Claim Health
Claim Health is an AI-native revenue operations platform for U.S. post-acute care providers — including home health, hospice, palliative care, and home care agencies — automating the full referral-to-reimbursement workflow through five integrated modules covering intake, authorization, billing, and revenue assurance.
- Company typePrivate
- Founded2024
- HeadquartersNew York, United States
- Headcount1–10
- GTM typeB2B
- OfferingSoftware
What Claim Health does
Claim Health is an AI-native revenue operations platform purpose-built for U.S. post-acute care providers, including home health, hospice, palliative care, and home care agencies operating in a market of approximately 68,000 provider organizations. The company automates the entire referral-to-reimbursement lifecycle through five integrated modules: Revenue Assurance (upstream EMR-based risk detection before claim submission), Smart Intake (centralized referral processing from fax, email, and portals with automatic eligibility verification), Authorization Autopilot (submission-to-renewal prior authorization tracking with exception alerting), Billing Operations (payment posting, reconciliation, denial handling, and prioritized follow-up), and Platform Intelligence (unified real-time revenue operations visibility). The platform ingests structured data, text, and multimodal inputs (including scanned PDFs and clinical forms) and is HIPAA compliant and SOC 2 Type 2 certified.
The underlying technology is positioned around upstream prevention of revenue leakage rather than downstream denial management, leveraging process automation, anomaly detection, and predictive analytics across the revenue cycle. The company was founded in 2024 by Kevin Calcado (CEO) and JJ Ram, joined Y Combinator's Spring 2025 batch, and is headquartered in New York City.
Claim Health operates a quote-based SaaS subscription model distributed through an enterprise field sales motion, with demo requests (Calendly) as the primary conversion mechanism. Distribution is augmented by partnerships with three major U.S. post-acute care industry associations (National Alliance for Care at Home, Pennsylvania Homecare Association, and Home Care Association of Florida) and content marketing through a company blog, case studies, and PR coverage. Named customers include Interim HealthCare, Ascend Health, Excelin, PARC, Promise Care, Bridge, Home Care RN, and Home Helpers, and the company reports early-customer outcomes including 80% reduction in manual hours, 15% improvement in approved claims, up to 4x referral throughput, and 3% EBITDA lift.
Claim Health firmographics
Firmographics- Name
- Claim Health
- Legal name
- Claim Health
- Website
- https://claimhealth.com
- Company type
- Private
- Founded year
- 2024
- Operating status
- Operating
- Headcount range
- 1–10 employees
- Short description
- Claim Health is an AI-native revenue operations platform for U.S. post-acute care providers — including home health, hospice, palliative care, and home care agencies — automating the full referral-to-reimbursement workflow through five integrated modules covering intake, authorization, billing, and revenue assurance.
- Ownership category
- akta.pro rank
Claim Health industry classification
Industry- Product category
- Healthcare Revenue Cycle Management Software
- NAICS
- Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)
- SIC
- Hospital & Medical Service Plans (6324), Services-Health Services (8000)
- akta.pro primary industry
- Payer-Provider Data Exchange (X12, prior auth, claims/clinical attachment) (HLACABAK)
- akta.pro secondary industries
- Patient Financial Engagement (Estimates, Billing Presentment, Payments) (HLACAEAI), Healthcare Billing & Patient Payments Presentment (FSAMAJAH), Healthcare Payouts (Payers-to-Providers, Patient Refunds) (FSAMAKAK)
Keywords
Where Claim Health is headquartered
LocationHeadquarters
- HQ city
- New York
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Claim Health business model
Business model- GTM type
- B2B
- Offering type
- Software
- Cost components
- Technology or R&D, Personnel, Marketing or Sales, Operations
Revenue model
- SaaS Platform Subscription: AI-native revenue operations platform for post-acute care providers, operating as a subscription-based SaaS model. The platform automates the entire referral-to-reimbursement lifecycle including intake processing, eligibility verification, authorization tracking, and payment reconciliation.
Go-to-market motion2 records
Distribution channels1 record
Marketing channels5 records
Claim Health product offering
Product offeringCore offering
Claim Health sells an AI-native revenue operations platform for post-acute care providers (home health, hospice, and home care agencies) that automates the entire referral-to-reimbursement workflow. The platform is delivered as a SaaS subscription with five integrated modules covering revenue risk detection, referral intake, prior authorization tracking, billing and reconciliation, and unified revenue analytics.
Product overview
Claim Health is an AI-native revenue operations platform for post-acute care providers, consisting of five integrated modules: Revenue Assurance, Smart Intake, Authorization Autopilot, Billing Operations, and Platform Intelligence. The platform automates the entire referral-to-reimbursement lifecycle, from patient intake and eligibility verification through payer authorization and payment reconciliation. Claim Health manages revenue operations end-to-end, identifying upstream risk before claims are submitted and resolving downstream billing issues through automated workflows.
Differentiator
Problem solved
Functional benefit
Products and services
- Revenue Assurance Continuously identifies upstream data, documentation, and coverage risk inside the EMR before claims are submitted, preventing denials, delays, and revenue loss for post-acute care providers.
- Smart Intake Centralizes referrals from fax, email, and portals into one automated workflow that extracts data, verifies eligibility, and routes accepted cases without manual entry, turning referral chaos into clean admissions.
- Authorization Autopilot Automates prior authorizations from submission to renewal, continuously tracking approvals and alerting teams only to exceptions requiring human review, eliminating authorization leakage.
- Billing Operations Resolves claims to cash through post-submission workflows including payment posting, reconciliation, denial handling, and prioritized follow-up.
