State Collection Service

What State Collection Service does

State Collection Service, Inc. is a privately held, third-generation family-owned healthcare receivables management company founded in 1949 in Madison, Wisconsin. The company provides end-to-end revenue cycle services to hospitals, health systems, and physician groups, with core offerings including Early Out Business Office (EBO) self-pay follow-up, Bad Debt Placement collections, Insurance Follow-Up and Denials Management, and Pre-Service Financial Clearance. State serves 540+ hospitals and physician groups, processing $9.7 billion in annual placements ($6.1 billion in self-pay and $3.6 billion in bad debt) and employs 700+ people across three U.S. office locations.

The company's technology platform, branded as State AI, integrates AI-driven workflows, real-time speech analytics covering 100% of calls, omnichannel patient communication (IVA, email, text, portal, call center), gamification, and EHR integration with all major systems. In 2025, State launched Echo, an agentic AI platform purpose-built for insurance follow-up that claims 400% productivity gains and 99.9% accuracy through continuous learning. State holds the #1 Best in KLAS ranking for Debt Collection Services (90.7 score), has won Best Places to Work in Collections for 10 consecutive years, and is HFMA Peer Reviewed.

State's revenue model is primarily transaction-fee based on contingency arrangements with healthcare providers. The company generates revenue through percentage-based fees on amounts recovered across EBO and bad debt placements, plus professional services revenue from inbound customer service call handling. Go-to-market is exclusively direct enterprise sales to large hospital systems, supplemented by thought leadership at HFMA events, hosted Healthcare Fly-Ins for policymakers, white papers, webinars, and case studies. State is led by President & CEO Tim Haag (grandson of founder Hilding Haag), CFO Kris Aeschlimann, and CIO Sameer Maini, with no private equity or institutional investment.

Name

State Collection Service

Legal name

State Collection Service, Inc.

Website

https://statecollectionservice.com

Company type

Private

Founded year

1949

Operating status

Operating

Headcount range

501–1,000 employees

Short description

State Collection Service is a third-generation, family-owned healthcare receivables management company providing Early Out, bad debt, insurance follow-up, and financial clearance services to 540+ U.S. hospitals and physician groups, processing $9.7 billion in annual placements.

Ownership category

akta.pro rank

Product category

Healthcare Receivables Management & Debt Collection Services

NAICS

Collection Agencies (561440)

SIC

Services-Consumer Credit Reporting, Collection Agencies (7320)

akta.pro primary industry

Accounts Receivable (A/R) & Collections Management (HLACACAJ)

akta.pro secondary industries

Specialty & Regulated Collections (Medical, Student Loan, Government, HOA) (BPAAAEAJ), Late-Stage / Hard Collections (Charge-Off, Litigation Prep Support) (BPAAAEAD), Early-Stage / Soft Collections (Pre-Delinquency, Reminders) (BPAAAEAC)

Keywords

• Healthcare receivables management
• Medical debt collection
• Revenue cycle services
• Insurance follow-up
• Patient billing services

Headquarters

HQ city

Madison

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Extended Business Office Services: Early out self-pay resolution services for healthcare providers. State provides follow-up services on $6.1 billion in placements annually serving over 540 hospitals and physician groups.
2. Bad Debt Collections: Bad debt collection services balancing performance with patient satisfaction. State provides bad debt services on $3.6 billion in placements annually serving over 540 hospitals and physician groups.
3. Insurance Follow-Up and Denials Management: Insurance follow-up services including late stage or low balance claim follow-up, denial management using robotic process automation and State Echo agentic AI.
4. Pre-Service Financial Clearance: Pre-service estimated patient balance verification and communication services before medical procedures.
5. Customer Service Call Handling: Inbound customer service call center services to augment healthcare provider staff or handle overflow patient calls.

