prior-authorization
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The Company Trying to Make Prior Authorization Disappear Before the Doctor Leaves the Room
Rhyme spent a decade turning healthcare's least musical ritual - portals, phone trees and fax machines - into a shared data network. Its next trick is harder: making the authorization vanish at the point of care.
Mel van Londen Is Teaching AI to Finish Healthcare's Paperwork
A former sailing captain, IDEO developer, and healthcare product leader has spent his career learning how complicated systems behave. At Develop Health, he is applying that education to the forms between a prescription and the person waiting for it.
The Surgeons Who Taught Software to Argue With Insurance Companies
Prior authorization is the paperwork chokepoint that delays surgeries and burns out staff. ClinicalBox built an AI that does the arguing - reading the chart, matching the policy, and building the case in about a minute.
The MRI Wasn't Broken. The Referral Was.
Medmo built a business around the least glamorous part of radiology: everything between a doctor's order and a usable result. After more than one million patient journeys, that connective tissue became valuable enough to reshape the company.
Kshitij Jaggi Is Turning Oncology’s Back Office Into a System of Action
The RISA co-founder has spent a decade learning that software only matters when it moves work. His latest bet is an AI operating layer built for the forms, portals, policies, and handoffs that decide how quickly oncology operations can run.
Waystar
The company that runs the plumbing behind American medical bills is betting AI can drain billions in administrative waste - and half the country's patients are already in its pipes.
Beacon Health
Beacon Health is a Y Combinator (W26) startup building AI agents that operate real electronic health record systems the way a human employee would - clicking through Epic, athenahealth, and eClinicalWorks to close care gaps, capture risk adjustment codes, handle prior authorizations, and run preventative screening outreach. Aimed at primary care practices in value-based care arrangements, the product turns recorded EHR workflows into deployable agents so small practices can chase quality measures and shared-savings revenue without hiring more back-office staff. Founded in 2025 by Mark Pothen and Obinna Akahara, the company has gone live with an independent physician association covering roughly 40,000 patients.
Insurf
Insurf is an AI-native decision and data layer for U.S. health insurance. Its first product, Inveto, turns denied healthcare claims into source-cited, physician-attested appeals so medical practices recover revenue they would otherwise write off. Each resolved claim feeds a proprietary coverage-decision graph of real payer behavior, which powers a second product, Surely, that prices the true cost of a health plan for employers and brokers. Founded in 2026 by Chang Lu and Bryan Chung, the company is part of Y Combinator's Summer 2026 batch and is based in San Francisco.
Daniel Friedman
Daniel Friedman is the CEO and cofounder of Ethermed, a Philadelphia-based health technology company that uses AI and clinical reasoning to automate prior authorization for payers and providers. He founded the company in 2021 with engineer Michal Such after concluding that administrative friction in healthcare was a solvable software problem rather than a permanent cost of doing business. Under his leadership Ethermed raised an $8.5M Series A in 2026 (over $15M total), signed nine health-system customers, and now processes millions of authorizations a year, most of them fully automated in seconds.
Autonomize AI
Autonomize AI is an Austin-based healthcare technology company building an AI-native platform - the 'Autonomize Intelligence Platform' - that embeds governed, agentic AI directly into clinical and operational workflows for health plans, providers, and life sciences organizations. Founded in 2022 by Ganesh Padmanabhan and Kris Nair, the company turns mountains of unstructured healthcare data into structured intelligence, deploying pre-built AI agents and copilots for tasks like utilization review, prior authorization, care management, and clinical chart review. It says its systems save roughly 36,000 clinical hours per month across Fortune 100 healthcare customers, and it raised a $28 million Series A in June 2025 led by Valtruis, The Cigna Group Ventures, and Tau Ventures.
Conduit Health
Conduit Health is a New York-based healthcare technology company that rebuilds the path to insurance-covered home medical supplies for Medicare and Medicaid patients. It combines clinical evaluation, insurance authorization, and physical supply fulfillment into one vertically integrated platform, powered by CareOS - an agentic AI engine trained on 50,000+ patient interactions that predicts approval likelihood and automates payer paperwork. Founded in 2024 by Natan Wise and Rocky Seftel, Conduit has delivered supplies to more than 50,000 patients and works with 100+ health plans covering nearly 90 million lives.
Ethermed
Ethermed is a Philadelphia-based health technology company that uses large language models and clinical reasoning to automate prior authorization - the paperwork-heavy approval process between healthcare providers and insurers. Its platform intercepts physician orders, gathers documentation, compares payer guidelines, fills forms and submits requests with an audit trail, cutting approval times from days to minutes. Founded in 2021 by Dan Friedman and Michal Such, the company raised an $8.5M Series A in April 2026, bringing total funding above $15M.
