Arbiter provides a cloud‑native care‑orchestration platform that integrates with existing EHR and payer systems via FHIR APIs to create a unified longitudinal patient record. Its agentic AI engine detects clinical gaps, automates referrals, prior authorizations, and patient outreach, and routes patients to in‑network providers, reducing administrative overhead and improving care timeliness for health systems and payers.
Funding
Funding not disclosed
Founders
Product
Problem
Healthcare delivery suffers from fragmented clinical, financial, and policy data across patients, payers, and providers. This fragmentation creates inefficiencies in referrals, prior authorizations, and care coordination, contributing to significant waste and delayed treatment.
Solution
Arbiter delivers a modular care‑orchestration platform that embeds directly into existing electronic health record (EHR) and payer workflows. The platform’s Record‑Action‑Alignment engine consolidates disparate data sources into a longitudinal “single source of truth,” applies agentic AI to recommend and execute the next optimal care step, and continuously monitors outcomes to keep all stakeholders synchronized. By surfacing real‑time clinical gaps, routing patients to the most appropriate in‑network providers, automating prior authorizations, and engaging patients through multi‑channel outreach and scheduling, Arbiter reduces administrative overhead and improves care timeliness. The solution is delivered as a cloud‑native service with APIs that support FHIR‑based integration, enabling health systems to scale coordination without replacing legacy infrastructure.
Target Audience
Primary customers are large health systems, integrated delivery networks, and commercial payer organizations that manage extensive provider networks and seek to streamline referral, authorization, and patient engagement processes.
Features
- Unified data layer that ingests clinical, claims, and policy information into a longitudinal patient record accessible via standard FHIR APIs
- Agentic AI engine that generates and executes real‑time care recommendations, including referral creation and prior‑authorization submission
- Gap‑detection module that monitors quality metrics and risk‑adjustment data to trigger evidence‑based referral alerts within the EHR
- Provider graph and routing engine that matches patients to in‑network providers based on cost, quality, and capacity, reducing leakage and optimizing site‑of‑care selection
- Automated prior‑authorization workflow that parses payer criteria, populates required fields, and submits requests directly to payer portals
- Patient engagement suite offering SMS, email, and portal notifications, real‑time appointment scheduling, reminders, and follow‑up tracking to improve completion rates
- Closed‑loop analytics dashboard that visualizes outcomes, tracks performance metrics, and continuously refines AI models through outcome feedback
- Seamless embedding via lightweight SDKs for major EHR platforms, supporting point‑of‑care use without disrupting existing clinical workflows