You must be aware that in healthcare, you need to have a mediclaim in order to relieve the burden of expenses that you incur when you need something performed on your or your relative on an urgent basis. It is obvious that you might not have the availability of cash at that time so mediclaim really helps. Now, there is a term called pre authorization which is basically an approval given to the doctor by health insurance company to perform the said procedure such as surgery. There is a new startup named Basys.ai which is trying to simplify this prior authorization process by 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 that “This translates to flattening the cost curve for patients and reducing administrative burden by leveraging AI.” Nigam added, “We also ensure we have a lot of information about the patients. 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. Once you match these policies with the patient information, then resolving a prior authorization request is more nuanced.”

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 that “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.” which should help them grow even further in this field.