Medclaim

What Medclaim does

MedClaim, Inc. is a privately held medical billing and revenue cycle management (RCM) company founded in 1996 by CEO Ginger Langan (Certified Professional Coder) and CFO Sabra McGibbon (CPA, inactive), headquartered in Goleta, California. The company provides full-service medical billing and accounts receivable management to physician practices across 18 medical specialties, including ENT, General Surgery, OB/GYN, Urology, Cardiology, and Neurology. Its core technology is a web-based, HIPAA-compliant billing and practice management platform featuring claims scrubbing, coding edits, integrated electronic scheduling, electronic document storage, and flexible EMR integration that allows clients to use their EMR of choice while MedClaim handles billing.

The business model is managed services: MedClaim charges service fees for end-to-end billing operations including claims submission, coding, denial management, patient collections, and credentialing via CAQH integration. Pricing is quote-based with no publicly disclosed rate structure. The company employs AAPC-certified coders and bilingual patient communication staff, and delivers services through assigned Account Representatives with live phone contact during business hours — explicitly avoiding phone trees. Go-to-market is sales-led through direct Account Representative outreach, supplemented by word-of-mouth referrals from satisfied physicians.

The company is bootstrapped and founder-led, with no external institutional funding, no parent company, and no M&A activity. Its operating geography is concentrated in California, with a particular density in the Santa Barbara region. Long-tenured client relationships (12+ years for some surgical groups) indicate strong retention, but the company shows no documented geographic expansion, hiring signals, or new product launches in the available data, suggesting a stable, regionally-focused operation. There is no evidence of AI/ML capabilities, proprietary models, or modern technology differentiation beyond standard RCM software features.

Name

Medclaim

Legal name

MedClaim, Inc.

Website

https://medclaimca.com

Company type

Private

Founded year

1996

Operating status

Operating

Headcount range

1–10 employees

Short description

MedClaim, Inc. is a privately held, founder-led medical billing and revenue cycle management company founded in 1996, serving physician practices across 18 specialties in California through a web-based, HIPAA-compliant platform with assigned Account Representatives, AAPC-certified coders, and direct, referral-driven sales.

Ownership category

akta.pro rank

Product category

Medical Billing Services

NAICS

Offices of Physicians (62111), Offices of Physicians (except Mental Health Specialists) (621111)

SIC

Services-Health Services (8000), Services-Prepackaged Software (7372)

akta.pro primary industry

Claims Management, Scrubbing & Clearinghouse (HLACACAB)

akta.pro secondary industry

Medical Coding, Billing & Clinical Documentation Support (BPAAAFAD)

Keywords

• Medical billing services
• Revenue cycle management
• Claims processing
• Medical coding services
• Practice management services

Headquarters

HQ city

Goleta

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Medical Billing and Accounts Receivable Management Services: Full-service billing for physicians including claims submission, coding, denial management, patient collections, and financial reporting. Revenue derived from service fees for managing physician billing operations.

Go-to-market motion1 record

Distribution channels1 record

Marketing channels2 records

Core offering

MedClaim provides outsourced medical billing and accounts receivable management services to physician practices across multiple specialties. Services include claims submission with scrubbing and coding edits, AAPC-certified coding from operative reports or medical notes, denial and underpayment tracking and appeals, bilingual patient collections and payment-plan setup, provider credentialing via CAQH, optional insurance contracting consultation, customized monthly financial reports, and new-practice setup support. Service delivery runs on a web-based, HIPAA-compliant platform with 24/7 account access and a dedicated Account Representative.

Product overview

MedClaim is a single unified medical billing and practice management service offering rather than a modular platform. The core offering is Medical Billing and Accounts Receivable Management, supported by integrated add-on modules including Medical Coding Services (using AAPC-certified coders), Electronic Scheduling, Electronic Records Storage (HIPAA-compliant), Insurance Contracting Services, Credentialing Services (via CAQH), and Customized Financial Reports. New Practice Setup Support provides comprehensive onboarding for physicians starting new practices. All services are delivered through web-based software with 24/7 account access, a dedicated account representative, and bilingual patient communication support.

