Claim Health

What do they actually do

Claim Health makes a small, live SaaS tool for post‑acute and at‑home care providers that finds and fixes claim problems before money is lost. It connects to intake and billing data, flags missing or inconsistent items in real time, automates routine submissions or corrections, and helps staff generate appeal letters when claims are denied. The product surfaces only the exceptions that need human review and shows time saved and dollars recovered on simple dashboards (YC company page, YC Launch, Claim Health homepage).

Early users are home health agencies, hospices, and home‑care providers, where billing and revenue teams use it day‑to‑day. The founders report examples like shrinking a multi‑day billing process to a few hours and uncovering missed revenue, indicating practical gains for small and mid‑size agencies. Near‑term, they aim to expand automation across more of the revenue cycle and add proactive outreach (e.g., voice agents) to collect missing info before submission; doing this at scale will require more payer rules, EHR/PM integrations, and appeals automation (YC company page, YC Launch).

Who are their target customer(s)

• Billing manager at a small home‑health agency: Spends hours manually checking each claim and chasing missing referrals/authorizations that drive denials and re‑work; needs a way to catch errors earlier and only handle true exceptions (YC company page, YC Launch).
• Revenue/finance leader (owner/CFO) at a mid‑size home‑health or hospice provider: Loses recurring dollars to underpayments and denial leakage that are hard to see in day‑to‑day ops, hurting cash flow and planning; needs clear visibility into recovered revenue and time saved (Claim Health homepage, YC company page).
• Denials/appeals specialist at a post‑acute provider: Spends too much time drafting repetitive appeal letters and tracking statuses across payers; needs faster, more consistent recoveries with less manual work (YC company page).
• Intake/referral coordinator: Receives incomplete referrals and missing documentation that stall billing; needs to catch and resolve intake issues early and, ideally, automate collection of missing info (YC Launch).
• Revenue‑cycle manager or third‑party biller for larger agencies: Requires scalable exception handling and broad payer/EHR integrations; manual triage doesn’t scale as claim volume grows (YC company page, YC Launch).

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

• First 10: Founder‑led pilots via warm intros from their network and YC exposure; connect to billing data, run intake/denial scans, and convert based on a short pilot that quantifies time saved and recovered revenue (YC company page, Claim Health homepage).
• First 50: Add targeted outbound (SDRs) to billing managers, revenue leaders, and third‑party billers using pilot case studies/ROI calculator; run tight group demos and publish short proof‑focused case studies, plus selective industry events for inbound (Claim Health homepage, YC Launch).
• First 100: Form channel partnerships with EHR/PM vendors, clearinghouses, and regional billing firms to co‑sell; productize a fast onboarding playbook (standard connectors, templates, 1‑week setup) and scale CS to run partner rollouts, using proven pilot metrics to close mid‑size agencies (YC company page, YC Launch).

What is the rough total addressable market

Top-down context:

Home health services accounted for $132.9B in 2022 spending and Medicare paid $23.7B for hospice, implying ≈$156.6B of billed, claimable revenue in U.S. post‑acute/home settings (CMS, MedPAC). The market is fragmented, with ~11,400 home‑health and ~5,200 hospice agencies (CDC, CDC).

Bottom-up calculation:

If 10–15% of $156.6B is initially denied and 50–60% is preventable/correctable, the recoverable pool is roughly $7.8B–$14.1B per year; some post‑acute estimates point higher (e.g., 25% initial denial, 70% preventable ≈ $27B) (Experian, Practolytics, Premier/AHA).

Assumptions:

• Hospice figure uses Medicare payments; Medicare is the dominant payer, but all‑payer hospice spend is larger (MedPAC).
• Initial denial rates of 10–25% and preventable shares of 50–70% reflect ranges from industry surveys/vendor analyses and vary by payer and region (Experian, Practolytics).
• U.S. market only; international adds separate payer rules and integrations.

Who are some of their notable competitors

• WellSky (Home Health & Hospice): Large post‑acute software vendor with home health and hospice EHRs plus revenue cycle tools and services used by many agencies.
• Homecare Homebase (HCHB): Leading home health/hospice EHR platform with billing workflows and RCM add‑ons; entrenched in post‑acute operations.
• Waystar: Broad healthcare claims and denials management platform (clearinghouse, edits, analytics) used by providers across settings.
• Inovalon (ABILITY Network): Connectivity and RCM tools widely used in post‑acute (e.g., eligibility, Medicare submissions, claim status) via the ABILITY suite.
• Change Healthcare (Optum): National clearinghouse and claims editing/denials tools that touch a large share of provider claims, including post‑acute.