ClaimAid Consulting

What ClaimAid Consulting does

ClaimAid Consulting Corporation is a privately held Indianapolis healthcare services company founded in 1989. It helps hospitals and healthcare facilities screen and enroll patients in Medicaid, Marketplace, and other assistance programs; recover self-pay balances before collection-agency escalation; and pursue final payment or valid denial on claims. It also serves K-12 school districts with Medicaid billing for eligible non-educational services for students with Individualized Education Programs and serves employers through BeWise, which helps part-time employees determine eligibility for subsidized coverage.

The operating layer combines on-site certified Patient Resource Advocates with web-based client portals, including IMED and ClaimAid Direct, for school-based Medicaid documentation and data submission. ClaimAid also states that it licenses staff as Navigators for Medicaid and Marketplace enrollment. The supplied technology evidence shows workflow and documentation systems, but no machine-learning model, AI training pipeline, or disclosed data flywheel.

ClaimAid goes to market through direct enterprise field sales, personalized meetings, and integrated on-site service teams. Its revenue mechanics include service fees tied to successful enrollment and reimbursement, contingency or per-claim charges, school reimbursement percentages or fixed service fees, and employer per-employee or subscription fees. Services are customized and quote-based, and no public pricing tiers are disclosed.

Name

ClaimAid Consulting

Legal name

ClaimAid Consulting Corporation

Website

https://claimaid.com

Company type

Private

Founded year

1989

Operating status

Operating

Headcount range

101–250 employees

Short description

Indianapolis-based ClaimAid Consulting provides healthcare eligibility, enrollment, self-pay, and claims-resolution services to hospitals, school districts, and employers through on-site advocates and web-based billing workflows, helping clients improve coverage access and reimbursement.

Ownership category

akta.pro rank

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Health and Welfare Funds (52512)

SIC

Hospital & Medical Service Plans (6324), Insurance Agents, Brokers & Service (6411)

akta.pro primary industry

Healthcare-Linked Social Benefits Administration (e.g., Medicaid/Means-Tested Health Coverage) (BPAIAKAH)

akta.pro secondary industries

Healthcare Billing & Patient Payments Presentment (FSAMAJAH), Level-Funded Group Health Plans (FSAIAFAC)

Keywords

• Medicaid eligibility services
• Patient advocacy enrollment
• School-based Medicaid billing
• Healthcare claims resolution
• Self-pay early-out collections

Headquarters

HQ city

Indianapolis

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Eligibility Services Revenue: ClaimAid provides eligibility determination and enrollment services to hospitals and healthcare facilities. Advocates are placed on-site to help patients screen for and enroll in Medicaid, Marketplace, and other public assistance programs. Revenue is generated through service fees tied to successful enrollments and reimbursements facilitated for client facilities.
2. School-Based Medicaid Billing Services: Services optimizing reimbursements for school districts providing Medicaid-approved non-educational services to students with IEPs. Includes Medicaid enrollment/re-enrollment, billing submission, follow-ups, and audit assistance. Revenue derived from a percentage of reimbursements generated or fixed service fees.
3. BeWise Employee Solutions: Customized solutions helping employers provide part-time employees with healthcare coverage eligibility assistance. Revenue model involves per-employee or subscription-based fees for enrollment assistance and ongoing support services.
4. Claims Resolution Services: Claims resolution and follow-up services for hospitals and healthcare providers to bring claims to final payment or valid denial. Revenue generated through contingency fees or per-claim service charges.

Go-to-market motion1 record

Distribution channels4 records

Marketing channels5 records

Core offering

ClaimAid Consulting provides outsourced healthcare eligibility, enrollment, and claims resolution services, embedding certified Patient Resource Advocates on-site at hospitals and healthcare facilities to screen and enroll patients in Medicaid, Marketplace, SSI/SSDI, and other coverage programs. The company also performs school-based Medicaid billing for K-12 districts serving students with IEPs and offers an employer program (BeWise) to help part-time workers obtain subsidized coverage. Revenue is generated through service fees tied to successful enrollments and reimbursements facilitated for client organizations.

