With over 1,000 insurance Companies in the United States, calculating how to pay each company is a complex challenge for doctors and hospitals.
Every insurance can require slightly different information about medical claims, even for the same procedure. Incorrectly presented claims can lead to denied coverage, requiring manual return and delayed payments.
According to Nick Perry, co -founder and general manager of Applicant HealthMost medical claims Neos result from hereditary billing suppliers struggling to hold rhythm with the growing complexities of modern health care.
After five years at Palantir, Perry founded candidate health in 2019 with the aim of simplifying medical billing by automating claims and removing manual work for billing teams.
Since then, the company has attracted a growing number of telephone suppliers, including AllaraNutritious, and Talcatrioand recently began adding large medical groups as clients. In 2024, the revenue of a candidate grew almost 250%.
Investors noticed the company’s rapid growth. On Wednesday, a candidate announced that it raised $ 52.5 million from a series C led by OAK HC/FT and existing investors. The round comes six months after the $ 29 million series B, which was led by 8VC with the participation of returning supporters first round capital, Boxgroup, and Y Combinator.
Perry built the company by hitting his experience Palantir, where he witnessed the power of data analysis primarily. Medical billing is ultimately a problem of data engineering, he told Techcrunch.
“Problems of a flag of legacy systems with claims, and return them to suppliers to fix the claim,” Perry said. But sincere health claims that it has developed, and is constantly refining, a sophisticated rule engine that allows providers to send accurate claims to insurance companies in the first attempt.
To date, a candidate has not supported himself to generative AI, but some of the latest funds will go to implementation of the latest machine learning techniques. For example, AI can identify claim types constantly refused by insurers, enabling Candit’s system to correct those claims before they are presented.
The company will eventually build an AI-operated function, which can call insurance companies on refused claims. But the final goal of the company is to avoid those calls altogether.
“Don’t have to be a non -phone call,” Perry said. “It’s much better just to send the claim right for the first time.”
In addition to competing with hereditary billing systems, many of which are built by electronic health registrations such as Epic and Athenahealth, candidate health competes with startups appearance and Adonis, which is supported by Point72 Ventures and General Catalyst.
