Backbone
Backbone deploys domain-specific AI agents to review clinical records against live payer policies, validating medical necessity, coding, and compliance before authorization or billing submission. The platform integrates with EMR systems and payer mix to begin certifying claims within 30 days, reducing denials and improving first-pass yield. Backbone stands behind approved claims with guarantees including anti-clawback protections and paid-or-credit on coverage.
- Healthcare Technology
- AI Agents
- Artificial Intelligence
- Digital Health
- Regulatory & Compliance Technology
- Software Only
Funding
Funding not disclosed
Founders
Founder details are not available yet.
Product
Problem
Healthcare providers face high rates of claim denials and revenue loss due to incomplete authorizations, coding errors, and non-compliance with complex, ever-changing payer policies. Manual chart review is inconsistent, costly, and cannot scale across every claim, leading to avoidable rework and delayed reimbursements.
Solution
Backbone deploys expert, domain-specific AI agents to proactively review the full clinical record against live payer policies and contracts, both pre-service and pre-bill. The platform validates medical necessity, coding, modifiers, and bundling rules, ensuring every authorization and claim is complete, compliant, and fully substantiated before submission. It provides denial risk alerts and targeted next steps for pre-service validation, and plan-specific edits with bundling/carve-out detection for pre-bill compliance. Backbone only greenlights claims that meet all requirements, and stands behind those approvals with claim guarantees, including anti-clawback protections and paid-or-credit on coverage.
Target Audience
Primary customers are healthcare providers, including specialty practices and health systems, that need to reduce claim denials, improve first-pass yield, and recover revenue from their existing payer mix and EMR workflows.
Features
- Medical-grade agentic AI that reviews 100% of charts against live payer rules and contracts
- Pre-service validation including commercial and LCD/NCD checks, denial risk alerts, and targeted next steps
- Pre-bill compliance with plan-specific edits, coding and modifier validation, and bundling/carve-out detection
- Integration with EMR systems and payer mix to begin certifying auth and claim correctness within 30 days
- Claim guarantees including anti-clawback protections and paid-or-credit on coverage for approved claims