What maxRTE does

maxRTE (legal entity HFMI LLC) is a privately held U.S. healthcare technology company headquartered in Burnsville, Minnesota, that has operated for more than 20 years selling software to healthcare providers for revenue cycle management. The company's product suite centers on three offerings: Insurance Discovery, which uses a proprietary algorithm to identify previously unknown medical coverage (commercial, government, exchange, Medicare Advantage via MBI lookup, Medicaid, Tricare, workers' compensation, TPAs, and Cobra) for self-pay patients and reportedly identifies billable coverage on up to 25% of self-pay accounts; Real-Time Eligibility, which delivers single-click insurance verification at point of registration; and Prior Authorizations (with an integrated Notice of Admission module that operates natively inside Epic). The technology stack is API-first and integrates with the four dominant U.S. hospital EHRs (Epic, Oracle, Athenahealth, Meditech) via HL7, FHIR, X12, SFTP, and API protocols, with a stated 2-week API implementation window.

The company sells primarily through enterprise field sales targeting large hospital systems and integrated delivery networks, supported by inside sales, free test file processing, and a self-service web portal. Pricing is a flat monthly subscription with unlimited transactions — all EHR integrations, payer connections, and feature enhancements are bundled into the recurring fee, eliminating per-transaction or contingency-based charges. Customers span enterprise health systems (Baylor Scott & White Health, Banner Health, Premier Health, North Mississippi Health Services, North Georgia Hospital System, HealthPartners, Sarasota Memorial, Regions Hospital, Cape Fear Valley), urgent care (FastMed), and community health centers. Reported customer outcomes include 50x-80x+ ROI, with named accounts recovering $2.9M-$3.47M in the first months of deployment.

maxRTE holds CAQH Core Eligibility and Benefits certification, SOC 2 Type 2 compliance, and DirectTrust EHNAC HNAP-EHN accreditation. The company positions itself against contingency-fee insurance discovery vendors on cost predictability and against comprehensive RCM suites on price-point focus. AI/ML claims are concentrated in the Prior Authorizations product (described as using "advanced machine learning algorithms") and in pre-registration insurance discovery workflows, though no named models, research publications, or technical disclosures support these claims. The firm is privately held with no disclosed external funding and a stated headcount of 1-10 employees, which is inconsistent with its enterprise customer roster and likely reflects a lean internal team supplemented by outsourced operations.

Name

maxRTE

Legal name

HFMI LLC

Website

https://maxrte.com

Company type

Private

Operating status

Operating

Headcount range

1–10 employees

Short description

maxRTE (HFMI LLC) is a privately held U.S. healthcare technology vendor selling insurance discovery, real-time eligibility, and prior authorization software to hospitals and health systems via flat-fee subscriptions and native EHR integrations with Epic, Oracle, Athenahealth, and Meditech.

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

Services-Computer Programming, Data Processing, Etc. (7370)

akta.pro primary industry

Eligibility & Benefits Verification (HLACACAD)

akta.pro secondary industries

Claims Management, Scrubbing & Clearinghouse (HLACACAB), Interoperability Standards, Profiles & Implementation (HL7/FHIR/IHE) (HLACABAA)

Keywords

• Healthcare revenue cycle
• Insurance discovery software
• Eligibility verification
• Prior authorization automation
• Healthcare eligibility software

Headquarters

HQ city

Burnsville

HQ country

United States

HQ region

North America

Markets served

GTM type

B2B

Offering type

Software

Cost components

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

Revenue model

1. Subscription Licensing (Flat Monthly Fee): Flat monthly subscription pricing with unlimited transactions, including both batch and single-file processing options. All EHR integrations, payer connections, and feature enhancements are covered under the agreement.
2. Value-Driven Insurance Discovery: Pricing model designed to maximize ROI for healthcare providers seeking cost-effective solutions. The transparent flat-rate pricing eliminates unpredictability of contingency fees, providing cost certainty and scalable growth.

Pricing tiers

Go-to-market motion3 records

Distribution channels4 records

Marketing channels7 records

Core offering

maxRTE provides a healthcare revenue cycle management software suite comprising Insurance Discovery, Real-Time Eligibility verification, and Prior Authorization automation (including Notice of Admission processing). Its proprietary algorithm uncovers hidden medical coverage for self-pay patients — commercial, government, and exchange plans — and identifies coverage for up to 25% of self-pay populations, helping hospitals recover uncompensated care. The platform integrates directly with major EHRs (Epic, Oracle, Athenahealth, Meditech) via API, HL7, FHIR, X12, and SFTP, supporting both batch and single-file real-time processing under a flat monthly subscription.

