What MDI Networx does

MDI NetworX (MDI NetworX LLC.), founded in 2014 and headquartered in Baltimore, Maryland, is a privately-held healthcare technology and operations company that delivers AI/ML-enabled business process outsourcing and software platforms to US health insurance payers, healthcare providers, and third-party administrators. The company operates across four locations (Baltimore and two Overland Park, Kansas offices, plus a Pune, India delivery center) and serves enterprise clients across Medicare, Medicaid, Tricare, Commercial, and Workers Compensation lines of business, with adjudication expertise across core platforms including Facets, Qiclink, QNXT, MC400, and Javelina.

The company's product portfolio is organized as a platform-plus-modules architecture. InsightPro serves as the AI/ML-enabled workforce analytics and QA core, with EnrollmentIQ (member enrollment automation) and AuditIQ (quality assurance) as branded modules. Surrounding products include RevEx (revenue cycle management), Golem (frontend claims processing using OCR/ICR), DocGem (document management and workflow), MCO PRO (PPO routing and repricing), and Mage (provider contract modeling). The company maintains additional sub-brands including Clarity Performance Solutions, ClaimEDIx, and the acquired American Healthcare Alliance PPO network. AI/ML capabilities span computer vision (OCR/ICR at 300 DPI), natural language processing (claims notes analysis and member chatbots), predictive analytics (workflow and capacity planning), anomaly detection (claims fraud), and robotic process automation across enrollment, claims, mailroom, and QA workflows.

MDI generates revenue through three streams: subscription-based SaaS/platform licensing for its proprietary products, managed services (onshore and offshore claims administration, enrollment, QA, provider call center, and No Surprises Act support), and professional services (implementation, configuration, and consulting across core adjudication platforms). Pricing is quote-based and not publicly disclosed. The go-to-market is enterprise field sales targeting mid-to-large healthcare organizations, complemented by strategic channel partnerships (UnitedAg) and acquisition-based geographic expansion (AHA in 2021; Cobalt MedPlans in November 2025, adding ~250 employees). The company holds HITRUST CSF, ISO 27001, and SOC/AICPA certifications, and has received Inc. 5000 recognition.

Name

MDI Networx

Legal name

MDI NetworX LLC.

Website

https://mdinetworx.com

Company type

Private

Founded year

2014

Operating status

Operating

Headcount range

51–100 employees

Short description

MDI NetworX is a privately-held Baltimore-based healthcare technology and BPO company that delivers AI/ML-enabled platforms and managed services to US health insurance payers, providers, and TPAs, with a product portfolio anchored by the InsightPro workforce analytics platform.

Ownership category

akta.pro rank

Product category

Healthcare Operations Technology

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Computer Systems Design and Related Services (54151), Computer Systems Design Services (541512)

SIC

Services-Computer Programming, Data Processing, Etc. (7370), Services-Computer Integrated Systems Design (7373), Services-Prepackaged Software (7372)

akta.pro primary industry

Payer-Provider Data Exchange (X12, prior auth, claims/clinical attachment) (HLACABAK)

akta.pro secondary industry

Claims Management & Digital FNOL Platforms (FSAGAGAC)

Keywords

• Healthcare claims processing
• Revenue cycle management
• Healthcare BPO services
• Workforce analytics platform
• Member enrollment automation

Headquarters

HQ city

Baltimore

HQ country

United States

HQ region

North America

Offices4 records

Markets served

GTM type

B2B

Offering type

Software

Cost components

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

Revenue model

1. Software Licensing (SaaS/Platform): Revenue from AI-enabled SaaS platforms including InsightPro, EnrollmentIQ, AuditIQ, RevEx, Golem, DocGem, MCO PRO, and Mage. These are sold as subscription-based or usage-based licenses to healthcare payers and providers.
2. Managed Services: Comprehensive healthcare operations outsourcing including claims administration, provider call center, member enrollment, quality assurance, business rule configuration, and reporting/analytics services delivered by onshore and offshore teams.
3. Professional Services: Implementation, consulting, and configuration services for healthcare payers including system integration, business rule configuration on platforms like Facets, Qiclink, QNXT, MC400, Javelina, and process optimization consulting.

Pricing tiers

Go-to-market motion2 records

Distribution channels3 records

Marketing channels7 records

Core offering

MDI NetworX provides AI/ML-enabled proprietary healthcare technology platforms combined with managed services to health insurance payers, providers, and third-party administrators. Its portfolio spans claims processing, quality assurance, revenue cycle management, member enrollment, document management, provider contract modeling, and PPO routing/repricing, delivered through onshore (US) and offshore (India) teams. The company also operates acquired sub-brands including American Healthcare Alliance (PPO network), ClaimEDIx, and Clarity Performance Solutions.

Product overview

MDI NetworX offers a portfolio of healthcare technology products organized as a platform-plus-modules architecture. The core offering centers on InsightPRO, an AI/ML-enabled workforce analytics platform that serves as the primary integrated environment. Supporting the platform are specialized products: RevEx (Revenue Cycle Management), Golem (Claims Processing Front-End), DocGem (Document Management), MCO PRO (PPO Routing and Repricing), and Mage (Provider Contract Modeling). Additional modules including EnrollmentIQ and AuditIQ extend InsightPRO's capabilities. The company also maintains sub-brands: Clarity Performance Solutions, ClaimEDIx, and American Healthcare Alliance (AHA), an acquired PPO alliance.

