You must be aware that in healthcare, you need to have a mediclaim to relieve the burden of expenses you incur when you urgently need something performed on you or your relative. You might not have cash available at that time, so mediclaim helps. Now, there is a term called pre-authorization, which is approval given to the doctor by the health insurance company to perform the said procedure, such as surgery. A new startup named Basys.ai is trying to simplify this prior authorization process using Generative AI. The company was founded in early 2022 by Amber Nigam and Jie Sun, who met while in Harvard’s health data science program. Amber Nigam told TechCrunch that “Basys combines generative AI and deep learning to power its “engine,” which can automate up to 90% of the prior authorization requests for drugs and procedures at high accuracy”.
Basys.ai founder Amber Nigam said, “The engine is trained on extensive Joslin Diabetes Center and Mayo Clinic’s longitudinal data of more than 10 million patients,” and added, “This translates to flattening the cost curve for patients and reducing administrative burden by leveraging AI.” Nigam said, “We also ensure we have much patient information. Sometimes, when you make decisions, it is not entirely based on one or two attributes; it’s based on hundreds or thousands of attributes along with the understanding of the insurance company’s policies. Resolving a prior authorization request is more nuanced once you match these policies with the patient information.”
He added, “Basys initially began selling to providers and had been bringing in revenue, but has since pivoted its business model to selling to health insurance companies. It is now initiating pilots with two large payers in Massachusetts and Minnesota.” The report adds, “The company is also working on capturing patient outcomes through reducing readmission rates and determining if the progression of the patient’s disease has stopped or slowed down.” This should help them grow even further in this field.
