With over 1,000 insurance firms within the U.S., determining how one can receives a commission by every firm is a posh problem for medical doctors and hospitals.
Every insurance coverage could require barely totally different data on medical claims, even for a similar process. Incorrectly filed claims can result in denied protection, requiring guide resubmission and delayed funds.
Based on Nick Perry, co-founder and CEO of Candid Health, most medical declare denials consequence from legacy billing system suppliers struggling to maintain tempo with the growing complexities of contemporary healthcare.
After 5 years at Palantir, Perry co-founded Candid Well being in 2019 with the purpose of simplifying medical billing by automating claims submissions and eliminating guide work for billing groups.
Since then, the corporate has attracted a rising variety of telehealth suppliers, together with Allara, Nourish, and Talkiatry, and has lately begun including giant doctor teams as clients. In 2024, Candid’s income grew almost 250%.
Traders seen the corporate’s quick development tempo. On Wednesday, Candid introduced that it raised a $52.5 million Sequence C led by Oak HC/FT and current buyers. The spherical comes six months after Candid’s $29 million Sequence B, which was led by 8VC with the participation of returning backers First Spherical Capital, BoxGroup, and Y Combinator.
Perry constructed the corporate by drawing on his Palantir expertise, the place he witnessed the facility of knowledge analytics firsthand. Medical billing is in the end a knowledge engineering drawback, he instructed TechCrunch.
“Legacy techniques flag issues with claims, and ship them again to suppliers to repair the declare,” Perry stated. However Candid Well being claims that it has developed, and frequently refines, a complicated guidelines engine that enables suppliers to submit correct claims to insurance coverage firms on the primary strive.
To this point, Candid hasn’t leaned into generative AI, however a number of the newest funding will go towards implementing the most recent machine studying strategies. As an example, AI can determine declare varieties constantly denied by insurers, enabling Candid’s system to right these claims earlier than they’re submitted.
The corporate could finally additionally construct an AI-powered characteristic that may name insurance coverage firms about denied claims. However the firm’s final purpose is to keep away from these calls altogether.
“There shouldn’t need to be a denial telephone name,” Perry stated. “It’s a lot better to only submit the declare appropriately the primary time.”
Along with competing with legacy billing techniques, a lot of that are constructed by digital well being file firms like Epic and Athenahealth, Candid Well being competes with startups Apero and Adonis, which is backed by Point72 Ventures and Basic Catalyst.