Forus
Forus is a New York-based healthtech company (formerly Tandem Technology, Inc.) that runs an AI-powered network connecting doctors, pharmacies, payers, and biopharma to get prescribed medications to patients faster. Its software embeds in physician workflows and automates the administrative steps between a clinical decision and a patient starting treatment - prior authorization, benefit verification, financial assistance, and pharmacy routing. Free for doctors and patients, Forus earns revenue through pharmaceutical partnerships. Founded in 2023 by former Oscar Health product leader Sahir Jaggi, the company reached a reported $1 billion valuation in May 2026 with backing from Thrive Capital, General Catalyst, and Accel.
Insight Health AI, Inc.
Insight Health AI is a physician-built healthcare technology company in Austin, Texas that builds voice-first and chat-based AI agents to automate routine clinical and administrative work - from patient intake, phone triage, and fax and referral processing to ambient clinical documentation. Founded in 2023 by a former Segment sales-engineering leader and two practicing physicians, the company sells its Lumi care assistant, Aura AI scribe, and specialty-specific agents to clinics and regional health systems. It raised an $11M Series A led by Standard Capital in April 2026, and reports more than 3 million autonomous patient interactions and roughly $50 million in annualized administrative savings across its customers.
Silna Health
Silna Health is a New York-based healthcare technology company that built what it calls the first ever "care readiness platform." It uses AI paired with insurance specialists to handle prior authorizations, benefit checks, and insurance monitoring upfront - clearing patients for care before their appointments. Founded in 2023 by Jeffrey Morelli, Pavel Asparouhov, and Sagar Jajoo, the company has raised $27 million from Accel and Bain Capital Ventures and says it has cut pre-visit insurance verification from roughly 30 minutes to 30 seconds.
Synthpop - Healthcare AI
Synthpop is a Cambridge, Massachusetts healthcare AI company building agentic automation that eliminates administrative bottlenecks across payer, provider and patient operations. Its platform combines document intelligence, payer-aware reasoning and conversational voice agents into one coordinated system that automates as much as 80% of healthcare back-office processes - referrals, prior authorizations, eligibility checks and claims follow-ups - by integrating directly with EHR, billing and e-prescribe systems. Founded in 2023 by Elad Ferber and Jan Jannink, the company has raised $23M total, including a $15M Series A in February 2026.
Vim
Vim is a healthcare technology company that builds a middleware and developer platform connecting data to clinical workflow at healthcare's 'last mile' - the point of care. Its EHR-agnostic Vim Connect layer sits on top of popular electronic health records, pulling in insights and applications from payers, health plans, and digital-health innovators and surfacing them directly inside a provider's existing workflow. By automating tasks such as care gap closure, diagnosis capture, prior authorization, referral management, and chart retrieval, Vim helps payers and providers align on value-based care while reducing administrative burden for clinicians.
Elad Ferber
Elad Ferber is the CEO and co-founder of Synthpop, a healthcare AI company that uses multi-agent automation to handle the administrative work behind patient care - referrals, prior authorizations, eligibility checks, documentation, and claims. A former Israeli Air Force Talpiot cadet and systems engineer with a Stanford MBA, Ferber previously co-founded the remote patient monitoring startup Spry Health, which was acquired by ZOLL Itamar in 2021. Founded in 2023 with CTO Jan Jannink, Synthpop has raised $23 million to date and pitches its AI as a labor solution that compresses 40-minute back-office tasks into under a minute.
Jeffrey Morelli
Jeffrey Morelli is the co-founder and CEO of Silna Health, a New York company building an AI-powered Care Readiness Platform that automates prior authorizations, benefit checks, eligibility verification, and insurance monitoring for specialty healthcare providers. The son of a career nurse, he was the first sales hire at income-verification startup Truework and earlier worked at autism-care company Nightingale before starting Silna in August 2023 with Pavel Asparouhov and Sagar Jajoo. Silna has raised $27 million from Accel and Bain Capital Ventures and has helped more than 50,000 patients get cleared for care. In 2025 Morelli was named among the Healthcare Technology Report's Top Healthcare Technology CEOs.
100ms
100ms builds voice-first AI agents for U.S. healthcare operations. Founded in 2020 as a low-code live video and audio infrastructure platform, the company pivoted to healthcare, applying its real-time communications expertise to automate patient access workflows - benefits verification, prior authorization, referral intake, scheduling, and intake - so care teams spend less time on phones and patients start treatment faster. Its agents are built to be HIPAA-compliant, with clinical safety guardrails and human escalation.