Go-to-market motion2 records

Distribution channels1 record

Marketing channels8 records

Core offering

State Collection Service is a healthcare receivables management firm that delivers Early Out Business Office (self-pay follow-up), Bad Debt Placement (third-party debt collection), Insurance Follow-Up and Denials Management, and Pre-Service Financial Clearance services to hospitals, health systems, and physician groups. Its offerings combine AI-driven technology platforms with trained human representatives to recover outstanding patient balances while maintaining patient satisfaction. Annual placements handled exceed $9.7 billion across 540+ hospitals and physician groups.

Product overview

State Collection Service operates as a unified healthcare receivables management platform offering a comprehensive suite of services organized around 'The State Experience' framework. The core portfolio includes Early Out Business Office (EBO) services for self-pay follow-up, Bad Debt Placement for late-stage collections, Insurance Follow-Up and Denials Management, and Pre-Service Financial Clearance. Central to the offering is State AI—a proprietary technology platform combining AI-driven workflows, real-time speech analytics, omnichannel communication, and gamification. The flagship product launch is Echo, an agentic AI system for insurance follow-up that delivers 4x productivity gains. All services are designed to balance recovery performance with patient satisfaction, and the company serves over 500 hospitals and health systems nationwide.

Differentiator

Problem solved

Functional benefit

Brands

• Echo: State Echo is an agentic AI system specifically designed for insurance follow-up. It combines representative training and judgment with the precision of AI, providing 4x productivity gains and up to 99.9% accuracy. The platform includes automated underpayment detection and proactive revenue cycle improvement reporting.

Products and services

• Early Out Business Office (EBO) Self-pay follow-up services for early-stage patient accounts, combining AI with knowledgeable, dedicated staff to resolve outstanding receivables while maintaining high customer service and patient satisfaction ratings. Targeted at hospitals, health systems, and physician groups with annual self-pay placements of $6.1 billion.
• Bad Debt Placement Bad debt collections service balancing recovery performance with patient satisfaction, supporting hospitals, health systems, and physician groups. Handles $3.6 billion in annual bad debt placements across more than 500 hospitals and 80+ physician groups.
• Insurance Follow-Up and Denials Management Insurance claim follow-up and denials management solution typically for late-stage or low-balance claims, using a technology platform for enhanced workflows and robotic process automation to resolve existing claims and track denials by CARC codes. Targeted at healthcare providers needing improved claim resolution.
• Pre-Service Financial Clearance Pre-service estimated patient balance verification and communication service. Pre-service representatives make courtesy calls to patients to communicate expected balances, verify supplemental insurance, and discuss payment options including financing or payment plans before medical procedures.
• Customer Service Call Handling Inbound customer service call center service to augment healthcare provider staff or handle overflow patient calls, providing professional customer service support for healthcare organizations.
• State Echo Agentic AI platform specifically designed for insurance follow-up and denials management. Combines representative expertise with AI precision to achieve 4x productivity gains and 99.9% accuracy in claim resolution. Includes automated underpayment detection by comparing denials to payer contracts, delivered as a generally available service offering to healthcare providers.
• The State Experience Integrated service approach combining AI-powered technology with human representatives to simultaneously increase healthcare recoveries and patient satisfaction scores, delivered as the overarching framework underpinning all of State Collection Service's healthcare receivables offerings.

Quantifiable outcome

• 400% productivity gains (4x) achieved in State Echo pilot programs
• +8 more outcomes

Named customers4 records

Segments3 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability7 records

Feature6 records

Partnerships

Eight partnerships are on record, tiered core and minor.