- Platform Intelligence Unifies revenue operations across the organization into a single, real-time view, providing leaders clear visibility into revenue risk, performance, and impact.
Quantifiable outcome
- Over 50% reduction in administrative workload for early customers
- +5 more outcomes
Companies that use Claim Health
Customer profileNamed customers4 records
Segments1 record
Ideal customer profiles1 record
Claim Health technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
AI capability6 records
Feature5 records
Claim Health partnerships and signals
Strategic signalPartnerships
Four partnerships are on record, tiered core and minor.
- National Alliance for Care at HomecorePartnership to support member organizations with resources and technology addressing operational challenges. The Alliance represents more than 10,000 home health, hospice, palliative care, and home care organizations across the United States. Claim Health provides practical tools, educational resources, and operational guidance focused on building stronger back-office capabilities and achieving greater financial predictability.
- Home Care Association of FloridacorePartnership to help member organizations strengthen their operational foundation and adopt more modern approaches to revenue management. HCAF represents a broad network of home care and home health organizations dedicated to advancing quality, compliance, and sustainability. Claim Health provides education, shared insights, and practical resources focused on improving back-office operations.
- Pennsylvania Homecare AssociationcorePartnership to help home-based care organizations reduce administrative burden and improve the efficiency of their revenue operations. PHA represents hundreds of home care and home health organizations throughout the Commonwealth. Claim Health works alongside PHA to support member agencies with tools, insights, and education focused on simplifying billing workflows and improving financial visibility.
- AxxessminorClaimHealth partnered with Axxess and other organizations to develop the 2026 Industry Growth Insights Report surveying home health, hospice, palliative care, and home care leaders on technology adoption, workforce challenges, and regulatory demands.
Scale indicators9 records
Recent moves6 records
Expansion highlights6 records
Claim Health competitors and assessment
Company assessmentDirect peers
- Axxess: A leading home health and hospice technology vendor offering EHR, billing, and revenue cycle solutions for post-acute providers. Most direct competitor in terms of customer base and workflow overlap (and is even a current Claim Health partner via the 2026 Industry Growth Insights Report).
- KanTime: Post-acute care software platform providing EMR, billing, and revenue cycle management for home health, hospice, and home care agencies. Directly comparable in target market and product scope.
- MatrixCare: Enterprise EHR and RCM platform for skilled nursing, home health, hospice, and senior living providers. Overlaps with Claim Health in automating the full referral-to-reimbursement workflow for post-acute agencies.
- HHAeXchange: Home care management platform connecting payers, providers, and patients with billing, scheduling, and EVV functionality. Closely comparable in automating revenue workflows for home care agencies.
Broad incumbents
- WellSky: Large, established post-acute and human services technology vendor with EHR, billing, and analytics across home health, hospice, and beyond. A broader incumbent with overlapping RCM capabilities for the same customer base.
- Netsmart: Healthcare IT vendor serving post-acute and behavioral health providers with EHR, billing, and RCM. Overlaps in automating revenue operations for home health, hospice, and related agencies.
- Waystar: Large healthcare revenue cycle platform offering claims management, eligibility, prior authorization, and denials solutions. Not post-acute specific, but competes for the same RCM budget and overlaps on core capabilities like authorization tracking and claim submission.
- Availity: Payer-provider collaboration network for eligibility, prior authorization, and claims exchange. Competes with Claim Health's Authorization Autopilot and Smart Intake modules at the payer-data exchange layer.
Emerging players
- Cohere Health: AI-driven prior authorization platform partnering with health plans and providers. Comparable as an AI-native entrant focused on authorization workflows, a core Claim Health module.
- Anterior: AI company automating prior authorization and clinical review for payers and providers. Comparable as a venture-backed AI-native peer attacking the same payer-provider workflow bottleneck.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat4 records
Key risks6 records
Key highlights7 records
Customer concentration
Claim Health social profiles
Digital presenceClaim Health compliance and trust
Trust signalCompliance2 records
Claim Health financial estimates
Financial estimateRevenue estimate
Valuation estimate
Claim Health leadership team
Management profileNumber of profiles
Profiles2 records
Claim Health funding detail
Funding detailFunding overview
Funding rounds2 records
Investors4 records
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Claim Health M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Claim Health
What does Claim Health do?
Claim Health sells an AI-native revenue operations platform for post-acute care providers (home health, hospice, and home care agencies) that automates the entire referral-to-reimbursement workflow. The platform is delivered as a SaaS subscription with five integrated modules covering revenue risk detection, referral intake, prior authorization tracking, billing and reconciliation, and unified revenue analytics.
Is Claim Health a public or private company?
Claim Health is a private company. It is classified as venture growth investor backed and is currently operating.
When was Claim Health founded?
Claim Health was founded in 2024. It employs 1 to 10 people.
Where is Claim Health based?
Claim Health is headquartered in New York, United States, in the North America region.
How does Claim Health make money?
One revenue line is on record: saaS Platform Subscription.
Who are Claim Health's main competitors?
Direct peers on record are Axxess, KanTime, MatrixCare and HHAeXchange. Broad incumbents are WellSky, Netsmart, Waystar and Availity. Emerging players are Cohere Health and Anterior.
Does Claim Health have an API?
No public API is recorded for Claim Health.
What industry is Claim Health in?
Claim Health's product category is Healthcare Revenue Cycle Management Software. Its primary akta.pro industry code is HLACABAK, Payer-Provider Data Exchange (X12, prior auth, claims/clinical attachment), with a secondary code of HLACAEAI, Patient Financial Engagement (Estimates, Billing Presentment, Payments). Its NAICS code is 524292 and its SIC code is 6324.