ClaimInformatics

ClaimInformatics discovers and recovers improper payments on behalf of employers and administrators. It develops a HIPAA Compliant system that provides new levels of accuracy and transparency for improved payment integrity. The platform is designed to provide a granular forensic review of all healthcare claim transactions. ClaimInformatics handle recovery and reconciliation of improper payments as well as detection of fraud, waste, and abuse. The Bloomfield, Connecticut-based company was established by Stephen Carrabba, Dawn Cornelis, and Steven Shepherd in 2017.

ClaimInformatics is a healthcare technology company specializing in payment integrity and healthcare cost containment. Founded in 2017, the company offers a SaaS-based solution to support health plans in addressing new transparency regulations. ClaimInformatics' core focus is on identifying and recovering improper payments in healthcare claims, with the aim of combating fraud, waste, and abuse in the healthcare system.

Plan administrators should make payment integrity reviews a part of their process

Healthcare Payment Integrity

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State attorney general releases taxpayer-paid audit on health claims | Victor Ashe

PatientRightsAdvocate.org Launches Hospital Price Files Finder — PatientRightsAdvocate.org

Simplifying healthcare administration with intuitive tech tools

Hospital Management

ClaimInformatics is a healthcare technology company specializing in payment integrity and healthcare cost containment. Founded in 2017, the company offers a SaaS-based solution to support health plans in addressing new transparency regulations. ClaimInformatics' core focus is on identifying and recovering improper payments in healthcare claims, with the aim of combating fraud, waste, and abuse in the healthcare system.
The company's proprietary platform, ClaimIntelligence, reviews claims before they are paid to ensure billing and pricing accuracy. This proactive approach can decrease a plan's healthcare spend by 10-25%. For claims that have already been paid, ClaimInformatics assists in identifying overpayments and recovering plan assets, potentially recouping 5-15% of paid plan assets. The company's technology and services are designed to help plan administrators and fiduciaries ensure compliance and protect plan assets against overbilling and fraudulent practices.
ClaimInformatics' approach involves a thorough examination of claims data, focusing on three main areas: claims not paid correctly (which account for 5-10% of all claims), opportunities for improvement in member interest, and claims that are fundamentally incorrect. The company's efforts have reportedly led to the recovery of hundreds of millions of dollars in improper payments through pre- and post-payment technology programs.
Key customers and partnerships
ClaimInformatics works with a range of clients, including Fortune 100 companies, financial institutions, healthcare organizations, unions, and government entities. The company has partnered with the Self-Insurance Institute of America, with one of its cofounders serving on the organization's price transparency committee. This committee focuses on legislation and education for self-funded entities. ClaimInformatics also collaborates with benefit consultants to help employer clients comply with federal transparency regulations.

Modernizing Medicine is a healthcare technology company that specializes in developing cloud-based electronic health record (EHR) systems and solutions tailored for specific medical specialties. Their flagship products, EMA and gGastro EHR, are designed to streamline clinical workflows and documentation processes, saving time for healthcare providers. These intuitive platforms incorporate built-in medical knowledge and can adapt to individual practice preferences.
Beyond EHRs, Modernizing Medicine offers an integrated suite of products and services, including practice management, revenue cycle management, endoscopy report writing, analytics, and advisory services. Their solutions aim to address the challenges of value-based care, such as population health management, quality measure reporting, and optimizing reimbursements.
Modernizing Medicine's innovative EHR architecture emphasizes speed, convenience, and adaptability, enabling doctors to complete exams efficiently. The systems can generate notes, suggest codes, and automate billing processes, reducing administrative burdens.
In November 2022, Modernizing Medicine agreed to pay USD 45 million to resolve allegations of accepting and paying illegal kickbacks, as well as causing users to report inaccurate information for federal incentive payments. The settlement addressed three marketing programs alleged to have violated the False Claims Act and the Anti-Kickback Statute.

Modernizing Medicine

Kyruus Health is a leading provider of care access solutions that connect patients with the right healthcare providers. The company's platform integrates comprehensive provider data, enabling informed decisions and seamless access to care across various touchpoints. Kyruus Health's offerings include provider search and scheduling tools, cost transparency solutions, and data management capabilities.
Kyruus Health's technology facilitates provider matching, appointment scheduling, and digital patient intake processes. The platform enhances the overall patient experience by streamlining access to care and ensuring transparency regarding provider expertise, availability, and costs. Additionally, Kyruus Health's solutions empower healthcare organizations, such as hospitals, medical groups, and health plans, to optimize provider utilization and comply with industry mandates.
Through strategic acquisitions and partnerships, Kyruus Health has expanded its network to encompass over 425,000 providers across more than 1,000 hospitals and 500 medical groups. As of 2023, the company served over 90 million health plan members from 100 different health plan brands, solidifying its position as a leading care access platform.
Key customers and partnerships
In July 2024, Kyruus Health announced a strategic partnership with XO Health, an innovative healthcare services organization designed for self-insured employers. This collaboration aimed to enhance XO Health's digital member experience by integrating Kyruus Health's provider search and cost transparency tools, ultimately creating a seamless healthcare journey for members, providers, and payers.
Furthermore, in May 2024, Kyruus Health expanded its national provider network by integrating virtual behavioral health providers, demonstrating its commitment to improving access to mental health services. This expansion added over 30,000 virtual behavioral health providers to the Kyruus Network, enabling health plans, hospitals, and medical groups to seamlessly integrate these providers into their online directories and address access gaps.
Kyruus Health also partnered with WellHive and V3 Gate to support the Veterans Health Administration (VHA), aiming to improve care for all Veterans by accelerating access to care through centralized appointment management across VHA sites.