Product overview

maxRTE offers a unified revenue cycle management platform consisting of three core products: Insurance Discovery, Real-Time Eligibility, and Prior Authorizations (which includes Notice of Admission automation). Insurance Discovery uncovers hidden coverage for self-pay patients, Real-Time Eligibility provides instant insurance verification at point of registration, and Prior Authorizations automates the submission and tracking of prior authorizations with NOA processing integrated into Epic. The platform uses proprietary algorithms, offers flat monthly subscription pricing with unlimited transactions, and supports both batch and real-time API integration with major EHR systems.

Differentiator

Problem solved

Functional benefit

Products and services

• Insurance Discovery Proprietary insurance discovery software that uncovers hidden medical coverage for self-pay patients including commercial, government, and exchange plans. The product uses a proprietary algorithm to identify coverage for up to 25% of self-pay patients across Medicare (via MBI Lookup), Medicaid, Tricare, workers compensation, TPAs, and Cobra, helping hospitals recover uncompensated care under a flat monthly subscription with both batch and single-file processing.
• Real-Time Eligibility Real-time insurance eligibility verification solution that provides instant insurance verification at the point of registration with a single click. Offers flat-rate all-in pricing for verifying patient coverage, benefits, and patient responsibility estimates, and is designed for value-driven healthcare organizations seeking to avoid denials, payment delays, and claim rejections.
• Prior Authorizations Prior authorization automation solution that automates the submission, tracking, and status updates of prior authorizations. Built-in intelligence identifies which procedures require authorization, with real-time status checks and alerts monitoring payer portals and a centralized dashboard providing full visibility across payers. Includes Notice of Admission (NOA) automation integrated inside Epic.

Quantifiable outcome

• Insurance coverage identified for up to 25% of self-pay patients
• +9 more outcomes

Named customers15 records

Segments4 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration4 records

AI capability5 records

Feature6 records

Partnerships

Four partnerships are on record, tiered core.

• Epic Systems CorporationcoreTechnology or IntegrationIntegration partnership with Epic Systems Corporation for seamless connectivity within Epic's EHR environment. maxRTE's solutions integrate with Epic through SFTP and API connections, with solutions visible directly within Epic workflows. The company participates in Epic's App Orchard marketplace and App Exchange community.
• OraclecoreTechnology or IntegrationIntegration partnership with Oracle for EHR connectivity and data exchange. maxRTE supports Oracle's healthcare platform integration standards.
• AthenahealthcoreTechnology or IntegrationIntegration partnership with Athenahealth enabling seamless connectivity with Athenahealth's cloud-based EHR and practice management solutions.
• MeditechcoreTechnology or IntegrationIntegration partnership with Meditech for EHR connectivity. maxRTE supports Meditech's integration standards for healthcare data exchange.

Scale indicators11 records

Recent moves5 records

Expansion highlights6 records

Direct peers

• Experian Health: Major competitor in healthcare insurance discovery and real-time eligibility verification for hospitals and providers. Directly comparable product overlap with maxRTE's core Insurance Discovery and Real-Time Eligibility offerings, often used in the same RFPs.
• Availity: Operates one of the largest healthcare eligibility and prior-authorization networks in the U.S. Directly competes on the same payer-data access and provider workflow that maxRTE monetizes.
• Waystar: Publicly recognized RCM platform with strong eligibility verification and prior-authorization modules serving hospitals and health systems. Overlaps with maxRTE on real-time eligibility and the NOA/prior-auth workflow inside EHRs.
• Infinx: Healthcare revenue cycle vendor combining patient access (eligibility, insurance discovery, prior authorization) with AI-driven automation. Closest like-for-like peer to maxRTE's three-product portfolio.
• Myndshft: Specializes in prior-authorization automation using AI for hospital and specialty providers. Directly comparable to maxRTE's Prior Authorizations product line.
• AKASA: AI-driven prior authorization and revenue cycle automation vendor serving large health systems. Competes for the same ML-enabled prior-auth wallet share that maxRTE targets.

Broad incumbents

• Optum (Change Healthcare): Incumbent at scale across eligibility, claims, and RCM via the Change Healthcare acquisition. Bundles insurance verification and discovery within a much broader portfolio that competes with maxRTE on enterprise deals.
• R1 RCM: Large-scale RCM services and technology provider to hospitals, with eligibility and patient-access capabilities included in its end-to-end platform. Competes at the system-of-record level rather than point-solution.

Emerging players

• Phreesia: Patient intake and eligibility-verification platform with growing provider-payer data capabilities. Adjacent competitor in the patient-access workflow that overlaps with maxRTE's pre-registration insurance discovery.
• Cotiviti: Healthcare payment-accuracy and eligibility/subrogation vendor serving payers and providers. Comparable to maxRTE in coverage-discovery and coordination-of-benefits capabilities, especially around hidden-coverage recovery.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks5 records

Key highlights6 records

Customer concentration

• Xx.com/maxRTE
• LinkedInlinkedin.com/company/maxrte

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles4 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 maxRTE