AI Startups Continue to Target Inefficient Administrative Processes

This month Healthcare Innovation has done several interviews with health system execs and startups around how improved interoperability and artificial intelligence are impacting administrative processes such as prior authorization. For instance, we spoke with Innovaccer CEO Abhinav Shashank about his company’s approach, and Cohere Health’s Matt Parker about the challenges of meeting the CMS Interoperability and Prior Authorization Final Rule.

The pace at which solutions are being introduced in this space — both by established vendors and AI startups — is accelerating. A New York-based startup called Silna Health, which has raised $27 million in funding led by Accel and Bain Capital, has created a Predictive Document Intelligence solution that evaluates whether clinical documentation meets payer- and specialty-specific requirements before a prior authorization is submitted.

In another deal announced this month, agentic AI company Ascertain announced a partnership with Cardiovascular Associates of America (CVAUSA), the nation's largest cardiovascular network, to deploy AI-powered technology to streamline operations and care administration across CVAUSA's network of more than 460 cardiologists and 290 advanced practice providers. 

Cardiology practices face an especially high administrative burden given the volume and complexity of advanced diagnostic imaging and interventional procedures involved in cardiac care. By automating manual data entry, documentation assembly, and payer communications, Ascertain said its platform enables clinical teams to redirect time toward patient care while improving throughput and reducing operational costs.

"At CVAUSA, our mission is to empower cardiovascular specialists to transform patient care. Prior authorizations have long created delays for patients who need timely access to cardiac imaging and procedures,” said Ben Diestel, senior vice president of innovation at CVAUSA, in a statement. “Ascertain’s agentic AI platform gives us the ability to address that challenge at scale, freeing our physicians and staff to focus on what they do best: saving lives. This partnership reflects our commitment to operational excellence and our vision for more efficient cardiovascular care delivery."

In a recent conversation with Healthcare Innovation, Silna Health co-founder and CEO Jeff Morelli explained the potential of his company’s solution.

“When we get supporting documentation for a prior authorization, our AI is able to analyze all the information, extract the information from those fields, and then complete the annotation summary of a prior authorization,” Morelli explained. 

Each payer has a different summary that you essentially have to submit when it comes to that prior authorization, he explained. A lot of the times that a prior authorization is denied, it is actually due to clerical errors or not understanding clinical guidelines, he added. “We’ve evolved this over the last couple of quarters to a point now that our AI actually analyzes all this supporting documentation, compares it against clinical guidelines, and then before we submit the authorization, we actually flag it to a provider: ‘Hey, this is likely to be denied because you're missing this information. Would you like to update it? Or would you like to submit it anyhow?’ And we're seeing some very promising results of our system catching those errors.”

Payers are constantly updating their clinical guidelines and what they're looking for in a prior authorization, Morelli added. “We have an AI system that can dynamically understand these changes and then actually flag to a provider before we submit them if it's likely to be denied.”

Silna said that prior authorization requests submitted using its technology are accepted 24.5% faster, and prior authorizations validated with the platform achieve a 98% first-pass acceptance rate. 

Morelli explained why Silna started deployed its solution in autism therapy and physical therapy specialties before rolling it out more broadly. 

“We started off initially in autism therapy and physical therapy because for autism therapy, the prior authorizations are very complex. You're typically requesting tens of thousands of dollars of service because it's service for six months, and potentially 35 hours a week,” he said. “Physical therapy is a very high-volume segment of the healthcare industry. It’s one of the most common types of healthcare that the average American will engage with every single year. By starting off in those two areas, it forced us to build a high-complexity, high-volume system, which has now allowed us to expand into 10 or so different segments. We're in speech therapy, occupational therapy, senior living, and cardiac rehab. I think it was that discipline to focus on these two segments that were distinct enough that really allowed us to build a more generalized approach.”