This company provides pre-payment claim review services for self-funded health plans and their members to ensure fair billing for hospital visits. They achieve savings by instantly screening for 501(r) discounts and using medical record data to flag overcharges before adjudication. The service maximizes savings for plans while reducing patient responsibility through comprehensive coding and clinical reviews.
Funding
$5.4M 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
Navigating complex hospital billing systems often leads to overpayment due to coding errors, unnecessary charges, and failure to apply eligible discounts such as those mandated by 501(r) regulations for non-profit hospitals. Traditional cost containment solutions often overlook these savings opportunities, particularly for lower-dollar claims, leaving both health plans and members vulnerable to inflated medical expenses.
Solution
Goodbill provides a cost containment solution that leverages member engagement, EHR integration, and AI-powered claim reviews to ensure fair and accurate hospital billing. The platform proactively identifies 501(r) discount eligibility and flags coding errors or unnecessary services *before* the claim is paid, maximizing savings for both plans and members. By directly integrating with major EHR platforms, Goodbill accesses patient visit data to improve claim review accuracy and identify savings opportunities that traditional methods miss. A dedicated case manager is available to members seven days a week, providing personalized support and ensuring a seamless experience. Goodbill's approach ensures that plans fulfill their fiduciary duty by making every healthcare dollar count.
Target Audience
Goodbill primarily serves self-funded health plans, TPAs, brokers, and advisors seeking to reduce healthcare costs for their clients and members, as well as individual consumers seeking assistance with hospital bill negotiation.
Features
- Instant 501(r) discount eligibility screening using member data and hospital connections
- EHR integrations for rapid retrieval of medical records and enhanced claim review accuracy
- AI-powered claim reviews that identify coding errors and unnecessary charges based on provider notes
- Reviews conducted by licensed coders and clinicians
- Direct negotiation with hospitals to secure additional discounts and fair pricing
- Member engagement platform with a personal case manager available 7 days a week
- Bilingual English and Spanish support
- Integration with existing claims processing platforms