Claim Health

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.

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

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

• Revenue cycle management
• Healthcare AI automation
• Post-acute care software
• Medical billing platform
• Claims processing automation

Headquarters

HQ city

New York

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Software

Cost components

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

Revenue model

1. 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

Core 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

Named customers4 records

Segments1 record

Ideal customer profiles1 record

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability6 records

Feature5 records

Partnerships

Four partnerships are on record, tiered core and minor.

• National Alliance for Care at HomecoreStrategic or Co-development Partner · 3 November 2025Partnership 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 FloridacoreStrategic or Co-development Partner · 4 August 2025Partnership 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 AssociationcoreStrategic or Co-development Partner · 9 July 2025Partnership 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.
• AxxessminorStrategic or Co-development PartnerClaimHealth 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

Direct 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

• LinkedInlinkedin.com/company/claimhealth
• Xx.com/claimhealth

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 records

Funding overview

Funding rounds2 records

Investors4 records

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 Claim Health