Claim Health
Also known as: Claim Health AI
AI native revenue cycle platform for post acute care that automates referral to reimbursement and prevents denials before submission.
Claim Health is an AI native revenue operations platform for post acute care providers such as home health, hospice, home care, and nursing homes. It automates the full referral to reimbursement cycle across modules for revenue assurance, smart intake, authorization autopilot, billing operations, and platform intelligence. The AI continuously identifies upstream data, documentation, and coverage risk inside the EMR to prevent denials before claims are submitted, centralizes and auto extracts referrals from fax, email, and portals, automates prior authorizations from submission to renewal, and resolves claims to cash through payment posting, reconciliation, and prioritized denial follow up. Routine work is automated while exceptions are surfaced to billers who make the important decisions, and the founders describe a long term vision of a self driving revenue cycle. The site states the product is HIPAA compliant.
Vendor details
Canonical URL
https://www.claimhealth.com
Category
Healthcare agent
Funding status
Seed round of 4.4 million dollars (January 2026) led by Maverick Ventures, with Peak XV, Y Combinator, and DHVP participating, plus C suite executives at large post acute providers, per Business Wire and Morningstar. Y Combinator Spring 2025 batch. Founded 2025 by Kevin Calcado (CEO) and JJ Ram. New York.
Company status
independent
Use cases & customers
Primary use cases
Target customers
Deployment options
Integrations
Works inside the provider EMR to catch revenue risk before submission, and centralizes referrals from fax, email, and portals into one workflow, with voice agents in development to request information from insurers.
Sources & related URLs
Capability coverage
9.0 / 14 capabilities · 64%
| Integrations & Tool CallingOperates inside the provider EMR to identify revenue risk, centralizes referrals from fax, email, and portals, and is implementing voice agents to request information enrichment from insurance companies per claimhealth.com and the YC page. | Full |
|---|---|
| Workflow OrchestrationAutomates and coordinates the full referral to reimbursement workflow across intake, eligibility verification, authorization management, billing, denial handling, and payment reconciliation per Business Wire. | Full |
| Knowledge Grounding & RAGGrounds decisions in payer rules and EMR data, applying documentation and coding rules such as OASIS M code validations to catch missing or invalid data before submission per claimhealth.com. | Full |
| Human Oversight & GuardrailsThe platform surfaces the claims that need attention and automates the routine ones, alerting teams only to exceptions that require human review while billers make the important decisions and triage per claimhealth.com and the YC page. | Full |
| Security, Identity & GovernanceThe website states the product is HIPAA compliant, but no named infosec certification such as SOC 2 or HITRUST was retrieved this session. | Partial |
| Observability & AuditabilityPlatform Intelligence tracks revenue performance in real time and gives consistent visibility and control across auths, payment posting, and reconciliation workflows per claimhealth.com. | Full |
| Memory & State PersistenceClaim and authorization state persists across the referral to cash lifecycle, with continuous tracking of approvals and renewals, though this is workflow state rather than a general agent memory store. | Partial |
| Deployment & Data ResidencyDelivered as a cloud SaaS platform; no self hosted or data residency option was retrieved this session. | Partial |
| Prebuilt Agents / Templates / PacksShips prebuilt revenue cycle modules for revenue assurance, smart intake, authorization autopilot, and billing operations, a packaged workflow approach rather than a self serve agent catalog. | Partial |
| Triggers & Channel CoverageWork is triggered by inbound referrals from fax, email, and portals and by claim and denial events, running continuously in the background, with voice agents contacting insurers per claimhealth.com and the YC page. | Full |
| Model Flexibility & RoutingNo customer selectable model or model routing is documented this session; the platform uses its own AI internally. | Unable to verify |
| APIs / SDKs / MCP ExtensibilityIntegrates into EMR and claim submission workflows implying connectors, but no public developer API, SDK, or MCP endpoint was documented this session. | Partial |
| Testing, Debugging & OptimizationRevenue assurance predicts and catches denials before they happen and continuously validates claim readiness, a predictive quality and impact tracking loop rather than a formal agent evaluation framework. | Partial |
| Browser / Computer-useNo browser driving or computer use capability was documented this session; the platform automates billing workflows and uses voice agents rather than operating a browser or GUI. | Unable to verify |
Pricing
Custom (contact sales)
Cost watchouts
Revenue cycle tools are often priced as a percent of collections or per claim; the commercial unit was not disclosed this session.
Variable cost rationale
If priced on claim volume or a share of collections, cost scales with the agency claim throughput and recovered revenue, but the unit was not retrieved this session.
Sales call required
Mixed (some tiers require a call)
Key ambiguities
No public entry price and no confirmation of whether pricing is subscription based or a percent of collections.
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