NGA-Denver

Name

NGA-Denver

Legal name

NGA Healthcare

Website

https://ngahealthcare.com

Company type

Private

Founded year

2013

Operating status

Operating

Ownership category

akta.pro rank

Product category

Healthcare Payer Contract Negotiation & Credentialing

NAICS

Agencies, Brokerages, and Other Insurance Related Activities (5242), Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)

SIC

Insurance Agents, Brokers & Service (6411)

akta.pro primary industry

Contract Management & Payer Rate Modeling (HLACACAI)

akta.pro secondary industry

Provider Network, Credentialing & Contracting Support (BPAAAFAI)

Keywords

• Payer contract negotiation
• Provider credentialing services
• Reimbursement rate optimization
• Healthcare contract consulting
• Insurance network contracting

Headquarters

HQ city

Tucson

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Contract Negotiation Services (Fixed-Fee): NGA Healthcare charges a fixed fee for contract negotiation services based on the number of providers in the practice multiplied by $1,000, multiplied by the number of payer plans targeted (minimum 4 plans). For example, a 3-provider practice targeting 4 plans would pay $12,000. Fees are charged upfront or as per agreement terms. No refunds if negotiations do not succeed on all plans, though historically 99% of cases result in at least one plan increasing rates beyond fees.
2. Credentialing Services: Provider credentialing services for independent practices across Medicare, Medicaid, and commercial payers. Credentialing is offered as a standalone service or bundled with negotiation services to help practices get onboarded to payer panels faster and begin billing quickly after credentialing is complete.
3. Performance-Based Contract Terms: NGA Healthcare operates on a performance-based model where the company's success is tied directly to client outcomes. The guarantee is: 'No rate increase, no re-credentialing win — no fee.' However, the primary fee structure is fixed-fee per the formula described above, with the performance guarantee providing a risk-mitigation framing for clients.

Pricing tiers

Go-to-market motion3 records

Distribution channels4 records

Marketing channels7 records

Core offering

NGA Healthcare negotiates payer (insurance) contracts on behalf of independent medical practices to secure higher reimbursement rates, and manages provider credentialing and payer enrollment across Medicare, Medicaid, and commercial plans. The firm operates under a performance-based guarantee (no rate increase, no fee) and serves clients across 46+ U.S. states.

Product overview

NGA Healthcare offers a two-service solution for independent medical practices: Negotiation Services and Credentialing Services. These services are offered as a unified offering aimed at optimizing practice revenue — Negotiation Services handles insurance payor contract negotiations to secure higher reimbursement rates, while Credentialing Services manages the provider enrollment and verification process with insurance companies. The company operates on a performance-based pricing model with a guarantee: no rate increase, no fee. NGA Healthcare claims a 99%+ success rate across 46+ states and helps practices achieve 15-50% increases for new contract negotiations and 10-20% increases above current rates for renegotiations.

Differentiator

Problem solved

Functional benefit

Products and services

• Negotiation Services Insurance payer contract negotiation service for independent medical practices, covering both new contracts and renegotiations of existing payer agreements. NGA Healthcare negotiates with commercial plans (and Medicaid where delegated) to secure higher reimbursement rates for clients, backed by a performance-based guarantee of meaningful rate increase or no fee.
• Credentialing Services Provider credentialing and payer enrollment service that verifies provider qualifications and enrolls them with Medicare, Medicaid, and commercial payers. Includes CAQH ProView profile management, PECOS and state MMIS enrollment, and re-credentialing tracking, with a focus on obtaining effective dates faster than competitors.

Quantifiable outcome

• 15-50% rate increase for new contract negotiations
• +8 more outcomes

Named customers10 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

Six partnerships are on record, tiered core and minor.