Differentiator

Problem solved

Functional benefit

Brands

• InsightPro: AI-enabled SaaS platform for workforce analytics and quality assurance, providing operational visibility and performance management for healthcare payers.
• RevEx
• Golem
• DocGem
• MCO PRO
• Mage

Products and services

• InsightPro AI/ML-enabled workforce analytics platform that provides real-time operational visibility, automated tracking, performance dashboards, workflow controls, and AI-driven quality assurance automation for healthcare payer operations.
• RevEx Revenue Cycle Management platform designed to streamline and optimize healthcare billing processes for hospitals, physician practices, and specialty care facilities.
• Golem Frontend claims processing solution providing an elegant interface for seamless backend workflow, with efficient data capture and quick, secure access to records.
• DocGem Document management and workflow platform that handles record access, confidentiality, workflow distribution, and reporting through automation.
• MCO PRO Fully-automated PPO routing and repricing application for managed care operations that performs tasks efficiently with complete transparency, accessible at any time during the claim process.
• Mage Provider contract modeling solution that reduces time, cost, and effort in preparing and negotiating financially viable contracts.
• EnrollmentIQ AI-powered all-in-one enrollment platform for faster enrollment intake, cleaner processing, stronger reconciliation, and accurate member data with unified workflow management.
• AuditIQ AI-driven quality assurance platform for healthcare payer operations that provides enhanced performance visibility, structured auditing, and analytics-driven feedback loops.
• Managed Services Comprehensive healthcare operations outsourcing service including claims administration, provider call center, member enrollment, quality assurance, business rule configuration, and reporting/analytics delivered by onshore (US) and offshore (India) teams.
• Claims Administration Claims administration service with experienced onshore and offshore claims adjudication and adjustment professionals providing faster settlements, better accuracy, and lower processing costs per claim.

Quantifiable outcome

• 40% improvement in claims processing turnaround times
• +9 more outcomes

Named customers6 records

Segments3 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability8 records

Feature8 records

Partnerships

Four partnerships are on record, tiered strategic and core.

• International Benefits Administrators (IBA)strategicTechnology or Integration · 10 February 2026MDI NetworX announced successful go-live of its InsightPro QA platform at IBA, deploying AI-driven automation and analytics for healthcare quality assurance workflows. The implementation provides enhanced performance visibility, structured auditing, and analytics-driven feedback loops.
• UnitedAgstrategicStrategic or Co-development Partner · 16 December 2025UnitedAg partnered with MDI NetworX to implement AI-powered automation for its member enrollment process using the InsightPro platform. The initiative aims to improve operational efficiency and member experience by reducing manual effort, eliminating friction points, and consolidating data management.
• Blue Cross and Blue Shield of Kansas CitycoreStrategic or Co-development Partner · 24 November 2025MDI NetworX acquired Cobalt MedPlans from Cobalt Health Solutions, a subsidiary of Blue Cross and Blue Shield of Kansas City. This acquisition expands MDI's U.S. operational footprint and payer services capabilities, adding two Kansas locations and approximately 250 employees.
• American Healthcare Alliance (AHA)coreStrategic or Co-development Partner · 5 October 2021MDI NetworX acquired American Healthcare Alliance, an Overland Park, Kansas-based alliance of preferred provider organizations. The acquisition expanded MDI's capabilities, services, and geographic reach while strengthening its position as a healthcare claims management provider.

Scale indicators5 records

Recent moves7 records

Expansion highlights6 records

Direct peers

• Conduent: Conduent operates a healthcare BPO business focused on claims administration, member engagement, and provider data management for U.S. payers and government programs. Strong overlap with MDI's core claims administration and digital mailroom offerings.
• Sutherland Global: Sutherland is a digital-led BPO with a sizable healthcare practice spanning claims, member/provider services, and AI-driven automation. Comparable onshore/offshore delivery model and payer-services focus to MDI NetworX.
• EXL Service: EXL is a global operations and analytics BPO with a dedicated healthcare payer practice (claims administration, care management, member services) and proprietary AI/data platforms. Closely comparable business model to MDI NetworX's blended services + SaaS approach.
• CitiusTech: CitiusTech is a healthcare technology services and BPO firm serving payers, providers, and life sciences with proprietary platforms and AI/data offerings. It is a direct competitor to MDI NetworX in healthcare payer operations outsourcing and AI-enabled claims/enrollment automation.
• Hexaware Technologies: Hexaware is an IT services and automation firm with a dedicated U.S. healthcare payer practice covering claims, member enrollment, and AI-automation services. Similar blend of managed services and productized automation as MDI NetworX.

Emerging players

• Edifecs: Edifecs provides healthcare interoperability, EDI, and X12 data-exchange platforms used by U.S. payers and providers. It overlaps with MDI's X12-based claims EDI, digital mailroom, and payer-provider data exchange capabilities, but is product-led rather than services-led.
• HealthEdge: HealthEdge offers a modern payer core platform and increasingly competes for AI-driven workflow automation budgets at U.S. health plans. An emerging platform-led competitor to MDI's services-plus-platform approach.

Broad incumbents

• Cognizant (Trizetto): Cognizant owns TriZetto Healthcare Products (Qiclink, QNXT, Facets), the core claims platforms MDI implements and supports, and operates a global healthcare BPO practice. It is both a platform partner and broad competitor across MDI's payer services portfolio.
• Optum (UnitedHealth Group): Optum is the largest U.S. healthcare technology and operations platform, serving payers, providers, and pharmacy benefit management with AI-enabled claims, enrollment, and analytics at massive scale. It represents the strategic ceiling for any healthcare-services automation vendor.
• Wipro (Healthcare): Wipro operates a global healthcare BPO/IT services arm with payer claims administration, provider RCM, and AI-enabled platforms. MDI leadership includes former Wipro operators, signaling overlapping talent pools and competitive bidding.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/MDI_NetworX
• Facebookfacebook.com/MDI-NetworX-106269617868358
• LinkedInlinkedin.com/company/mdi-networx

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles10 records

Subsidiaries5 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A2 records

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about MDI Networx