Develop Health
Develop Health is a San Francisco Bay Area healthtech company building AI that removes the paperwork between a doctor writing a prescription and a patient actually getting it. Its EHR-integrated platform uses more than a dozen purpose-built large language model pipelines to verify insurance coverage in real time, assemble and submit the correct prior authorization package, track status, and draft appeals for denials - work that normally consumes hours of a care team's day. Founded in 2022 by former Canvas Medical and Rupa Health operators, the company raised a $14.3M Series A in August 2025 and says it cuts medication-access admin work by roughly 83% while supporting hundreds of thousands of patients a month.
RISA Labs
RISA Labs is a Palo Alto healthtech company building an AI operating system for oncology. Its platform, BOSS (Business Operating System as a Service), decomposes the paperwork-heavy work of cancer care - prior authorization, benefits verification, eligibility checks, denial management - into micro-tasks handled by a network of AI agents, digital twins, and reinforcement learners that plug into EHRs and payer portals. Founded in 2024 by IIT Kanpur alumni Kshitij Jaggi and Kumar Shivang, RISA aims to cut the days-long administrative delays that keep cancer patients waiting for treatment.
Sahir Jaggi
Sahir Jaggi is the founder and CEO of Forus, an AI-powered network (formerly known as Tandem) that automates the paperwork sitting between a doctor's prescription and a patient actually getting the drug. Forus emerged from stealth in May 2026 with $160M in funding at a $1B valuation from Thrive Capital, General Catalyst, and Accel. Before Forus, Jaggi spent six years as a product leader at Oscar Health after studying biomedical engineering and computer science at Columbia.
Acentra Health
Acentra Health is a McLean, Virginia healthcare technology and clinical services company formed in 2023 from the merger of CNSI and Kepro. It builds Medicaid and Medicare systems, care management platforms, and quality-oversight services for state and federal government health programs, combining public-sector software with clinical staff who review authorizations, assessments, and appeals. Backed by The Carlyle Group, it employs roughly 3,300-3,400 people across the U.S. and India.
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.
Lamar Health
Lamar Health is a San Francisco software company that automates the paperwork behind expensive specialty medications. Its AI-driven platform handles unified intake, insurance verification, clinical and payor requirement checks, and prior authorization submission and tracking for specialty pharmacies, infusion clinics, and home infusion pharmacies - the drugs that average around $70,000 per patient per year. Founded by Ph.D. geneticist Eesha Sharma and backed by Y Combinator (W21), Lamar aims to get patients on therapy in days instead of weeks without forcing providers to add headcount.
PARx Solutions
PARx Solutions is a Burlington, Massachusetts healthcare technology and services company that untangles one of medicine's most frustrating chores: prior authorization. Its Prior Authorization Support System (PASS) pairs a secure web portal with a call center of healthcare and reimbursement specialists who handle the paperwork and back-and-forth with health plans on a prescriber's behalf. Because the service is sponsored by drug manufacturers, it is free to physician offices and pharmacies, and it helps patients actually get the medications their doctors prescribed rather than abandoning treatment in the administrative maze.
PrescriberPoint
PrescriberPoint is a Boston-based, AI-enabled point-of-care platform that supports clinicians at every step of the prescribing journey - from researching FDA-approved drug information to checking coverage and out-of-pocket costs, submitting prior authorizations, and enrolling patients in savings programs. Spun out of work with Eli Lilly and BCG, it consolidates fragmented prescribing resources for tens of thousands of medications into one portal, and in 2025 reached more than 5 million healthcare professionals - one of the largest active HCP networks in digital health.
Sandy Health
Sandy Health is a San Francisco healthtech company building an AI-powered operations platform that acts as the financial layer for healthcare. It connects scheduling, intake, eligibility verification, prior authorization, an AI clinical scribe, and revenue intelligence into one system so providers can predict reimbursement before, during, and after every visit. Founded by cancer survivor and MIT-trained engineer Diego Saavedra-Kloss, Sandy targets the administrative friction that drains time and revenue from patient care.
Standard Practice
Standard Practice builds voice AI for healthcare revenue cycle teams. Its AI agents place outbound phone calls to insurance payors and pharmacies - dialing, navigating IVR menus, waiting on hold, and speaking in a human-sounding voice - to handle claim follow-ups, benefits verification, prior authorizations, and EDI enrollment. The goal is to strip the phone-tag drudgery out of medical billing so practices get paid more, faster, while staff focus on higher-value work. Founded by Steven Greene and Phil Markunas after pivoting from their earlier venture Nibble Health, the New York company targets the roughly $1 trillion in annual U.S. healthcare administrative costs.