Out-patient care centres

42 CFR Part 2 governs substance-use records more tightly than HIPAA governs the rest of health care, and state licensure, accreditation and utilisation-review integration all precede the first sale. The buyer set — residential and outpatient programmes — is also consolidating into chains that standardise on Netsmart or Kipu at the group level. Nothing is disclosed here. Every vendor named on this record is private, or sits inside a parent that does not break the line out, so no revenue floor can be built and the market size is genuinely unknown rather than estimated.

What this category is. The back office between a care provider and whoever pays: eligibility checks, claims and the clearinghouse that carries them, coding, denials and appeals, payer-to-provider payments, patient statements and collections, and the credentialing and enrolment that let a clinician bill a plan at all. The coded customer is ambulatory care (621): physician groups, clinics, labs and home health. But the largest buyers of several segments are hospitals and health systems (outsourced revenue cycle, inpatient coding) and health plans (payer payments, provider data, credentialing). How it differs from the neighbouring records. Electronic health records and practice management (6211) sells the chart and scheduling; athenahealth appears here only for its revenue-cycle business, and its funding is not re-researched. EHR+ patient engagement (6211) sells the portal and intake. Patient booking (6211) sells patient acquisition. HIPAA compliance (6211) sells security and audit. Medical imaging (621510) sells PACS. This record is the money and paperwork layer. Who owns the rails. Optum completed its combination with Change Healthcare on 3 October 2022 [A, Optum]. The February 2024 ransomware attack on Change touched about 192.7 million individuals, the largest US healthcare breach on record [B, CyberInsider citing the HHS OCR filing], and stopped claims for providers across the country. That shows how much of the network runs through one company. Availity says it connects over two million providers to every US health plan and handles over 13 billion transactions a year; its shareholders include Anthem (Elevance), Humana, HCSC and GuideWell, and Novo Holdings bought Francisco Partners' stake in July 2021 [A, Novo Holdings]. Waystar (Nasdaq: WAY) earned $1,099M of revenue in 2025, up 17%, from about 30,000 clients representing over 1 million providers [A, Waystar release]. Experian Health sells patient access, eligibility and identity inside Experian plc. Zelis runs the payer-to-provider payment side: 725 payer clients, 850K+ providers and $300B+ of payment volume by its own count [C]. Bain Capital and Parthenon sold a minority stake to a Mubadala-led group that closed on 26 November 2024 [A, Kirkland & Ellis]; the reported $17B valuation is Bloomberg's, not opened here. Who owns the outsourced work. R1 RCM was taken private by TowerBrook and CD&R at about $8.9B, closing 19 November 2024 [A, CD&R]. Ensemble Health Partners began as Bon Secours Mercy Health's revenue-cycle arm; Golden Gate Capital bought 51% in 2019 in a deal reported at about $1.2B [B, Becker's]. athenahealth, bought by Bain Capital and Hellman & Friedman for $17B [B, Healthcare Dive], bundles billing with its ambulatory record. The AI wave is already funded. AKASA (inpatient coding for 500 hospitals, by its own count) raised a $60M Series B led by BOND in 2021 [A]. Adonis raised a $40M Series C led by Quadrille Capital in March 2026, over $95M in total, and claims more than 4x revenue growth in 2025 [A, company release]. Candid Health raised a $52.5M Series C led by Oak HC/FT, $99.5M in total [B, HLTH]. Infinitus raised a $51.5M Series C led by Andreessen Horowitz, $102.9M in total, for AI agents that call payers [B, Pulse 2.0]. In credentialing, Medallion has raised $130M (latest $43M led by Acrew Capital, August 2025) and has acquired Andros [A]. CertifyOS raised a $40M Series B led by Transformation Capital in June 2025 [A]. Uno Health (Medicaid and benefits enrolment) was bought by Findhelp in October 2025 [B]. Canada. Provincial plans pay physicians, so the US claims-and-denials problem mostly does not exist. Billing is bundled with the record: more than 40,000 Canadian health professionals use a TELUS Health EMR [A, TELUS], and TELUS's CHR files OHIP claims through MDBilling [A, TELUS help centre]. mdbilling.ca now redirects to Dr.Bill, which claims 13,000+ physicians across OHIP, MSP and AHCIP [C]. TELUS eClaims covers direct billing to private insurers for allied health. Why a newcomer cannot get in. The clearinghouse and payment rails are owned by Optum, Availity (owned by payers), Waystar and Zelis. Each depends on connections to thousands of payers and on volume pricing. The outsourced hospital work is owned by private-equity platforms worth billions. Every point task an AI startup might attack (coding, denials, payer calls, credentialing, patient billing) already has a venture-backed player with $50M–$130M raised, and the incumbents are buying or building the same AI. Waystar's acquisition of Iodine is one example. In Canada the pain is small and the record vendors bundle it. Incumbent vulnerability decides it.