ClarityCare
ClarityCare deploys Electra, an AI agentic workforce that automates prior authorization and utilization review for health plans, payers, and TPAs. Electra handles intake through communication across fax, portal, and phone channels, checks requests against clinical guidelines and member benefits, and can approve or escalate but never denies. Each enhanced nurse can oversee 6–8 agentic FTEs, reducing operating costs while maintaining full CMS-0057-F and NCQA compliance.
- AI Agents
- Healthcare Technology
- Artificial Intelligence
- Software Only
Funding
Raised to date
$20MRaised to date based on public sources. This may differ from the amount the company actually raised and is based only on what is publicly available on the internet.
across 2 rounds
+1$16.5M · Series A
Announced Oct 2026 · from article date
Disclosed cumulative: $16.5M
Not on chart (date unknown): Seed $3.5M
Founders
Founder details are not available yet.
Product
Problem
Health plans, payers, and TPAs face increasing regulatory requirements and administrative complexity in prior authorization and utilization review. Manual chart review and routine authorizations consume significant clinical staff time, slowing case turnaround and inflating operating costs while clinicians are pulled away from complex cases that need their judgment.
Solution
ClarityCare deploys Electra, an enterprise-grade AI agentic workforce that automates the administrative and clinical work required to run cost containment operations. Electra processes incoming requests across all channels—provider portals, clinical faxes, and phone calls—into unified cases, then checks each request against clinical guidelines and member benefits while maintaining a full audit trail. The platform can approve and escalate but never issues denials, and it closes operational loops end-to-end by working directly in fax inboxes, creating cases in utilization management systems, and sending outbound letters and faxes. Each enhanced nurse can oversee the output of 6–8 agentic FTEs, and the system goes live within weeks, reducing operating costs while maintaining complete oversight.
Target Audience
Primary customers are health plans, payers, and third-party administrators (TPAs) that need to scale utilization review and cost containment operations while reducing administrative burden and maintaining regulatory compliance.
Features
- AI agents integrate with existing UM and claims systems, onboarded like staff using existing access and policies
- Every agent logs reasoning, cites guidelines, and ensures full CMS-0057-F and NCQA compliance; SOC 2 Type II certified and HIPAA-secure
- 98% approval match rate between AI recommendations and clinician decisions
- One-day case turnaround versus two weeks for manual processing
- End-to-end case handling: intake, organize, evaluate, recommend, and communicate across fax, portal, and phone channels
- Agentic layers adapt to each client's exact configuration and flex to new workflows as demands and scope change