LunaBill

What do they actually do

LunaBill runs AI voice agents that call health insurance payers on behalf of hospital and clinic billing teams. The agents navigate IVR menus, ask follow‑up questions, capture claim status and denial reasons, and when possible trigger reprocessing or escalate appeals during the same call. Calls are recorded and summarized into structured notes (LunaBill homepage).

Billing teams upload problem‑claim lists (CSV/Excel exports from their EHR or practice management system). Results show up in a dashboard and are designed to plug into existing workflows, with an emphasis on HIPAA compliance and enterprise security (LunaBill homepage).

Who are their target customer(s)

• Hospital revenue cycle directors overseeing payer follow-up teams: Large volumes of payer calls drive backlogs, long A/R cycles, and staff burnout/turnover. They need to reduce manual phone work without reworking existing EHR/PM processes.
• Clinic and independent practice billers with small teams: Limited headcount makes it hard to keep up with routine follow-ups, so unresolved claims delay cash. They need a way to automate status checks and denials follow-up from simple exports.
• Third‑party billing/outsourced RCM firms: High staffing costs and throughput variability due to repetitive payer calls across many clients. They need scalable automation to reclaim hours and standardize output quality.
• Health system finance leaders (CFOs/revenue leaders): Denied or stalled claims cause revenue leakage and unpredictable cash flow. They want measurable reduction in denial resolution time and on‑call reprocessing to improve collections.
• Compliance, audit, and IT leaders responsible for EHR/PM integrations: They require HIPAA compliance, audit trails, and reliable write‑backs into existing systems without breaking workflows. They look for minimal‑lift integrations and enterprise controls.

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

• First 10: Run hands‑on concierge pilots via warm intros (YC, founders’ network, Founders, Inc.), ingest a small CSV of problem claims, automate calls for 2–4 weeks with recordings and structured outcomes, and convert based on time/revenue impact (LunaBill YC profile Founders, Inc.).
• First 50: Hire 1–2 BD reps to run a targeted outbound motion to billing teams and RCM firms, standardize a low‑friction pilot contract/ROI deck, and use referral incentives from early customers to source intros (LunaBill).
• First 100: Pursue channel/integration distribution: secure EHR/PM connector partnerships, ship a procurement‑ready HIPAA/security packet and enterprise SLA, and bundle into reseller deals with third‑party billing firms (LunaBill).

What is the rough total addressable market

Top-down context:

U.S. Revenue Cycle Management (RCM) spend is estimated around $172B in 2024, which sets the upper bound; the slice tied to payer interactions/denials likely falls in the 5–15% range (~$8.6B–$25.8B) (Grand View Research; AHA/Premier).

Bottom-up calculation:

A narrow, purchase‑ready slice sums U.S. denial‑management (≈$5B) plus medical billing outsourcing (≈$6.3B), implying roughly an $11B market for automating payer‑call/denial workflows (I‑Conic Grand View Research).

Assumptions:

• U.S.-only scope; excludes international markets.
• 5–15% of total RCM spend is directly tied to payer interactions, denials, appeals, and related phone follow-ups.
• Automated voice agents can address a material portion of denial-management and outsourced billing budgets.

Who are some of their notable competitors

• SuperDial: Direct competitor offering voice AI agents for revenue‑cycle workflows (insurance verification, claim follow‑ups, prior auths) that place payer calls on behalf of billing teams (SuperDial).
• Infinitus: Configurable AI voice agents for clinical/admin calls, including eligibility, claims, and prior auths; enables automated payor interactions similar to LunaBill’s target use cases (Infinitus).
• Prosper AI: Voice‑AI vendor focused on patient access and payer tasks (eligibility, prior auths, claims follow‑up), competing on automating routine payer calls (Prosper AI • Elion listing).
• Talkdesk (and similar CCaaS platforms): Enterprise contact‑center platform with healthcare modules and automated voice workflows; large systems may choose it over a point RCM solution (Talkdesk).
• R1 RCM: Incumbent RCM outsourcer with automation for claims follow‑up and denials; providers may outsource payer calling or use R1’s platform instead of adopting a standalone tool.