Differentiator

Problem solved

Functional benefit

Products and services

• Medical Billing Services Full-service medical billing for physician practices including charges entry, claims submission, claims scrubbing and coding edits, electronic submission, and clean first-pass claim processing to maximize cash flow.
• Accounts Receivable Management Comprehensive management of outstanding receivables including tracking denials and underpayments, explanation-of-benefits review, appeals, and patient collections supported by bilingual staff for payment plans.
• Medical Coding Services Coding and auditing services performed by AAPC-certified coders using operative reports or medical notes provided by the physician.
• Insurance Contracting Services Optional consultation on insurance contracting for physician practices, including payer-mix analysis and resolution of insurance company issues.
• Credentialing Services Provider credentialing services for physicians, leveraging CAQH (Council for Affordable Quality Healthcare) when supported by participating insurance companies.
• New Practice Setup Support Comprehensive business support for physicians launching new practices, including credentialing, insurance contracts, office procedures, staff training, scheduling software setup, and workflow design.
• Customized Financial Reports Monthly customized financial and practice management reports covering accounts receivable aging, procedure productivity, and insurance company payment reports.

Quantifiable outcome

• Collected thousands of dollars from old uncollected charges for transitioning clients
• +1 more outcomes

Named customers5 records

Segments3 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration2 records

Feature5 records

Partnerships

One partnership is on record.

• CAQHcoreTechnology or IntegrationMedClaim utilizes CAQH (Council for Affordable Quality Healthcare) for credentialing services when insurance companies support the platform. CAQH provides a standardized provider credentialing system that MedClaim leverages on behalf of clients to streamline the insurance credentialing process.

Scale indicators3 records

Recent moves6 records

Expansion highlights4 records

Direct peers

• DrChrono (EverHealth): DrChrono (now part of EverHealth) provides EHR, practice management, and medical billing/RCM services targeted at small and specialty physician practices. Directly competes with MedClaim in the SMB physician billing segment with cloud-based software plus managed services.
• AdvancedMD: AdvancedMD provides cloud-based medical billing, practice management, and EHR software for independent physician practices. Directly comparable to MedClaim's offering of full-service billing and practice management tools to SMB physician groups.
• Practice Fusion: Practice Fusion offers a cloud-based EHR with integrated billing and RCM capabilities for independent physician practices. Directly comparable to MedClaim in serving SMB physician offices with claims management and billing workflows.
• CureMD: CureMD provides integrated EHR, practice management, and medical billing/RCM services for physician practices and specialty groups. Comparable to MedClaim in offering claims scrubbing, coding, denial management, and full-service billing to physician offices.
• Kareo (Tebra): Tebra (formed from the merger of Kareo and PatientPop) provides cloud-based medical billing, RCM, and practice management software to small and mid-sized physician practices. Direct competitor to MedClaim in serving independent physician offices with managed billing services and integrated software.

Emerging players

• RXNT: RXNT provides cloud-based medical billing, EHR, and practice management software aimed at small to mid-sized physician practices. Comparable to MedClaim in delivering claims management and billing services to ambulatory physician groups, typically as a more technology-led, lower-touch alternative.

Broad incumbents

• athenahealth: athenahealth is a large, established healthcare IT vendor offering EHR, practice management, and revenue cycle management services to physician practices and health systems. Competes with MedClaim across the same RCM and medical billing category but at much greater scale and broader scope.
• Greenway Health: Greenway Health offers EHR, practice management, and revenue cycle management software for ambulatory practices. Comparable to MedClaim in delivering billing and claims management to physician offices, with broader specialty and enterprise reach.
• eClinicalWorks: eClinicalWorks is a major ambulatory EHR and practice management vendor with integrated RCM and medical billing services. Comparable to MedClaim in serving physician offices with claims management and billing tools, but as a much larger platform player.
• NextGen Healthcare: NextGen provides EHR, practice management, and revenue cycle management solutions primarily to ambulatory specialty practices. Overlaps with MedClaim's specialty practice focus across 18 specialties, but at significantly larger enterprise scale.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights6 records

Customer concentration

• LinkedInlinkedin.com/company/medclaim-inc

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 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 Medclaim