Claiming.com.au

What Claiming.com.au does

Claiming.com.au (legally Sapient Pty Ltd) is a Melbourne-based B2B medical billing platform that has operated since 2005 and was formalized under its current brand around 2013. It provides an API-first service that enables Australian medical software vendors (Practice Management System providers) to submit and process Medicare, DVA (Department of Veterans' Affairs), and ECLIPSE (private health fund) claims on behalf of medical practices, with additional coverage of Overseas Visitors, OEC, Easyclaims, AIR (Australian Immunisation Register), pathology, diagnostic imaging, and specialist claim types. The platform includes both a production environment and a sandbox/test environment for integrators, maintains more than seven years of backwards compatibility, and supports payment reports and form generation as auxiliary endpoints. The company monetizes via transaction fees on claims processed and reports having processed in excess of $100,000,000 in cumulative claims.

Technically, Claiming.com.au was the first vendor to complete the full Notice of Integration against the new Medicare webservices platform in 2020 and migrated all clients from the legacy PKI-based channel to Medicare Webservices in March 2022, ahead of the industry-wide transition. It operates as a small (1-10 employee), bootstrapped, privately held company with no disclosed funding rounds. Its distribution is entirely indirect: revenue flows through third-party medical software vendors that embed the Claiming.com.au API into their own Practice Management Systems, creating an integration-led moat in the Australian GP, specialist, pathology, and diagnostic imaging billing ecosystem.

Name

Claiming.com.au

Legal name

Sapient Pty Ltd

Website

https://claiming.com.au

Company type

Private

Founded year

2005

Operating status

Operating

Headcount range

1–10 employees

Short description

Claiming.com.au is a Melbourne-based, API-first B2B medical billing platform serving Australian medical software vendors with Medicare, DVA, ECLIPSE, and related government and private health claim integrations since 2005.

Ownership category

akta.pro rank

Product category

Healthcare Billing API

NAICS

Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (518)

SIC

Services-Health Services (8000)

akta.pro primary industry

Medical Billing & Coding Automation (HLACACAA)

akta.pro secondary industry

Eligibility & Benefits Verification (HLACACAD)

Keywords

• Medical billing API
• Medicare integration
• Healthcare claims processing
• Electronic claiming software
• ECLIPSE billing integration

Headquarters

HQ city

Melbourne

HQ country

Australia

HQ region

Oceania

Offices1 record

Markets served

GTM type

B2B

Offering type

Software

Cost components

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

Revenue model

1. API Access and Transaction Fees: Software vendors and medical practices pay for access to the Claiming.com.au API to submit electronic Medicare, DVA, and ECLIPSE claims. Revenue is generated through transaction-based fees on processed claims, likely scaled by volume of claims submitted through the platform.

Go-to-market motion1 record

Distribution channels1 record

Marketing channels3 records

Core offering

Claiming.com.au provides a Medical Billing API that allows Australian medical software vendors to integrate Medicare Online, Bulk Bill, DVA, and ECLIPSE claim submissions, verifications, eligibility checks, payment reporting, and automatic form generation into their Practice Management Systems. The company also offers an Australian Immunisation Register (AIR) API extension for immunisation-related workflows. Customers access the platform via REST endpoints with oAuth 2.0 authentication across sandbox and production environments, with transaction-based fees applied to claims processed through the platform.

Product overview

Claiming.com.au offers a unified Medical Billing API platform for Australian healthcare software vendors. The core product is the Medical Billing API which provides comprehensive integration with Medicare Online, DVA (Department of Veterans Affairs), and ECLIPSE systems. The platform is structured as a modular API with distinct endpoints for: verification services (patient Medicare, Fund, DVA, and Concession verification), claims processing (Bulk Bill, Medicare Patient, DVA, ECLIPSE In-Patient Medical, Overseas, Pathology, and Diagnostic Imaging claims), Online Eligibility Checking (ECM, ECF, OEC, ECO), payment retrieval, and form generation. An extension module provides Australian Immunisation Register (AIR) functionality. The platform operates via REST API with oAuth 2.0 authentication, offering separate sandbox and production environments, and positions itself as infrastructure so medical software developers don't need to build their own Medicare integration.

Differentiator

Problem solved

Functional benefit

Products and services

• Medical Billing API A unified REST API platform enabling Australian medical software vendors to integrate Medicare Online, Bulk Bill, DVA, and ECLIPSE claim submissions, verifications (Medicare, Fund, DVA, Concession), online eligibility checking, payment reporting, and automatic generation of required forms (DB4 Assignment of Benefits, Lodgement Advice, D1216S) within their Practice Management Systems. Authentication is handled via oAuth 2.0 with separate sandbox (https://sandbox.claiming.com.au/v2) and production (https://api.claiming.com.au/v2) environments. The target customers are software developers and vendors building Practice Management Systems for medical and allied health providers.
• Australian Immunisation Register (AIR) API An extension module of the Medical Billing API that provides Australian Immunisation Register functionality, including recording immunisations, fetching access lists, adding vaccine details (including overseas vaccines), adding catch-up dates, recording medical contraindications, natural immunity exemptions, and updating individual details such as indigenous status. It is offered to medical software vendors serving providers who perform immunisations in Australia.

Quantifiable outcome

• Dramatically reduce rejected claims through pre-validation
• +2 more outcomes

Segments1 record

Ideal customer profiles1 record

Technology focussed Yes

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Feature5 records

Scale indicators3 records

Recent moves2 records

Expansion highlights4 records

Direct peers

• MedicalDirector: Major Australian PMS vendor (owned by Telstra Health) delivering clinical and billing software to GPs. Comparable as a PMS competitor that could either use Claiming.com.au or build/own billing integration directly.
• Clinic to Cloud: Australian cloud-based PMS with integrated Medicare claiming and billing. Comparable as an Australian PMS vendor serving specialist practices with billing integration requirements.
• MediRecords: Australian cloud-based medical practice management system with integrated Medicare and DVA billing. Comparable as a PMS vendor operating in the Australian claiming ecosystem.
• Tyro Health: Australian healthcare payment and Medicare claiming platform that integrates with PMS systems. Directly comparable as a B2B infrastructure layer enabling Medicare/EFTPOS transactions for healthcare providers.
• Best Practice Software: Leading Australian PMS vendor for GPs and specialists, integrating Medicare and DVA claiming. Comparable as a customer/competitor in the Australian eHealth billing stack.
• Halaxy: Australian practice management and patient management platform with billing and claiming functionality. Comparable as an Australian healthcare software vendor integrating with Medicare and private health funds.
• HealthKit: Australian cloud-based practice management software with integrated Medicare claiming. Comparable as a PMS with embedded billing/claiming capabilities serving Australian allied health providers.

Broad incumbents

• Waystar: US healthcare revenue cycle management platform providing claims processing and billing infrastructure at scale. Comparable as a broader RCM incumbent showcasing the consolidated billing-API category at scale.
• Stripe (Healthcare Billing): Global payments infrastructure platform extending into healthcare billing with API-first developer experience. Comparable as a broader API-first payments infrastructure player that could eventually extend into healthcare claim rails.
• Change Healthcare: Major US healthcare technology company (now Optum) providing revenue cycle, claims processing, and interoperability. Comparable as a large incumbent in the medical billing/integration infrastructure space.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat4 records

Key risks5 records

Key highlights6 records

Customer concentration

• Xx.com/claimingcomau
• LinkedInlinkedin.com/company/claiming-com-au

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 Claiming.com.au