About Avelis Health

Avelis Health offers an AI-powered platform that audits medical claims to identify and recover overpayments for self-funded health plans. It also automates the process of securing financial assistance from non-profit hospitals for patients, optimizing plan spend and ensuring members receive eligible benefits.

<problem> Self-funded health plans incur significant annual spend due to erroneous medical claims that do not adhere to contracted terms. This leads to budget overruns, increased employee premiums, and reduced coverage effectiveness. Additionally, many patients do not receive the financial assistance they are eligible for from non-profit hospitals, resulting in missed savings opportunities for plans. </problem> <solution> Avelis Health provides an AI-powered post-payment audit engine designed to identify and recover overpayments from medical claims. The platform enforces contracted plan terms by analyzing claim data and retrieving necessary medical records to detect complex billing errors. Beyond claim recovery, Avelis Health also automates the process of identifying and applying for financial assistance from non-profit hospitals on behalf of patients. This dual approach optimizes health plan spend by reducing erroneous payouts and leveraging available patient assistance programs. The system offers real-time dashboards for transparent tracking of recovered funds and identification of recurring billing error patterns. </solution> <features> - AI-driven post-payment audit engine for identifying billing discrepancies and enforcing contracted plan terms. - Automated medical record retrieval to support claim validation and error detection. - Machine learning models trained to detect complex and hard-to-identify billing errors. - Automated screening and application process for non-profit hospital financial assistance programs. - Real-time savings dashboard with claim-by-claim reporting and trend analysis of billing errors by facility. - Audit trails designed to support ERISA compliance and fiduciary protection for plan sponsors. - Secure data handling and processing to maintain confidentiality and integrity of financial and medical information. </features> <target_audience> The primary customers are self-funded health plan sponsors, including employers and Taft-Hartley plans, seeking to reduce healthcare expenditures and ensure compliance. </target_audience> <revenue_model> Revenue is generated through a performance-based model, taking a percentage of recovered funds from erroneous claims and successfully applied financial assistance. </revenue_model>

What does Avelis Health do?

Where is Avelis Health located?

Avelis Health is based in San Francisco, United States.

When was Avelis Health founded?

Avelis Health was founded in 2025.

How much funding has Avelis Health raised?

Avelis Health has raised 500000.

Location

San Francisco, United States

Founded

2025

Funding

500000

Employees

2 employees

Major Investors

Y Combinator

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Avelis Health

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Executive Summary

avelishealth.com 700+

Crunchbase

Founded 2025 – San Francisco, United States

Funding

Estimated Funding

$500K+

Major Investors

Y Combinator

Team (<5)

No team information available.

Company Description

Problem

Self-funded health plans incur significant annual spend due to erroneous medical claims that do not adhere to contracted terms. This leads to budget overruns, increased employee premiums, and reduced coverage effectiveness. Additionally, many patients do not receive the financial assistance they are eligible for from non-profit hospitals, resulting in missed savings opportunities for plans.

Solution

Avelis Health provides an AI-powered post-payment audit engine designed to identify and recover overpayments from medical claims. The platform enforces contracted plan terms by analyzing claim data and retrieving necessary medical records to detect complex billing errors. Beyond claim recovery, Avelis Health also automates the process of identifying and applying for financial assistance from non-profit hospitals on behalf of patients. This dual approach optimizes health plan spend by reducing erroneous payouts and leveraging available patient assistance programs. The system offers real-time dashboards for transparent tracking of recovered funds and identification of recurring billing error patterns.

Features

AI-driven post-payment audit engine for identifying billing discrepancies and enforcing contracted plan terms.

Automated medical record retrieval to support claim validation and error detection.

Machine learning models trained to detect complex and hard-to-identify billing errors.

Automated screening and application process for non-profit hospital financial assistance programs.

Real-time savings dashboard with claim-by-claim reporting and trend analysis of billing errors by facility.

Audit trails designed to support ERISA compliance and fiduciary protection for plan sponsors.

Secure data handling and processing to maintain confidentiality and integrity of financial and medical information.

Target Audience

The primary customers are self-funded health plan sponsors, including employers and Taft-Hartley plans, seeking to reduce healthcare expenditures and ensure compliance.

Revenue Model

Revenue is generated through a performance-based model, taking a percentage of recovered funds from erroneous claims and successfully applied financial assistance.