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Codax Accelerator case studyRevenue cycle AIHealthcare fintechAcquisition-led growthRCM companies

Acquisition-led growth: 2 RCM companies in design partnership, worth $8M ARR

An accelerator-stage revenue cycle AI company that grows by partnering with and acquiring independent RCM companies. Codax put a founder-operator with 15 years in life sciences in front of the owners who run billing for practices, as a buyer and partner, not a vendor.

$8M

ARR in design partnership

$15M

Acquisition pipeline

53%

Of the acquisition pipeline in design partnership

$7M

Further targets in pipeline, ARR

Part of the Codax Accelerator

This company is a startup from the Codax Accelerator, not a growth department engagement.

The Codax Accelerator is our programme for accelerator-backed founders. Instead of running a full growth department, we put an extended growth team behind the founder and amplify what they are already doing, so the founder owns growth without spending every hour on it.

How the Codax Accelerator works

90 days

Assess and fix in two weeks, then build, test and scale together

$1,500 a month

An extended growth team across outbound, design partners and advisory

Founder-led

The founder stays the voice and the closer on every deal

Follow-on

A follow-on investment considered for the next round

About the startup

Accelerator-stage revenue cycle AI company

AI that runs the back office of billing, built for the companies that do it

Every visit a practice bills becomes a claim, and every claim can be delayed, denied or underpaid. Much of that work is done by independent revenue cycle management companies, many of them owner-run firms built over decades. The company automates billing, collections and denial work with its own AI and works with these RCM companies first as design partners, then as acquisitions it runs on its platform. It is led by a founder-operator who has spent 15 years in life sciences, building products across insurance, providers and RCM companies.

The founder edge

A founder-operator with 15 years in life sciences, building products across insurance, providers and RCM companies. Owners hear from a buyer and partner who knows their business, not a vendor.

At a glance

Owners, not software buyers

Before

An AI platform for billing and collections and a growth plan that needed owners of RCM companies to say yes. Standard SaaS outbound does not start that conversation, and the founder's time was the bottleneck.

What we did

Positioned the founder as an operator and acquirer owners could trust, built lists of independent billing and RCM firms, opened owner-to-owner conversations, tested a message about the owner's future and led with a design partnership.

After

$8M ARR in design partnership across two acquisitions, $7M and $1M ARR, from a $15M acquisition pipeline, with $7M more in pipeline.

01 The market

A broken revenue cycle, and a crowded race to fix it

Claims are denied, appealed and paid weeks late. The cost is enormous, the work is manual, and that has made revenue cycle automation one of the busiest categories in healthcare AI.

Exhibit 1. What denials cost the system

~15%

Of claims submitted to private payers are initially denied1

Premier, 2024

54.3%

Of those denials are overturned and paid, after the work of appealing1

Premier, 2024

$43.84

Average cost to fight a single denied claim1

Premier, 2024

$19.7B

Spent by providers each year on denial reviews1

Premier, 2024

Exhibit 2. The top causes of denials, share of providers

Data errors46%
Authorisation issues36%
Incomplete patient information30%

Almost 3 in 4 providers say denials are rising.2

Experian Health, State of Claims 2024. Every one of these is manual, repeatable work, which is exactly what automation removes.

Exhibit 3. The automation prize in US healthcare administration

$90B
Routine administrative spending, a year
$20B
Savings still available through automation
$222B
Already avoided through automation, 2024

2024 CAQH Index. Automation avoided $222B in 2024, up 15% on the year before, with upwards of $20B more available.3

A calculator in an open leather folder on a desk

Every claim is a negotiation with a payer.

For the billing companies in the middle, that negotiation is the business: more denials and more rework on the same claims, with fewer experienced people to do it.

31%

Of revenue cycle leaders name workforce shortages among their top three stresses4

41%

Report denial rates above 3.1%4

~3 in 4

Providers say denials are rising2

The insight

The independent RCM companies that run billing for practices feel the pressure on denials, staffing and margins every day. Many are owner-run, so the way in is the owner, and a partnership, not a software sale.

RCM

Companies as customers

Acquire

Then run them on its AI

02 The buyer

Asking owners to trust you with a business they built

The buyer is an owner deciding who to trust with a business they spent years building. A software pitch does not start that conversation.

A billing specialist smiling at her desk in a busy back office

Who the work is for

The teams behind every claim

Independent RCM companies employ the people who code, submit, chase and appeal claims. An owner deciding their future is deciding theirs too, which is why trust has to come before terms.

$7M

ARR, the largest single acquisition

2

Acquisitions in design partnership

Exhibit 5. Why standard outbound would not work

The wrong buyer

SaaS outbound aims at procurement and IT.

Owners never see it

The wrong message

Features and pricing.

Owners care about their future

High stakes

Selling a business is personal.

Trust comes before terms

A small, named market

Independent billing and RCM firms.

Every account matters

The founder's calendar

Every deal needs the founder in the room.

Time is the bottleneck

03 The strategy

Owners, not software buyers

Hiring a sales team would have put strangers in front of owners. Leaving it all to the founder was too slow. So we built the deal flow around a founder-operator.

1

Straight to the owner

Lists of independent billing and revenue cycle firms. Outreach went to founders and owners, never procurement. In an owner-run business, the owner is the only buyer.

2

A message about their future

Succession, staffing, margins and the cost of keeping up with technology. Tested with the founder until replies became calls.

3

Design partner first

A design partnership lowered the stakes and let owners see the product working inside their own operation, before any conversation about acquisition.

