Innovative Healthware Services

What Innovative Healthware Services does

Innovative Healthware Services, Inc. (DBA ClaimsBridge) is a privately held healthcare technology company founded in 2003 and headquartered in Arnold, Maryland. The company operates a unified, end-to-end pre-adjudication claims ecosystem composed of two core product lines, ClaimsBridge Connect and ClaimsBridge Navigator, both powered by the proprietary ClaimsBridge Celerity rules-based pricing engine. Connect handles claims acquisition, mailroom processing, paper-to-EDI conversion, scrubbing, intelligent routing, repricing, and X12 270/271 eligibility verification, while Navigator provides network access (traditional PPO, high-performance, narrow, and supplemental), custom network design, tiered Pricing Solutions (Essential, Premier, Premier Select), and Out of Network Services including No Surprises Act compliance and QPA/IDR support. The platform is cloud-hosted on Microsoft Azure and is integrated with over two dozen claims adjudication platforms and over 120 channel partners including brokers, benefit consultants, stop-loss carriers, TPAs, and healthcare networks.

The company serves four primary customer segments: third-party administrators (TPAs), self-funded employers, PPOs and health plan administrators, and healthcare providers. Customer count has grown from approximately 20 to over 80 under CEO Kevin Gibson, and the company has processed 100 million claims cumulatively. Revenue is generated through a mix of transaction/claims processing fees, recurring managed services and platform subscriptions, and implementation or professional services engagements, with flexible pricing structures including percentage-of-savings or flat per-employee-per-month (PEPM) contracts, multi-year terms, and fee-and-savings guarantees for out-of-network services.

ClaimsBridge is bootstrapped with no external venture or private equity funding, holds SOC 2 Type 2 certification, and aligns its practices with HIPAA. Strategic priorities evident in the data include deepening the WLT Software integration announced in June 2025, expanding the Navigator tiered pricing product set, and continuing to grow the partner-led distribution channel to capture share in the self-funded employer market where administrative complexity accounts for an estimated $496 billion in annual U.S. healthcare spend.

Name

Innovative Healthware Services

Legal name

Innovative Healthware Services, Inc.

Website

http://www.claimsbridge.com/

Company type

Private

Founded year

2010

Operating status

Operating

Headcount range

11–50 employees

Short description

Innovative Healthware Services (ClaimsBridge) is a Maryland-based healthcare technology company that provides a unified pre-adjudication claims ecosystem, combining the proprietary Celerity pricing engine with network access and reference-based pricing to serve TPAs, self-funded employers, PPOs, and healthcare providers.

Ownership category

akta.pro rank

Product category

Healthcare Claims Processing Software

NAICS

Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (518), Computer Systems Design and Related Services (54151), Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (51821)

SIC

Services-Computer Programming, Data Processing, Etc. (7370), Services-Computer Programming Services (7371)

akta.pro primary industry

API Management & Developer Portals for Health Data (HLACABAD)

akta.pro secondary industry

Application & API Security for Digital Health (WAF/RASP/API gateways) (HLACAJAH)

Keywords

• Healthcare claims processing
• Medical claims repricing
• Reference-based pricing
• Network access solutions
• Eligibility verification services

Headquarters

HQ city

Arnold

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Software

Cost components

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

Revenue model

1. Transaction/Claims Processing Fees: Claims processing fees likely based on transaction volume or a percentage of savings achieved. Out-of-network services pricing can be based on percentage of savings or flat PEPM (per employee per month) models.
2. Subscription/Managed Services: Ongoing managed services fees for the ClaimsBridge Connect and Navigator platforms, providing unified pre-adjudication workflow and network/pricing solutions.
3. Implementation and Professional Services: Implementation services for new clients including claims file analysis, 2-way connectivity setup, pricing parameter configuration, and employer group-level product configuration.

Pricing tiers

Go-to-market motion2 records

Distribution channels2 records

Marketing channels5 records

Core offering

Innovative Healthware Services (DBA ClaimsBridge) operates a unified, end-to-end pre-adjudication healthcare claims ecosystem delivered through two core product lines. ClaimsBridge Connect provides claims processing infrastructure (acquisition, routing, EDI conversion, scrubbing, repricing, eligibility verification) powered by the proprietary ClaimsBridge Celerity Engine, while ClaimsBridge Navigator delivers network access, network build, configurable reference-based pricing solutions, and out-of-network cost containment services. The platform is sold primarily to TPAs, self-funded employers, PPOs, and health plans across the United States.

Product overview

ClaimsBridge is a healthcare technology company offering a unified, end-to-end pre-adjudication claims ecosystem through two core product lines: ClaimsBridge Connect and ClaimsBridge Navigator. The platform is powered by the ClaimsBridge Celerity Engine, a rules-based pricing engine that automates claims acquisition, routing, scrubbing, repricing, and eligibility verification. ClaimsBridge Navigator provides network access solutions (traditional PPO, high-performance networks, supplemental networks), network build services, and configurable pricing solutions across Essential, Premier, and Premier Select tiers supporting Medicare-based pricing, Reference-Based Pricing (RBP), and custom contract methodologies. The platform serves third-party administrators, health plans, self-funded employers, and healthcare networks, processing over 100 million claims with direct connectivity to over 120 partners.

