Fuse

What do they actually do

Fuse provides software that automates front‑office revenue tasks for outpatient clinics. Today, they offer digital patient intake (mobile/web forms and insurance‑card capture), real‑time eligibility and benefits checks at the CPT (procedure) level—including automated portal checks and payer phone calls—and patient cost estimates that draw on the granular benefits data they collect and parsed payer rate files. Results write back into the EHR or are surfaced to front‑desk/billing staff to reduce manual hold time and eligibility‑related denials [home/features](https://www.fuseinsight.com/; https://www.fuseinsight.com/patient-intake).

They say the platform is HIPAA‑compliant and operates under SOC 2 Type II controls, with a public security page outlining their practices security. Their site claims they’ve helped “hundreds of providers” and includes quotes from private practices using the product site.

Fuse is also rolling out a second product line: extracting payment terms from provider contracts, reconciling them against remittances to detect underpayments, and generating appeals—positioned as revenue recovery and contract analytics for providers. This direction is described in their YC page and launch materials, and ties to a longer‑term vision of supporting rate benchmarking and future contract modeling [YC](https://www.ycombinator.com/companies/fuse-2; https://www.linkedin.com/posts/y-combinator_fuse-yc-s24-helps-healthcare-providers-activity-7232386038525046786-X6Wg).

Who are their target customer(s)

• Small independent outpatient practices (solo or small‑group primary care and specialties): They spend significant staff time on manual intake and insurance verification, leading to slow check‑ins and avoidable claim denials that hurt margins and patient experience patient intake.
• Front‑desk/reception teams at clinics: They still scan cards, transcribe paper forms, and wait on hold with payers to confirm eligibility, creating bottlenecks and frustrated patients patient intake.
• Medical billing / revenue‑cycle staff at small‑to‑mid sized practices: Reconciling remittances to contracts to find underpayments is tedious and error‑prone; drafting and submitting appeals consumes time better spent on higher‑value activities YC page.
• Specialty procedure clinics and ambulatory surgery centers: They need CPT‑level benefits checks and prior‑authorization details before procedures; missing details cause denials and surprise patient bills home/features.
• Practice owners and managers responsible for finances: They lose money to underpayments and opaque negotiated rates, and want tools to identify underpayments, benchmark rates, and recover what’s owed about/positioning.

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

• First 10: Founder‑led, no‑risk pilots with nearby independent practices: hands‑on onboarding to map workflows, connect to the EHR, and run portal/payer checks manually to deliver quick time‑savings and denial reductions, capturing testimonials and metrics patient intake.
• First 50: Package a short implementation playbook and referral credit; use one dedicated seller to target small practice owners and billing managers with pilot case studies and trust signals (SOC 2/HIPAA docs) to ease procurement security.
• First 100: List in EHR marketplaces and sign a few reseller deals with billing companies/practice‑management vendors; run targeted outbound to specialties needing CPT‑level checks and use underpayment‑recovery pricing as an entry to shorten cycles and create an upsell path [home/features](https://www.fuseinsight.com/; https://www.ycombinator.com/companies/fuse-2).

What is the rough total addressable market

Top-down context:

Fuse targets front‑office RCM tasks (intake, eligibility, estimates) for independent outpatient clinics and is expanding into underpayment detection/contract analytics. Within the U.S., this niche supports a mid‑hundreds‑of‑millions to low‑single‑digit‑billion software and recovery‑fee opportunity depending on pricing and adoption assumptions.

Bottom-up calculation:

Illustrative: assume 100,000 small outpatient clinics as the addressable segment, an average $6,000/year subscription for intake/eligibility/estimates, and optional recovery fees (e.g., 20% on $15,000/year recovered underpayments per clinic). That implies ~$600M in subscription TAM plus ~$300M in recovery fees, or roughly ~$0.9B combined.

Assumptions:

• Addressable segment approximated as 100k small independent U.S. outpatient clinics (excludes large health systems).
• Average software pricing of ~$500/month per clinic for intake/eligibility/estimates.
• Underpayment recovery: average $15k/year identified per clinic with a ~20% contingency fee; participation varies by clinic.

Who are some of their notable competitors

• Phreesia: Enterprise‑grade digital intake and front‑desk automation that includes automated eligibility/benefits checks and upfront collections; overlaps with Fuse on intake, insurance capture, and front‑end RCM features product.
• Waystar: Broad RCM platform whose financial‑clearance module offers real‑time eligibility, coverage detection, and patient estimates; more oriented to larger RCM workflows than a focused intake + contract‑analytics stack eligibility.
• Eligible: API for eligibility, claims events, prior auth, and line‑item cost transparency; competes on programmatic retrieval of benefits/estimates that a product like Fuse could consume or build against overview.
• Cedar: Patient financial engagement and price‑transparency tools for pre‑visit estimates, billing clarity, and payments; overlaps with Fuse’s estimate/transparency features, with emphasis on consumer billing experiences for larger systems solutions.
• Zelis: Payment‑integrity and pricing platform serving payers and providers; overlaps conceptually with underpayment/contract analytics but is built for payer‑scale payment accuracy rather than front‑desk intake payment integrity.