Kyruus

AKASA is a healthcare technology company that leverages advanced generative AI and machine learning models to address administrative inefficiencies and financial challenges in the revenue cycle management (RCM) process. Their AI solutions are specifically trained on vast amounts of clinical and financial data to comprehend the nuances of the healthcare industry.
AKASA's platform is powered by large language models and generative AI capabilities akin to ChatGPT, but optimized and tailored for the healthcare domain. Their AI understands clinical context, grasps the intricate details of health systems, and is designed to integrate directly into staff workflows, enabling automation of routine tasks and improving operational efficiencies.
The company takes an "expert-in-the-loop" approach called Unified Automation, which combines machine learning with human expertise. This allows their technology to adapt to the dynamic nature of revenue cycle operations while benefiting from the judgement of AKASA's in-house team of RCM veterans with an average of over 15 years of industry experience.
AKASA's solutions aim to reduce the substantial administrative waste associated with billing and insurance communication failures, estimated at over USD 500 billion annually in the USD 4 trillion healthcare industry. By automating comprehensive and complex tasks, AKASA enables healthcare providers to reallocate staff toward patient-facing activities and enhance care delivery.

AKASA

XSOLIS is an AI technology company that offers a platform and solutions to create a more efficient healthcare system by facilitating improved communication and alignment between healthcare providers and payers. The company's flagship product, CORTEX, is an AI-driven platform that utilizes real-time predictive analytics to continuously assign an objective medical necessity score and assess the anticipated level of care for every patient. This technology aims to eliminate waste by leveraging data science, automation, transparency, and objective insights to ensure appropriate care settings.
XSOLIS's solutions streamline patient status communications, enabling providers and payers to align on medical necessity, length of stay timelines, and appropriate care levels. The platform's AI capabilities enable the creation of live clinical profiles for each patient, recognizing patterns to generate predictive analytics for determining the most suitable care setting. CORTEX reduces the administrative burden of case reviews through its proprietary Care Level Score (CLS), allowing teams to prioritize discharge planning tasks and driving optimal workflows.
By August 2022, XSOLIS achieved a three-year revenue growth of 388%, ranking No. 1795 on the 2022 Inc. 5000 list of America's fastest-growing private companies. The company reported 111% growth in its payer network and a 44% increase in hospital partnerships in the same year.

XSOLIS

Suki AI is a healthcare technology company that develops an AI-powered voice assistant, Suki Assistant, designed to help clinicians complete administrative tasks efficiently. The Suki Assistant utilizes natural language processing and generative AI to transcribe conversations between clinicians and patients into clinical notes, populating electronic health records (EHRs) with relevant data. By automating documentation, the company aims to reduce the time clinicians spend on paperwork, claiming to shrink it by as much as 72% in family medicine settings.
Suki Assistant offers multiple modes, including ambient note generation, dictation, and voice commands. The ambient mode leverages generative AI to listen to clinician-patient interactions and auto-generate clinical notes in real-time without human intervention. Clinicians can accept, reject, or edit the AI-generated content to ensure accuracy. In addition to documentation, Suki Assistant can retrieve patient information, such as medication lists and allergies, from EHRs and provide diagnosis code recommendations.
Suki Assistant is deeply integrated with major EHR systems, including Epic, Cerner, athenahealth, Elation, and Meditech, enabling bidirectional synchronization of notes and codes. The company expanded its capabilities to support inpatient care settings in October 2023, making it the first AI-powered voice solution tailored for clinicians in hospitals. Suki Assistant operates across various platforms, including iOS, Android, web, Windows, Mac, and as a Chrome extension.
In October 2023, Suki announced the acquisition of an undisclosed company to enhance its personalization features, allowing the assistant to adapt to individual user preferences and existing workflows.

Suki

Platforms used by hospitals to manage the various aspects of patient care to improve overall efficiency, such as automating routine tasks, improving communication and coordination among healthcare providers, and enhancing patient outcomes within the hospital setting

Platforms that enable patients to actively participate in their healthcare journey by educating and engaging them, along with improving communication with healthcare providers

Platforms that help healthcare organizations analyze patient data and other performance metrics to improve decision-making and optimize resource allocation

Platforms that are designed to help hospitals and health systems manage their financial operations from patient billing and insurance claims to revenue tracking and analysis

AI-powered software solutions that are designed to help healthcare organizations streamline and automate the process of documenting patient encounters

Companies that use GenAI as a core part of their product offering for hospital management

IoT medical solutions turn traditional hospitals into smart hospitals, allowing them to streamline workflows

AI/ML algorithms optimize workflows, enable predictive modeling, and analyze patient data in healthcare

Offers software platforms that streamline and improve hospital operations

ClaimInformatics

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