Problem

Independent healthcare practices routinely receive denials or inadequate payments for out-of-network care, including emergency services and care delivered at in-network facilities. The pain is both operational and economic: billing teams must navigate payer negotiations, regulatory deadlines, coding and documentation, while practices may otherwise spend months contesting a denial or sell the receivable to collections for a fraction of its value. The central use case is recovering underpaid claims that qualify for the No Surprises Act’s independent dispute-resolution process, where the provider must substantiate its requested payment against the payer’s offer.

The opportunity is material because providers often leave recoverable revenue unclaimed. In reported federal IDR data, providers won about 77% of resolved cases, and provider wins produced a median payment equal to 322% of the typical in-network rate, versus 100% when payers won. For a small or midsize practice, converting this overlooked revenue without adding a large internal billing operation is the core value proposition.

Product / Service

Clearest Health is an AI-enabled, provider-facing revenue-recovery platform focused on underpaid out-of-network claims. It analyzes a practice’s claims, identifies the IDR opportunities with the highest expected value, and uses a proprietary database and matching algorithm that links adjudicated dispute outcomes to CPT codes, payers, regions, and facility types. It then recommends evidence-backed offer amounts, prepares dispute documentation, applies payer-specific filing strategies, and manages the process through resolution.

The delivery model is a managed, end-to-end service rather than a stand-alone analytics tool: Clearest offers a no-cost initial claims analysis, promises an analysis turnaround of 48 hours, and says there are no upfront costs to the practice. The intended benefit is higher recovery from the same patient volume with less workload for the billing team; Clearest claims 2–3x higher recoveries and says its service avoids sending additional bills to patients.

Market

Clearest competes in healthcare revenue-cycle management and specialized out-of-network claim recovery, particularly the growing market for No Surprises Act IDR and state-level arbitration support. Its target customers are independent healthcare practices, while the broader market includes hospitals, emergency and anesthesia groups, radiology providers, surgical practices, and other organizations that face underpaid out-of-network claims. Direct and adjacent alternatives include specialized recovery and arbitration firms such as Callagy Recovery, healthcare law firms, and incumbent RCM partners that handle IDR as one service among many. Clearest positions itself around proprietary outcome data and an IDR-only focus rather than generic claims or billing support.

The company appears to have meaningful early commercial traction rather than being pre-revenue in the sense of having no operating activity, although it does not disclose revenue or ARR. Its website reports more than $47 million recovered across more than 200 practices, and the company says it has analyzed or matched millions of resolved disputes. Clearest is an active Y Combinator Summer 2023 SaaS health-tech company; public company data also reports a $2.8 million seed round. These traction figures are company-reported, so they should be treated as directional rather than independently audited.