Marquee Managed Care Solutions

What Marquee Managed Care Solutions does

Marquee Managed Care Solutions, Inc. is a privately held managed care services provider focused exclusively on the California workers' compensation market. The company delivers an integrated suite of services to insureds, self-insured programs, and self-insured groups, including bill review, utilization review, telephonic and field case management, Medical Provider Network (MPN) consulting, compounded/narcotic medication review, lien negotiation through its Negotiations & Resolution Unit (NRU), and Special Investigations Unit (SIU) services. The company is URAC accredited for utilization review under California's SB1160 framework and is led by a board-certified Occupational Medicine Medical Director who serves as a clinical escalation point for staff.

The company's underlying technology is a customized bill review and case management platform built around a sophisticated business rules engine, paperless case management system, and claims software integration that interoperates with multiple client systems. The platform supports real-time coordination between nurses and bill reviewers on the same system, customizable notifications and reporting, automated duplicate bill detection, and state-mandated electronic reporting. Revenue is generated through managed services contracts for the core offerings and outcome-based fees for lien negotiations, where the NRU averages savings in excess of 49% below the Official Medical Fee Schedule. Marquee operates from a single mailing address in San Diego, California, and as of November 1, 2023 is a subsidiary of Davies following the integration of ACM Claims into the parent group.

Name

Marquee Managed Care Solutions

Legal name

Marquee Managed Care Solutions, Inc.

Website

https://marqueemcs.com

Company type

Private

Founded year

1988

Operating status

Operating

Headcount range

51–100 employees

Short description

Marquee Managed Care Solutions is a URAC-accredited, privately held managed care services provider for the California workers' compensation market, offering integrated bill review, utilization review, case management, MPN consulting, and lien negotiation to insureds and self-insured programs.

Ownership category

akta.pro rank

Headquarters

HQ city

San Diego

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Negotiation Resolution Services: Fees are outcome based, tied directly to savings achieved for clients. The NRU averages savings in excess of 49% below fee schedule, and fees for negotiation services are based on results achieved to ensure maximum client savings.
2. Managed Care Services: Comprehensive programs including claims management, managed care, bill review, case management, utilization review, and medical provider networks provided to insureds, self-insured programs, and self-insured groups in the California workers' compensation market.

Pricing tiers

Go-to-market motion1 record

Distribution channels1 record

Marketing channels3 records

Core offering

Marquee Managed Care Solutions provides a holistic, integrated suite of managed care services exclusively for the California workers' compensation market. Its core offerings include bill review, utilization review, telephonic and field case management, medical provider network (MPN) consulting, lien negotiation and resolution, and special investigations support. Services are delivered through customized software with integrated workflows that allow nurses and bill reviewers to coordinate in real time, supporting cost containment and regulatory compliance for insurance carriers, self-insured programs, and self-insured groups.

Product overview

Marquee Managed Care Solutions offers an integrated managed care platform for the California workers' compensation market. The core product suite includes Bill Review (customized bill review with fraud detection), Clinical Management Solutions (automated vendor referral and reporting), Utilization Review (state-certified integrated with bill review), Telephonic Case Management & Early Return to Work, and Field Case Management. These integrate with add-on modules including Compounded/Narcotic Medication Review, Medical Provider Network (MPN) Consulting, Negotiations & Resolution Unit (NRU) for lien resolution, and Special Investigations Unit (SIU) services. The platform is technology-driven using sophisticated business rules engines and paperless case management systems with claims software integration capabilities.

Differentiator

Problem solved

Functional benefit

Products and services

• Bill Review

Quantifiable outcome

• 20% reduction in total claims costs through MPN services since 2008
• +1 more outcomes

Segments3 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature7 records

Partnerships

One partnership is on record.

• ACM Claims (joined Davies)coreStrategic or Co-development Partner · 1 November 2023On Nov. 1, 2023, Marquee announced exciting changes as ACM Claims joined Davies. Davies is the parent company/holding organization for Marquee Managed Care Solutions.

Scale indicators3 records

Recent moves6 records

Expansion highlights3 records

Direct peers

• CorVel Corporation: Public managed care company providing workers' compensation claims management, bill review, utilization review, and case management nationally. Most directly comparable to Marquee in service mix, though operating at significantly larger scale and across multiple states.
• Genex Services: National provider of workers' compensation case management, medical management, and managed care services. Directly competes with Marquee in telephonic and field case management for injured workers across multiple states.
• Mitchell International: Workers' compensation technology and services provider specializing in bill review, pharmacy management, and claims management software. Comparable to Marquee on the bill review and claims integration technology layer.
• Helmsman Management Services: Liberty Mutual subsidiary providing workers' compensation claims administration and managed care services. Competes with Marquee for self-insured employer and insurer accounts seeking integrated managed care solutions.
• MedRisk: Specialized managed care organization focused on physical therapy and rehabilitation for workers' compensation claims. Comparable niche focus and managed care approach, though narrower in clinical scope than Marquee's broader workers' comp services.
• Broadspire (Crawford & Company): Third-party administrator offering managed care, claims management, and medical cost containment for workers' compensation. Direct competitor to Marquee with broader geographic reach and parent company scale.
• Sedgwick: Major third-party administrator providing claims management, managed care, and utilization review for workers' compensation. Overlaps with Marquee on bill review, case management, and utilization review but operates at much larger scale with multi-state coverage.
• One Call: Workers' compensation specialty services network providing diagnostic, transportation, and physical therapy management. Adjacent managed care services for workers' comp payers, comparable customer base to Marquee.

Broad incumbents

• The Hartford (Workers' Comp): Major workers' compensation insurance carrier with internal managed care operations. Represents a broad incumbent in the same market, with overlapping customers but a fundamentally different business model (carrier vs. third-party administrator).
• Encova Mutual Insurance: Workers' compensation insurer operating in California with internal managed care capabilities. Adjacent market participant that may compete with or partner with Marquee for bill review and utilization review services.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks7 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/marquee-managed-care-solutions

Compliance1 record

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 Marquee Managed Care Solutions