Aegis

What do they actually do

Aegis sells an early-stage SaaS tool that automates much of the manual work providers do when appealing denied health insurance claims. It watches claims feeds for denials, prioritizes them, pulls needed records (charts, EOBs), drafts payer‑specific appeal packages with AI, submits via portals/fax/clearinghouse, and tracks status in a dashboard with basic analytics Aegis website, YC page.

The product is live and sold through demos/pilots. The company says most customers can be onboarded and filing appeals within 5–7 days, and it markets faster submissions and lower cost per appeal as outcomes. There’s no public pricing or customer list; the team is small and early, selling to provider‑side revenue cycle teams and billing firms Aegis website, YC page.

Who are their target customer(s)

• Billing manager at a small-to-medium physician practice: Small teams lose time chasing charts, EOBs, and payer rules, so denials pile up and deadlines get missed. They need faster detection, document pulls, and drafting to keep up.
• Revenue cycle manager at a hospital or health system: High denial volumes require many FTEs and make it hard to see which appeals are worth the effort. They need prioritization and clear recovery analytics to allocate work.
• Medical billing / third‑party RCM firm: They juggle multiple payer portals and submission formats across many clients, which slows throughput and compresses margins. Standardizing packages and submissions would cut manual work.
• CFO or finance lead at a provider organization: Unresolved denials create unpredictable cash flow and lost revenue. They want measurable recovery and lower cost per appeal with transparent ROI reporting.
• Specialty practice or ambulatory surgery center with high‑value claims: A single denied claim is material and needs detailed clinical documentation from the EHR, which is slow and pulls in clinical staff. Faster chart pulls and payer‑specific evidence speed complex appeals.

How would they acquire their first 10, 50, and 100 customers

• First 10: Founder‑led outreach to local practices, billing managers, and a few RCM firms; run short, scoped pilots with discounted or success‑contingent pricing while handling integrations and submissions in a hands‑on way. Capture before/after metrics and convert wins into 1–2 concise case studies and referral intros Aegis website, YC page.
• First 50: Hire 1–2 sales reps and an implementation lead to run parallel pilots; formalize an onboarding checklist (claims feed → documents → submissions). Target regional billing firms and specialty practices with focused email/webinars and secure a few channel partnerships (e.g., clearinghouses, billing shops) to drive bundled intros.
• First 100: Productize common payer templates and build verifiable connectors for top EHRs/clearinghouses to reduce custom work; launch tiered pricing and marketplace listings for inbound. Expand channel partnerships with MSOs and large billing firms, and use a customer‑success motion with ROI reports to drive retention and expansion.

What is the rough total addressable market

Top-down context:

Providers spent about $25.7B on claims adjudication in 2023, with roughly $18B potentially unnecessary because many denials were later overturned—clear dollars automation can target Premier. Analysts peg the broader U.S. RCM market near $172B, with denial management a single‑digit‑billion slice within that spend Grand View Research, industry reports.

Bottom-up calculation:

Starting from the ~$18B avoidable adjudication pool, if software can address 40–60% of that work and vendors capture 20–30% of the resulting value as fees, the near‑term U.S. TAM for denial‑automation/appeals falls roughly in the $1.4B–$3.2B range Premier.

Assumptions:

• A substantial share (40–60%) of avoidable adjudication work is automatable without major workflow changes.
• Vendors can sustainably capture 20–30% of created savings via software and/or managed services fees.
• Adoption concentrates first in physician practices and mid‑market hospitals before expanding to large systems.

Who are some of their notable competitors

• Waystar: Large RCM vendor with denial management modules used by many providers; often an incumbent platform in billing operations.
• Change Healthcare (Optum): Clearinghouse and RCM tools that include denials and appeals workflows, with broad payer connectivity.
• Experian Health: RCM suite with claims and denial management features embedded in provider billing workflows.
• FinThrive (formerly nThrive): Provides denial management software and services across hospitals and physician groups as part of a broader RCM offering.
• Availity: A major clearinghouse with payer‑specific workflows and denials analytics used by providers and billing firms.