Health Plan Services

More Than a TPA

Efficient Administration With Integrated Medical Impact

Evolent Health works with health plans to grow, drive down administrative costs and provide a superior experience to their network and members. We deliver efficient third party administration and medical management services to health plans and providers with delegated risk.

  • A complete and integrated suite of technology and services needed to operate, grow and evolve your health plan
  • Claims processing platform with broad flexibility and configurability to meet simple and complex benefit design and provider contract requirements
  • Experienced and knowledgeable team of health plan leaders with a track record of creating value
  • Innovative technology and service solutions evolving the health plan experience for providers and members

"Being able to bring what Evolent has in their focus and in their technology to supplement what we already know and do in the market? That's 1+1=3."

Dr. Martin Hickey
CEO, True Health New Mexico

Best-in-Class Administration

With decades of experience and billions of claims paid our flexible and modern platform delivers exceptional performance and service for both members and providers.

Reduce administrative costs

With a six-month average implementation timeline, our experienced team and rules-based claims payment platform can quickly increase auto-adjudication and improve financial and procedural claims payment accuracy.

Achieve high member and provider satisfaction

Our highly trained customer service representatives achieve high resolution and satisfaction rates by working diligently and respectfully with your members and providers.

Impact Well-Being at a Lower Cost

Across our provider partners, we have built our solution to include the clinical tools and scalable capabilities needed to better serve all populations and evolve and grow your plan.

Improve patient health

By seamlessly integrating our population health management technology with back-office function, Evolent delivers more clinical impact while driving down costs.

Manage medical spend

With integrated utilization management and clinical tools and the support from our team of experts, we reduce inappropriate health care services without compromising quality or member satisfaction.

Drive continuous improvement

A monthly operations dashboard and improvement recommendations delivered by our team of operational experts and actuaries are powered by the latest enrollment, provider and claims data.

Learn More About Our Integrated Offering