Product overview

ClaimAid Consulting operates as a healthcare coverage eligibility and billing services company offering a unified platform of services across three market segments: Hospitals & Healthcare Facilities, Schools, and Employers. The core product portfolio consists of five main service offerings: Eligibility Services (patient advocacy for healthcare coverage enrollment), Self-Pay Solutions (early-out patient balance recovery), Claims Resolution (medical insurance claim resolution), School-Based Medicaid Billing (Medicaid reimbursement optimization for schools), and BeWise (employer-sponsored healthcare coverage assistance for part-time employees). These services work together to help organizations maximize Medicaid reimbursements and help patients/employees gain access to subsidized healthcare coverage.

Differentiator

Problem solved

Functional benefit

Brands

• BeWise: A solution for employers to help part-time employees determine eligibility in Medicaid, Expanded Medicaid, ACA/Marketplace, and Social Security Income/Disability.

Quantifiable outcome

• One rural hospital client achieved top 5% ranking among 3,000+ competing hospitals after implementing ClaimAid eligibility services

Named customers4 records

Segments3 records

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Partnerships

One partnership is on record.

• Iowa Association of School Boards (IASB)minorStrategic or Co-development Partner · 1 January 2022ClaimAid co-sponsors the Star Student Scholarship and Special Education Teacher Scholarship with IASB, a nonprofit organization representing Iowa's 327 public school districts, nine area education agencies, and 15 community colleges. This partnership supports educational goals while building brand awareness in the K-12 education sector.

Scale indicators4 records

Recent moves3 records

Expansion highlights5 records

Direct peers

• MedData (Optum): MedData, now part of Optum/UnitedHealth Group, provides hospital patient eligibility, registration, and self-pay services nationally. Highly comparable to ClaimAid's Eligibility and Self-Pay Solutions product lines, but at national scale.
• BESLER: BESLER is a healthcare revenue cycle consulting and services firm specializing in eligibility, reimbursement, and claims support for hospitals. Closely comparable niche in hospital revenue cycle optimization.
• Public Consulting Group: PCG is one of the largest U.S. providers of school-based Medicaid billing services, directly comparable to ClaimAid's School-Based Medicaid Billing business. Operates at significantly larger scale across many states.
• FinThrive: FinThrive (formerly nThrive) is an end-to-end healthcare revenue cycle management platform that includes eligibility, claims resolution, and patient engagement capabilities that overlap with ClaimAid's hospital product lines.
• Parallon: Parallon, an HCA Healthcare subsidiary, provides hospital business operations including patient access, eligibility, and revenue cycle services. Directly comparable to ClaimAid's hospital eligibility and claims resolution offerings.
• The Outsource Group: The Outsource Group provides hospital self-pay, eligibility, and early-out collections services. Highly comparable to ClaimAid's Self-Pay Solutions and Eligibility product lines.
• MiraMed Global Services: MiraMed provides outsourced healthcare revenue cycle services including eligibility verification, billing, and claims resolution for hospitals and physician groups. Closely comparable in services and customer base.
• Health Management Associates: HMA (recently acquired by Lewin Group/Optum) provides healthcare eligibility consulting and government health program services, with overlap on Medicaid eligibility and enrollment work similar to ClaimAid.

Broad incumbents

• Guidehouse: Guidehouse is a large management consulting firm with a healthcare segment providing eligibility, revenue cycle, and public-sector health consulting. Broader portfolio than ClaimAid but overlaps on hospital and state Medicaid advisory work.

Emerging players

• Ontario Systems: Ontario Systems provides healthcare revenue cycle and patient accounting software, including self-pay and eligibility workflows. Adjacent technology provider to ClaimAid's self-pay and claims operations.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat4 records

Key risks6 records

Key highlights6 records

Customer concentration

• Xx.com/claimaid
• YouTubeyoutube.com/channel/UCVfBeI6aaeWSkZNt03efw8A
• Facebookfacebook.com/ClaimAid
• LinkedInlinkedin.com/company/claimaid

Revenue estimate

Valuation estimate

Number of profiles

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 ClaimAid Consulting