Is Revolutionizing Prior Authorization With AI And Mayo Clinic’s Data

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The healthcare sector has long grappled with the complexities of prior authorization, a process that requires doctors to obtain approval from health insurance companies before performing certain medical procedures., a promising startup, aims to streamline this process using advanced AI techniques.

The Challenge of Prior Authorization

Prior authorization, while designed to prevent unnecessary procedures and control healthcare costs, often results in delayed or abandoned care. The administrative overhead associated with this process accounts for a significant portion of U.S. healthcare expenditures, ranging between 20% and 34%.

A Call for Digital Transformation

The Centers for Medicare & Medicaid Services (CMS) recently proposed a shift towards digitizing the prior authorization process, emphasizing the need to alleviate the burden it places on the healthcare system. This move has opened doors for tech companies to introduce innovative solutions that enhance the utilization of healthcare data.


Founded in early 2022 by Amber Nigam and Jie Sun, both alumni of Harvard’s health data science program, is poised to transform the prior authorization landscape. The company employs generative AI and deep learning to power its engine, which can automate up to 90% of prior authorization requests with high accuracy. Impressively, this engine is trained on extensive data from the Joslin Diabetes Center and Mayo Clinic, encompassing over 10 million patients.

A Unique Approach to Prior Authorization stands out by offering a solution that doesn’t require sensitive data from insurance companies or doctors. This approach significantly reduces integration time, making the platform more accessible and efficient. By automating the encoding of payer policies, can also expedite timelines with health plans, outpacing many of its competitors.

Funding and Future Prospects has successfully secured $2.4 million in pre-seed funding, with notable investors like Eli Lilly (Lilly Ventures), Mayo Clinic, and Nina Capital backing the venture. The company initially targeted providers but has since shifted its focus to health insurance companies. With ongoing pilots in Massachusetts and Minnesota, is on a trajectory to redefine prior authorization in the healthcare sector.

A Vision for Comprehensive Healthcare envisions a future where decisions regarding prior authorization are not just based on a few attributes but consider a plethora of patient information. This nuanced approach, combined with a deep understanding of insurance company policies, ensures that prior authorization requests are resolved efficiently and effectively.