4

The founder in every room

Codax kept the calendar full. The founder ran every conversation, from first call to terms.

Operatorbuyer, partner, closerOwner listsbilling and RCM firmsAcquirer profilean operator owners trustOwner outreachone owner to anotherDeal advisorypartnership to acquisition

The founder owns

  • Product and roadmap
  • The thesis and the voice
  • Every sales call
  • Closing and terms

Codax amplifies

  • Target lists and buying signals
  • Copy written with the founder
  • LinkedIn and email outreach at volume
  • A monthly pipeline review

Copy is tested together every round. What books calls gets more volume.

04 The work

What we did, step by step

The acquirer profile, owner lists, owner-to-owner outreach, message testing, design partner strategy and deal advisory, run around one founder-operator.

1

Profile and positioning

Assess and fix

Owners look up the person asking for their business. The founder had to read as an operator and acquirer who understands it from the inside.

Acquirer profile

An operator, not a vendor

The founder's LinkedIn built around 15 years across insurance, providers and RCM companies and a clear thesis for running billing firms on AI, so owners saw a buyer who knows how their business works.

Positioning

Their future, not our software

The pitch moved from product features to the owner's own questions: succession, staffing, margins and the cost of keeping up with technology.

Offer

A partnership with a destination

Design partnership first, with acquisition as the path, so the first step was small and the long-term story was clear.

2

Owner lists

Assess and fix

A small, named market, worked owner by owner.

The market

Independent RCM and billing companies

Firms that run billing and revenue cycle work for practices, many of them owner-run and built over decades.

The person

Founders and owners

Outreach went to the founder or owner of each firm, never procurement.

The signals

Who to reach first

Lists enriched and prioritised so the founder's first conversations went to the owners most likely to engage.

3

Owner-to-owner outreach

Build

The founder approached owners as a buyer and operator, one owner to another. Codax built the lists, wrote with the founder and kept the conversations moving.

First contact

Owner to owner

A short, personal note from the founder to each owner on the list, about their business and its future, so trust started person to person.

Follow-through

A conversation, not a sequence

Follow-ups across LinkedIn and email written with the founder, each one pointing to a conversation about the owner's future, never a demo.

Calendar

Kept full

Replies turned into booked calls, so the founder's hours went into conversations with owners ready to talk.

4

A message tested until it worked

Test

The message about the owner's future was tested with the founder until replies became calls. Each theme maps to a pressure the market data shows.

Exhibit 6. The message: their future, tied to pressures they already feel

Theme 1

Succession

What happens to the business and its people when the owner steps back.

The question every owner-run firm eventually faces.

Theme 2

Staffing

Running billing with fewer hands as experienced staff get harder to hire.

31% of revenue cycle leaders put workforce shortages among their top three stresses.4

Theme 3

Margins

Denials and rework eat into what a billing firm earns on every claim.

About $43.84 to fight each denied claim.1

Theme 4

Keeping up with technology

The cost of competing with AI-equipped platforms as an independent.

$20B in savings still available through automation.3

5

Design partners and advisory

Scale

A design partnership lowered the stakes, and strategic advisory shaped how each deal moved forward.

Design partner strategy

Lower the stakes

A design partnership let owners see the product working inside their own operation before any acquisition, turning a hard decision into a first step.

GTM refinement

From software sale to partnership

The go-to-market shifted from selling software to inviting owners into a partnership, with the acquisition as the destination.

Strategic advisory

Deal by deal

Advice on deal structure, the order of conversations and how to frame each design partnership on the path to acquisition, reviewed with the founder every month.

The founder in every room

First call to terms

Codax kept the calendar full. The founder ran every conversation, from first call to terms.

05 The impact

$8M ARR in design partnership from a $15M acquisition pipeline

Exhibit 7. A $15M acquisition pipeline, $8M in design partnership

53% of pipeline
Acquisition, $7M ARRAcquisition, $1M ARRFurther targets, $7M ARR

Exhibit 8. Where the $15M sits

Acquisition 1$7M ARR
Acquisition 2$1M ARR
Further targets in pipeline$7M ARR

Exhibit 9. Conversion of the pipeline

More than half the acquisition pipeline in design partnership

$8M

ARR in design partnership

2

Acquisitions in design partnership

$7M

Largest single acquisition, by ARR

$7M

Further targets in pipeline, ARR

06 What it shows

Acquisition-led growth in revenue cycle

Four things this engagement shows about winning in a crowded revenue cycle market.

01

Sell to the companies in the middle

Independent RCM companies run billing for practices and feel every denial. They were reachable, under pressure and underserved.

02

An operator, not a vendor

A founder with 15 years across insurance, providers and RCM companies speaks the owner's language. Approaching owners as a buyer and partner reads as a conversation, not a pitch.

03

Partnership before the deal

A design partnership lets an owner see the product inside their own operation. It turns an acquisition from a leap into a next step.

04

Make the message about them

Owners do not buy software. They decide the future of something they built. Succession, staffing, margins and technology are what start that conversation.

Client perspective

“We weren't selling software. We were asking owners to trust us with businesses they spent years building. Codax helped me find the words, and I ran every call.”
Co-FounderRevenue cycle AI company

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The Codax Accelerator

The same model, for your 90 days

An extended growth team across outbound, design partners and advisory, built around the founder, from founders and growth leaders who have scaled.

$1,500 a month

90 days. A follow-on investment considered for your next round.

See the Codax Accelerator