CoreChoice

What CoreChoice does

CoreChoice is a private specialty healthcare network platform founded in 2012 and headquartered in Boca Raton, Florida. The company positions itself as a "specialty super network" that connects healthcare providers with insurance carriers, third-party administrators (TPAs), preferred provider organizations (PPOs), self-insured entities, and employer groups. Its service portfolio spans radiology, medical air transport, interventional pain management, neurodiagnostic testing, behavioral healthcare, diabetic care management, and sleep apnea testing. The company states access to approximately 22,000 imaging centers and over 1 million providers across all 50 U.S. states plus Washington D.C. and Puerto Rico.

The underlying platform is built on electronic data interchange (EDI) integration with payer, TPA, and provider systems, supporting a proprietary claims processing workflow and an internally developed Exclusive Provider Organization (EPO) repricing methodology for workers' compensation. CoreChoice generates revenue on a transaction-fee basis across four primary streams: PPO repricing, the EPO workers' compensation model, medical air transport arrangements, and reference-based pricing. Enterprise go-to-market is concentrated in the healthcare cost-management value chain, with named relationships including carriers Optum, Broadspire, and Coventry; TPA Enlyte Mitchell; PPO networks Prime Health, First Health, Zelis, claritev, Equian, GlobalCare, HHC Group, and PMC; and claims platform Change Healthcare. Pricing is quote-based and negotiated rather than standardized, consistent with enterprise contract structures.

Operationally, CoreChoice has pursued a strategy of vertical and channel expansion through partnerships and product launches rather than acquisitions or external funding. Notable moves include the 2016 Alacura partnership for medical air transport, the 2018 MINES & Associates partnership for opioid and substance use disorder treatment, the 2019 launch of the EPO model for workers' compensation, and the 2020 SleepMaster Solutions exclusive contract paired with a Sleep Apnea Testing product launch. The leadership team disclosed publicly consists of CEO Steven H. Shapiro and one additional executive; no funding rounds, headcount figures, or financial disclosures are publicly available.

Name

CoreChoice

Legal name

CoreChoice, Inc.

Website

https://corechoice.net

Company type

Private

Founded year

2012

Operating status

Operating

Headcount range

1–10 employees

Short description

CoreChoice is a Boca Raton-based specialty healthcare network platform founded in 2012 that aggregates roughly 22,000 imaging centers and 1 million-plus providers to deliver transaction-fee repricing, EPO, and reference-based pricing services to insurance carriers, TPAs, PPOs, and employer groups.

Ownership category

akta.pro rank

Product category

Specialty Healthcare Network Services

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

National PPO Networks (HLAEANAA)

akta.pro secondary industries

Direct Contracting / Narrow Network PPOs (HLAEANAK), Managed Care / Network-Based Group Health Plans (Carrier Network Products) (FSAIAFAO), Group PPO / EPO / POS Plans (FSAIAFAL)

Keywords

• Specialty healthcare network
• Radiology network services
• Workers compensation networks
• Medical air transport
• PPO repricing services

Headquarters

HQ city

New York

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Operations, Personnel, Technology or R&D, Marketing or Sales

Revenue model

1. Specialty Network/PPO Repricing: CoreChoice reprices radiology and interventional pain management claims in the workers compensation sector through its PPO network model. Radiology facilities bill payors directly and are paid at contracted rates.
2. Exclusive Provider Organization (EPO): CoreChoice develops specific networks within given cities/states/regions to service carriers or employer groups. Medical providers receive all referrals in exchange for accepting lower rates. CoreChoice handles billing, payments, and process monitoring.
3. Medical Air Transport Management: Prospective scheduling model for medical air transport services (rotary and fixed wing) at significant discounts, and retrospective model for resolving bills for flights already completed. Partnership with Alacura for service delivery.
4. Reference Based Pricing: CoreChoice has the ability to structure full service networks of medical providers and facilities including hospitals at reference based pricing.

Go-to-market motion1 record

Distribution channels3 records

Marketing channels4 records

Core offering

CoreChoice operates a nationwide specialty healthcare network (a "specialty super network") that connects insurance carriers, third-party administrators (TPAs), PPOs, self-insured entities, employer groups, government organizations, and union/Taft-Hartley groups with contracted providers for radiology, medical air transport, interventional pain management, neurodiagnostic testing, behavioral health, and diabetic care management. The company offers both PPO repricing and Exclusive Provider Organization (EPO) models, handling scheduling, claims processing via EDI, and direct billing from facilities to payors at pre-negotiated rates (commonly 50-80% off billed charges).

Product overview

CoreChoice is a specialty healthcare network platform operating as the nation's first 'specialty super network' for radiology, medical air transport, neurodiagnostic testing, interventional pain management, behavioral healthcare management, and diabetic care management. The platform functions as a network aggregator connecting healthcare providers (over 22,000 radiology facilities, 1 million+ total providers) with insurance carriers, third-party administrators, PPOs, and self-insured entities. Core products include the Radiology Network, Medical Air Transport Services, and Exclusive Provider Network (EPO) model. Add-on modules include the Opioid and Substance Use Disorders Network (via MINES partnership) and Sleep Apnea Testing and Treatment (via SleepMaster Solutions partnership). The company services commercial group health, workers' compensation, and auto liability insurance sectors.

Differentiator

Problem solved

Functional benefit

Quantifiable outcome

• Radiology facilities paid within 30-45 days directly from carrier
• +4 more outcomes

Named customers15 records

Segments4 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Partnerships

Five partnerships are on record, tiered flagship, core and minor.

• SleepMaster Solutions (Advanzeon Solutions)flagshipGTM or Marketing Partner · 26 February 2020Exclusive 3-year contract for sleep apnea testing and treatment program. SleepMaster Solutions positioned to screen, test and treat union members accessing CoreChoice network. Program impacts in excess of 1,000,000 members in first segment. CoreChoice expands network offering to include sleep apnea testing and treatment as covered benefit.
• MINES & AssociatescoreStrategic or Co-development Partner · 8 October 2018Partnership to form nation's first PPO network solution to combat opioid and polysubstance use epidemic. Network contains 24,000 providers including inpatient/outpatient treatment centers, physicians, and behavioral health specialists. Includes PPO repricing model and true managed care model with Network Care Coordinator for direct referrals. Managed care processes utilize MINES' integrated case management protocols. 50-80% discounts on billed charges.
• AlacuracoreStrategic or Co-development Partner · 2 November 2016Comprehensive network agreement for medical air transportation services. Alacura provides prospective scheduling model (24/7/365 for rotary and fixed wing services) and retrospective bill resolution. Services available nationally and internationally for group health and workers compensation insurance sectors. Alacura coordinates benefits determination, eligibility, medical necessity, end-to-end logistics, and claim processing.
• AIM Specialty HealthcoreStrategic or Co-development Partner · 28 June 2012Partnership to increase consumer access to high quality and low cost specialty care. AIM's OptiNet tool gives network providers ability to share quality measures, licensure, accreditation, equipment standards and cost information. Leverages AIM's Specialty Care Shopper Program for active member outreach on cost and quality transparency. Resulted in one of nation's largest networks of affordable, high quality radiology providers.
• Telemedicine PortalminorOthersBehavioral healthcare includes telemedicine portal as part of the service offering

Scale indicators6 records

Recent moves6 records

Expansion highlights2 records

Market position

Competitive moat4 records

Key highlights7 records

Customer concentration

• Xtwitter.com/CoreChoice
• Facebookfacebook.com/CoreChoice-170643040205389
• LinkedInlinkedin.com/company/corechoice-inc.

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 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 CoreChoice