• Helmsman Management Services (Liberty Mutual): Helmsman Management Services is Liberty Mutual's TPA operation, providing claims administration for self-insured workers' comp, auto, and general liability customers. Comparable in core TPA function and self-insured client focus, but operates as an in-house unit of a major carrier rather than an independent specialist like NAHGA.
• Gallagher Bassett Services: Gallagher Bassett is a major TPA and claims management firm within Arthur J. Gallagher, serving self-insured employers across workers' comp, liability, and health. Comparable TPA service offering and carrier-outsourced claims processing, with much broader geographic and line-of-business footprint than NAHGA.
• Broadspire (Crawford): Broadspire is Crawford & Company's TPA and managed care division providing claims administration for workers' comp, disability, and liability lines. Overlaps with NAHGA in TPA service profile and managed care/cost containment services for self-insured and carrier-outsourced programs.

Direct peers

• Cannon Cochran Management Services (CCMSI): CCMSI is a mid-size independent TPA providing claims administration, managed care, and loss control services for self-insured employers and carriers. Closely comparable to NAHGA in business model and TPA service profile, though CCMSI focuses more on workers' compensation and property/casualty than secondary accident claims.
• Rising Medical Solutions: Rising Medical Solutions is a managed care and medical claims management firm focused on workers' compensation and group health. Comparable to NAHGA in administering health/accident claims with cost containment and bill review capabilities for carrier-outsourced programs.
• York Risk Services Group: York Risk Services Group is an independent TPA providing claims administration, managed care, and loss control for workers' comp and liability lines. Comparable in TPA service profile and self-insured/customer base, though focused on workers' comp rather than NAHGA's accident/health secondary insurance niche.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key highlights7 records

Customer concentration

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles8 records

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 NAHGA Claim Services