• UnisLinkcoreStrategic or Co-development PartnerUnisLink, an Arizona-based RCM solutions and medical billing company, partners with NGA Healthcare to offer a comprehensive value proposition combining contract negotiation with full revenue cycle management. The partnership integrates UnisLink's advanced technology, data analytics, and billing services with NGA Healthcare's payer contract expertise to help independent practices maximize revenue, improve billing accuracy, and reduce administrative burden. UnisLink's services include improved billing accuracy, enhanced patient collections, streamlined operations, and data-driven insights through UnisLink Engage Analytics. The partnership targets independent physicians seeking both higher reimbursement rates and improved billing operations.
• Boston ScientificminorGTM or Marketing PartnerBoston Scientific, a global medical technology leader specializing in cardiovascular, endoscopy, and other medical devices, partners with NGA Healthcare by introducing the firm to healthcare provider practices within their network. A testimonial from Orlando Gastroenterology (Sri Pothamsetty, MD) explicitly states that 'Boston Scientific initially introduced us to NGA Healthcare.' This referral relationship helps Boston Scientific's provider customers optimize their financial performance, which in turn supports the use of Boston Scientific devices in those practices.
• 4D GlobalminorStrategic or Co-development Partner4D Global is an Arizona-based medical billing company serving clients across the U.S. for over a decade, specializing in comprehensive Revenue Cycle Management (RCM) services including patient demographic and charge entry, coding, payment posting, denial management, and provider credentialing. The partnership enhances financial performance and ensures compliance with industry standards, providing essential support for accreditation specialists during contract negotiations.
• ACHC (Accreditation Commission for Health Care)minorStrategic or Co-development PartnerACHC is a U.S.-based nonprofit organization offering accreditation services across healthcare settings including home health, hospice, durable medical equipment, pharmacy, and behavioral health. Established in 1985, ACHC provides an alternative to other accrediting bodies, focusing on the needs of small providers. Partnering with ACHC ensures adherence to industry standards, facilitating smoother contract negotiations and compliance processes for NGA Healthcare's clients.
• SCS Specialized Collection Systems, Inc.minorStrategic or Co-development PartnerSCS, established in 1976 and based in Houston, Texas, focuses exclusively on healthcare collections using patient-centric, education-based strategies. Services include third-party debt recovery, account consolidation, AI solutions, business intelligence, and consulting services. Their commitment to integrity, ethics, and advanced security systems aligns with industry standards for NGA Healthcare's credentialing and contract negotiation clients.
• GPOphthominorChannel Partner/ Reseller/ DistributorGPOphtho is a physician-founded Group Purchasing Organization serving ophthalmology and optometry practices throughout the United States. By partnering with trusted healthcare vendors, GPOphtho delivers exclusive member pricing, preferred partner programs, and valuable resources designed to help practices operate more efficiently while delivering exceptional patient care.

Scale indicators7 records

Recent moves5 records

Expansion highlights5 records

Direct peers

• 4D Global: 4D Global is an Arizona-based RCM and credentialing firm publicly listed as an NGA partner; it competes head-to-head with NGA in medical billing, credentialing, and contract-negotiation services for independent practices nationwide.
• DoctorsManagement: DoctorsManagement provides medical practice consulting including payer contract negotiation, credentialing, and revenue cycle management for physician practices — a near-identical service stack to NGA Healthcare across a comparable customer base of independent practices and specialty groups.
• PMMC (Practice Management Medical Corporation): PMMC negotiates payer contracts and manages revenue cycle on behalf of hospitals and physician practices, directly overlapping NGA's contract-negotiation and managed-services model across the same provider-customer segment.
• Capstone Health Resources: Capstone Health Resources offers payer contract negotiation, credentialing, and practice management consulting for independent practices — a closely comparable boutique consulting firm competing for the same SMB and mid-market physician customers as NGA Healthcare.
• UnisLink: UnisLink is NGA's core RCM partner and itself a physician-billing and analytics provider; it overlaps NGA on the revenue cycle and contract negotiation value chain while bundling its own Engage Analytics platform.

Broad incumbents

• athenahealth: athenahealth provides EHR, RCM, and practice-management software to independent practices, increasingly bundling payer-contract benchmarking and rate-analysis features that intersect with NGA's contract-negotiation services.
• R1 RCM: R1 RCM is a major publicly traded revenue cycle management and practice-management company serving hospitals and physician groups, competing with NGA in the contract-negotiation and end-to-end RCM space at much greater scale.
• Optum (UnitedHealth Group): Optum is the largest healthcare services and RCM platform in the U.S., bundling payer-relations technology, analytics, and contract-support capabilities that compete with NGA at the high end of the independent-practice and provider-services market.

Regional players

• Medical Billing Wholesalers: Medical Billing Wholesalers provides payer contract negotiation, credentialing, and RCM services to independent practices, with comparable specialization but a more regionally concentrated client footprint than NGA's 46-state reach.

Emerging players

• Athelas: Athelas is an AI-powered RCM and ambient-documentation platform for independent practices and a listed NGA partner; it represents the emerging software-enabled competitor targeting the same SMB physician segment with technology-led contract and revenue tools.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights6 records

Customer concentration

• LinkedInlinkedin.com/company/nga-healthcare

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 NGA-Denver