Differentiator

Problem solved

Functional benefit

Brands

• ClaimsBridge Connect: Claims processing infrastructure powered by ClaimsBridge Celerity Engine. Includes claims acquisition, mailroom, routing, EDI, contract/fee schedule management, and pricing transparency tools.
• ClaimsBridge Navigator
• ClaimsBridge Celerity Engine

Products and services

• ClaimsBridge Connect Cloud-based claims processing infrastructure powered by the proprietary ClaimsBridge Celerity Engine, providing claims acquisition, paper-to-EDI conversion, automated scrubbing, intelligent routing, repricing, and eligibility verification (X12 270/271) for TPAs, health plans, and self-funded employers.
• ClaimsBridge Navigator Suite of high-performance network and reference-based pricing solutions including Network Access, Network Build, configurable Pricing Solutions (Essential, Premier, Premier Select tiers) for Reference-Based Pricing (RBP), Medicare-based pricing, and Out of Network Services with No Surprises Act compliance support.

Quantifiable outcome

• 20-40% improvement in clean claim rates through advanced claim scrubbing and pre-submission standards
• +4 more outcomes

Named customers2 records

Segments4 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration1 record

AI capability3 records

Feature5 records

Partnerships

Four partnerships are on record, tiered core and strategic.

• WLT SoftwarecoreTechnology or Integration · 10 June 2025Strategic partnership announced June 10, 2025 combining ClaimsBridge's high-performance claims pricing solutions with WLT's robust benefits administration platforms (MediClaims, MediConnX, CompClaims). The integration creates a seamless user experience covering everything from claims intake to reimbursement within a unified system, providing administrators and third-party payers with powerful adjudication tools, intelligent pricing engines, and automated claims routing.
• The Loomis CompanystrategicImplementation/ SI/ Consulting Partner · 1 January 2021The Loomis Company, a TPA subcontracted through Bright Health Group, partnered with ClaimsBridge for pricing claims services. Jason Werner, CIO, personally handled the coding and implementation, representing a significant revenue boost and technology partnership award.
• AequumstrategicStrategic or Co-development Partner · 1 January 2019Partnership spanning over 5 years providing legal advocacy services to ClaimsBridge clients. Aequum defends balance bills for plan participants, provides patient advocacy, and assists with No Surprises Act IDR (independent dispute resolution) claims. The partnership reduces healthcare costs and brings innovative health plans to self-funded employers.
• Quality Care PartnerscoreStrategic or Co-development Partner · 1 January 2012Partnership since 2012 where ClaimsBridge serves as the data integrator and aggregator for Quality Care Partners' statewide Ohio preferred provider network, managing all repricing for provider contracts using true Medicare-based methodology. ClaimsBridge enables QCP to apply current CMS table rates specific to each provider, creating a vertically integrated solution with less than one-day turnaround on electronic claims.

Scale indicators7 records

Recent moves7 records

Expansion highlights5 records

Broad incumbents

• Change Healthcare (Optum): Change Healthcare (now part of Optum) is the largest U.S. healthcare clearinghouse and revenue cycle platform, offering EDI, claims processing, and pricing at massive scale, representing the broad incumbent that ClaimsBridge competes against for enterprise TPA and payer workloads.

Emerging players

• PNT Data: PNT Data delivers healthcare data integration, EDI, and claims workflow tools to payers and providers, positioned as a smaller emerging alternative to ClaimsBridge in pre-adjudication infrastructure.

Direct peers

• Lyric (formerly ClaimsXten): Lyric (ClaimsXten) provides claims editing, payment integrity, and pricing logic to payers and TPAs, directly competing with ClaimsBridge Celerity Engine's scrubbing and repricing functionality.
• Availity: Availity operates a large-scale healthcare information network connecting providers, health plans, and TPAs for eligibility, claims, and clinical data exchange, sharing ClaimsBridge's interoperability and EDI-centric architecture and TPA customer base.
• Zelis: Zelis is a healthcare cost management platform offering claims cost containment, network access, repricing, and payment integrity solutions to payers, TPAs, and self-funded employers, directly overlapping ClaimsBridge's Navigator and Connect product lines.
• Edifecs: Edifecs specializes in healthcare data integration, EDI, and interoperability between payers, providers, and TPAs, competing with ClaimsBridge Connect's EDI processing, scrubbing, and routing capabilities.
• Quadax: Quadax provides healthcare EDI, claims management, and revenue cycle services to hospitals, payers, and TPAs, overlapping with ClaimsBridge Connect's claims processing and EDI conversion capabilities.
• MultiPlan: MultiPlan provides PPO network access, cost containment, and claims pricing services to insurers, TPAs, and self-funded employers, closely paralleling ClaimsBridge's reference-based pricing and Navigator Network Access offerings.
• The Phia Group: The Phia Group delivers claims cost containment, repricing, and network solutions targeted at self-funded employer plans and TPAs, closely matching ClaimsBridge Navigator's pricing and out-of-network service portfolio.

Others

• Datavant: Datavant is a health data exchange and connectivity platform focused on de-identified clinical data routing, adjacent to ClaimsBridge's interoperability focus but operating in a different data layer (clinical vs. administrative claims).

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks5 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/innovativehealthware

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles9 records

Funding overview

Funding rounds1 record

Investors1 record

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A1 record

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Innovative Healthware Services