Alliance of Claims Assistance Professionals

What Alliance of Claims Assistance Professionals does

The Alliance of Claims Assistance Professionals (ACAP) is a 501c(3) nonprofit professional association incorporated in 1998 in Wheaton, Illinois and currently administered from Stamford, Connecticut. ACAP functions as both a membership body for independent Claims Assistance Professionals (CAPs) and a free public referral directory that connects individuals and businesses needing help with medical claims to vetted member practitioners. Members are independently owned, fee-based practitioners who assist clients with medical claim filing, appeals, balance-billing disputes, insurance audits, Medicare enrollment, and patient advocacy; membership requires documented professional experience, multiple references, and demonstrated familiarity with billing codes and terminology (CMS-1500, UB04, CPT, ICD-10, HCPCS, COB, MSP). ACAP does not sell a software platform or technology product; its offering is reputational curation, referral flow, and ongoing professional education delivered via monthly CAP_TIONS articles, white papers, and a 'Find a CAP' directory on claims.org.

ACAP's revenue comes almost entirely from membership dues paid by independent CAPs, making it a subscription-recurring nonprofit rather than a transactional or product business. Its go-to-market is a direct-to-consumer referral model: ACAP drives consumers experiencing claim denials, billing errors, out-of-network surprises, or complex Medicare decisions to its online directory through educational content marketing (monthly articles, white papers, and earned media), where they are matched to a member CAP who delivers fee-based services independently. The association is governed by a volunteer Board of Directors led by President Katalin Goencz and Secretary Robert Berman, with no disclosed investors, parent company, or institutional sponsorship.

The organization serves three core segments: individual patients and consumers navigating insurance and billing disputes, caregivers and family members managing benefits for others, and small-to-mid-sized businesses seeking assistance with employee health benefit claims. Member CAPs operate across at least nine U.S. states (CA, CO, CT, FL, ME, MO, NJ, NY, OR), with ACAP positioning its coverage as ranging from local and regional to national and global representation. The association has historical roots in the National Association of Claims Assistance Professionals (NACAP), founded in Downers Grove, Illinois in 1991 under Norma Border and Kathryn Dokas and dissolved in 1998.

Name

Alliance of Claims Assistance Professionals

Legal name

Alliance of Claims Assistance Professionals

Website

https://claims.org

Company type

Private

Founded year

1998

Operating status

Operating

Headcount range

11–50 employees

Short description

ACAP is a 501c(3) nonprofit association that curates a vetted directory of independent Claims Assistance Professionals providing fee-based medical claims, appeals, and patient advocacy services to U.S. individuals, caregivers, and small businesses across nine states.

Ownership category

akta.pro rank

Headquarters

HQ city

Stamford

HQ country

United States

HQ region

North America

Offices3 records

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

Personnel, Operations, Marketing or Sales, Others

Revenue model

1. Membership Dues: ACAP operates as a 501c(3) nonprofit organization. The organization's primary revenue is derived from membership dues paid by independent Claims Assistance Professionals who join the association. Member benefits include listing in the online directory, referral requests from potential clients, participation in conference calls, members-only communications, and access to education on industry trends and regulations.

Go-to-market motion1 record

Distribution channels2 records

Marketing channels4 records

Core offering

ACAP is a 501(c)(3) nonprofit professional association that maintains a free online directory connecting individuals and businesses with vetted, independent Claims Assistance Professionals (CAPs). CAP members are independent fee-based practitioners who assist clients with medical claim filing, insurance denial appeals, billing audits, provider negotiations, Medicare enrollment, and overall healthcare benefits navigation. The association funds its operations through membership dues from CAPs while providing the directory as a free public service.

Product overview

The Alliance of Claims Assistance Professionals (ACAP) is a professional association organization, not a software product company. It provides a directory and membership services for independent Claims Assistance Professionals (CAPs) who offer fee-based medical claims assistance and patient advocacy services to individuals and businesses. ACAP itself does not offer a software platform, product, or module. The organization connects clients with CAP service providers and maintains membership standards for the profession.

Differentiator

Problem solved

Functional benefit

Products and services

• ACAP Membership for Claims Assistance Professionals Paid association membership for vetted Claims Assistance Professionals (CAPs) and Electronic Claims Assistance Professionals (ECPs), providing directory listing, inbound client referrals through the ACAP 'Find a CAP' service, members-only communications, participation in conference calls, and access to industry education and regulatory updates.

Quantifiable outcome

• 66% of appealed claims are upheld or original denial is reversed
• +2 more outcomes

Named customers6 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

Scale indicators2 records

Recent moves6 records

Expansion highlights3 records

Emerging players

• GoodRx: Consumer healthcare cost-transparency and telehealth platform with medication savings and provider visit services. Comparable in addressing consumer confusion around medical bills and insurance, though focused on pharmacy and primary-care access rather than complex medical-claims resolution.
• CoverMyMeds (McKesson): Tech-enabled prior-authorization and appeals platform used by providers, pharmacies, and patients to automate the very appeal workflow ACAP's CAPs perform manually. Comparable because it addresses the same denial-appeal problem ACAP solves, but with technology that scales faster than a human directory.

Others

• Centers for Medicare & Medicaid Services (CMS): Federal agency administering Medicare/Medicaid and defining the claims forms (CMS-1500, UB04), coding standards, and appeal rules that ACAP's members are expert in. Indirect but central to ACAP's value proposition — ACAP's expertise is largely navigating CMS-defined processes and regulations.

Direct peers

• National Patient Advocate Foundation: Patient advocacy nonprofit focused on policy reform and direct patient navigation across insurance, medical debt, and access issues. Comparable mission to ACAP's claims assistance and patient advocacy work; differs in being a direct-service and policy organization rather than a directory of independent practitioners.
• Patient Advocate Foundation: National nonprofit providing direct case management, financial aid, and insurance/claims navigation to patients with chronic or life-threatening illnesses. Directly comparable mission (patient advocacy against medical bills and denials) and overlap with ACAP's customer segments, though PAF delivers services directly rather than via a referral directory.
• Health Advocate (a Veritas Capital portfolio company): Provider of employee-assistance-style health advocacy, billing/claims resolution, and Medicare support sold to employers and health plans. Comparable customer base (employees/individuals needing claims help) and overlapping service scope (appeal filings, billing errors, provider negotiation) — ACAP competes for the same wallet via independent CAPs.

Broad incumbents

• Healthcare Financial Management Association (HFMA): Large, established membership association for healthcare finance professionals across providers, payers, and vendors. Comparable as a healthcare-finance membership association with education, certifications, and community; broader in scope than ACAP, which focuses narrowly on consumer-side claims assistance.
• American Association of Healthcare Administrative Management (AAHAM): National professional association for healthcare administrative and patient access professionals, offering certification, education, and networking. Comparable membership-association structure and revenue model (dues, certifications) to ACAP, though AAHAM focuses on the provider/administrator side rather than consumer-side claims advocacy.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat2 records

Key risks5 records

Key highlights5 records

Customer concentration

• Facebookfacebook.com/Alliance-of-Claims-Assistance-Professionals-100054308525101
• LinkedInlinkedin.com/company/alliance-of-claim-assistance-professionals

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 Alliance of Claims Assistance Professionals