payment-integrity
(10)
Machinify’s $670 Million Bet: Fix America’s Medical Bills Before They’re Paid
Machinify started with a broad promise to turn enterprise data into decisions. A decade later, it is making a narrower, harder wager: teach machines the rules of American healthcare, then catch costly claims errors before the money leaves the building.
HealthEdge Is Building the Operating System Health Plans Were Too Scared to Replace
The dullest machinery in American healthcare may be the most expensive to leave untouched. HealthEdge spent 20 years turning claims rules, care workflows and provider records into one payer platform - then merged with the operator that knew how to move insurers onto it.
Zelis Wants to Fix the Part of Healthcare Nobody Sees - the Money Moving Underneath It
Most patients will never know its name. Yet Zelis helps decide what a claim should cost, how a provider gets paid and whether a confusing bill becomes a three-month ordeal - or a solvable problem.
Musheer Ahmed Is Moving Healthcare’s Error Check to the Moment Before the Bill
A cybersecurity dissertation became an Atlanta company with a precise thesis: the cheapest claim error is the one that never enters the system. Now Ahmed is pushing payment integrity from forensic cleanup toward prevention at “Point Zero.”
Codoxo Wants to Catch the $400 Billion Healthcare Leak Before a Claim Exists
Most payment-integrity teams hunt bad claims after the paperwork arrives. Codoxo built an AI company around a more useful question: what if the error never entered the system?
Alaffia Health
Alaffia Health is a New York-based healthtech company that uses agentic AI paired with expert clinicians to help health insurers detect and stop waste, fraud, and abuse in medical claims. Its Autodor platform forensically reviews complete patient medical records against submitted claims to power payment integrity, utilization management, and appeals workflows - reviewing complex facility claims up to 20x faster than manual processes while keeping humans in the loop for defensible, explainable outcomes.
TJ Ademiluyi
TJ Ademiluyi is the CEO and co-founder of Alaffia Health, a New York healthcare-technology company that pairs licensed clinicians with agentic AI to review medical claims for health plans. Raised in a family that ran a medical-billing business, he traded a finance career at Goldman Sachs to build software that reads patient records, checks provider bills against policy, and flags overpayments before they are paid. He founded the company in 2020 with his older sister, Adun Akanni, was named to Forbes' 2023 30 Under 30 in Healthcare, and in February 2026 raised a $55 million Series B led by Transformation Capital, bringing total funding above $73 million.
basys.ai
basys.ai is a Cambridge, Massachusetts healthcare technology company that builds enterprise-grade, domain-specific AI for health plans and payers. Founded in 2022 by Harvard health data science alumni Amber Nigam and Jie Sun, the company automates prior authorization, utilization management, and payment integrity, turning a process that can take days into decisions rendered in minutes - with plain-language rationales and hyperlinks to the exact policy criteria and clinical notes behind each decision. The platform is designed to encode a payer's own coverage policies so it can compare them against a patient's longitudinal record without requiring integration marathons or sensitive data handoffs.
Penguin Ai
Penguin Ai is a healthcare-native agentic AI platform built to chip away at the roughly $1 trillion in administrative waste choking U.S. healthcare. Founded by former chief data officers from UnitedHealthcare, Kaiser Permanente and Optum, the company ships Gwen, a build-your-own AI environment that turns plain-language prompts into containerized digital workers for prior auth, claims, coding and payment integrity.
Fawad Butt
Fawad Butt is the co-founder and CEO of Penguin AI, a Palo Alto-based healthcare AI platform company that raised $29.7M in Series A funding in September 2025. A former Chief Data Officer at Kaiser Permanente, UnitedHealthcare, and Optum, Butt spent years on the buyer side spending hundreds of millions on generic tech before deciding to build the solution healthcare actually needed. Penguin AI targets the $1 trillion annual administrative burden in US healthcare with purpose-built agentic AI, small language models, and digital workers that compress prior authorization reviews from 30 minutes to under two, positioning itself as 'the Epic of the healthcare back office.'