• Brownstein Hyatt Farber Schreck LLPcoreStrategic or Co-development Partner · 22 April 2026Brownstein partnered with State to host the inaugural Healthcare Fly-In meeting on April 22, 2026, bringing together healthcare executives, policymakers, and industry experts. The firm provides policy expertise and lobbying services to help State and its clients navigate legislative and regulatory landscapes affecting healthcare revenue cycle management.
• HFMA (Healthcare Financial Management Association)coreStrategic or Co-development PartnerState is committed to continuous improvement through active involvement in HFMA. Executive team members serve on HFMA task forces and hold leadership positions including President of HFMA Wisconsin Chapter and membership on the Medical Accounts Receivable Resolution Task Force.
• ACA InternationalcoreStrategic or Co-development PartnerACA International is the international association of credit and collection professionals. Tim Haag serves as President Elect of ACA International's Board. Mike Frost chairs ACA International's Federal Affairs Committee and serves on the Board of Directors. Tina Hanson is a certified ACA instructor holding Scholar and Fellows degrees.
• KLAS ResearchcoreOthersState was ranked #1 in the Best in KLAS Debt Collection Services category achieving a score of 90.7 in KLAS Research's annual assessment of software and service providers in healthcare.
• Ronald McDonald House Charities Eastern WisconsinminorOthersState's 5th Annual Golf Outing raised $44,000 for Ronald McDonald House Charities Eastern Wisconsin, supporting families with children experiencing medical issues.
• Golf Outing SponsorsminorGTM or Marketing PartnerEvent sponsors including Frost Echols LLC, Simplicated Inc., SndRight, M3 Insurance, VoApps Inc., Oak Bank, Crimson IT, Sift Healthcare, RevSpring, Clearwater, Axley Brynelson LLP, PDCM Insurance, TCN, Trust Point Inc., Anteloope, TransUnion, Hawkins Ash CPAs, RSM US LLP, and Tratta participated in State Annual Golf Outing supporting charitable cause.
• Great Lakes Collectors AssociationminorStrategic or Co-development PartnerRegional industry association. Tim Haag served as President of the Great Lakes Collectors Association in 2019.
• Best Companies GroupminorOthersAdministers the Best Places to Work in Collections program sponsored by ACA International, which State has won for 10 consecutive years.

Scale indicators10 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• TruBridge: Provides end-to-end RCM and healthcare analytics to community hospitals and physician groups. Overlapping customer base in mid-sized hospitals and similar services spanning early-out, bad debt, and insurance follow-up.
• Finvi (formerly Ontario Systems): Healthcare-focused debt collection and receivables workflow software provider. Directly comparable to State's healthcare receivables focus; State's Executive Advisor Steve Beard previously led Finvi's healthcare division.
• Avadyne Health (Firstsource Solutions): Healthcare patient access, early-out/self-pay, and business office services arm of Firstsource. Direct competitor in hospital self-pay and bad debt recovery with similar technology-enabled workflows.
• RevSpring: Patient engagement, billing, and payments technology company serving healthcare providers. Overlaps with State's omnichannel communication, patient statements, and payment plan workflows.
• CBCS (Credit Bureau Collection Services): National debt collection agency with a dedicated healthcare vertical including medical bad debt, insurance follow-up, and early-out services. Closest like-for-like third-party agency competitor to State.
• Transworld Systems: National third-party collection agency and outsourced business office services provider with healthcare and small-business collections. Competes for similar hospital and physician group placements.

Broad incumbents

• Conifer Health Solutions: Tenet Healthcare's RCM services subsidiary offering end-to-end revenue cycle, including self-pay, bad debt, and insurance follow-up for large health systems. Larger and more diversified than State but overlapping service lines.
• Optum (UnitedHealth Group): Diversified healthcare services giant with a substantial RCM and patient financial services franchise. Competes broadly for hospital collections contracts, but bundles them within a much wider product portfolio.
• R1 RCM: Large-scale RCM outsourcing and software provider to hospitals and physician groups. Overlapping collections and insurance follow-up capabilities but delivered as part of an enterprise-wide RCM engagement.
• Parallon (HCA Healthcare): HCA Healthcare's shared services arm providing RCM, including patient access and business office services, to HCA facilities and external health systems. Direct overlap in hospital collections services at greater scale.

Market position

Strengths4 records

Weaknesses5 records

Competitive moat5 records

Key risks5 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/168793789797378
• LinkedInlinkedin.com/company/state-collection-service-inc.
• Instagraminstagram.com/statecollects
• TikToktiktok.com/@statecollection?is_from_webapp=1&sender_device=pc

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles12 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 State Collection Service