Develop Health utilizes AI to automate medication prior authorization by pre-checking patient plans and medical histories, significantly reducing form completion time by over 80%. This technology addresses the inefficiencies in managing complex medication reimbursement processes, leading to higher approval rates and improved patient access to necessary medications.
Funding
$1.8M raised to dateRaised 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.
Founders
Product
Problem
Healthcare providers face significant administrative burdens and time constraints managing complex medication reimbursement processes, leading to staff exhaustion and patient frustration. Manually navigating varying payer requirements and completing extensive prior authorization forms contributes to delays in patients accessing necessary medications.
Solution
Develop Health offers an AI-powered platform designed to streamline and automate the medication prior authorization process. The system pre-checks patient plans and medical histories against payer criteria to determine coverage details and prior authorization requirements upfront. AI algorithms automate benefit verification by directly contacting plans and PBMs to gather precise coverage details and copay information. The platform also predicts prior authorization outcomes, auto-fills necessary clinical information, and facilitates the submission of first-time approvals, reducing the time to therapy and improving overall patient care efficiency.
Target Audience
The primary target audience includes healthcare providers, such as physicians, clinics, and hospitals, seeking to reduce administrative overhead, improve medication access for patients, and increase prior authorization approval rates.
Features
- AI-driven benefit verification using insurance card images to identify contact numbers and directly call plans/PBMs
- Automated AI calls to gather coverage details and copay information upfront
- Clinical eligibility tool that predicts prior authorization outcomes based on patient coverage, prescribed drugs, and clinical data
- AI-powered auto-filling of prior authorization forms with necessary clinical information
- Integration with existing healthcare systems to streamline data exchange
- Automated AI clinical assessments to verify patient history against plan criteria