Paxos Health uses customized AI to synthesize patient data, clinical guidelines, and payer policies to automate the creation of prior authorization and appeal documents. This platform transforms patient access teams by shifting their role from document creation to AI output review, significantly increasing productivity and accuracy. The service supports complex reimbursement workflows, helping medtech and DME providers secure approvals even when policies are unfavorable.
Funding
Funding not disclosed
Founders
Product
Problem
Navigating complex medical device reimbursement workflows, particularly for new-to-market products or when facing negative payer policies, is administratively burdensome and time-consuming. This complexity often leads to delayed patient access, increased operational costs, and a strain on internal resources tasked with generating prior authorizations and appeals.
Solution
Paxos Health provides an AI-powered platform designed to automate and optimize patient access workflows for medtech and Durable Medical Equipment (DME) companies. The system synthesizes comprehensive patient data, cross-referencing it with payer policies, clinical guidelines, and medical literature to generate robust prior authorizations and appeals. This AI-driven approach transforms patient access teams from document writers into reviewers, enhancing the accuracy and efficiency of the reimbursement process. By integrating with existing CRM systems and leveraging voice AI for payer interactions, Paxos Health accelerates approval timelines and reduces operational overhead.
Target Audience
The primary customers are medtech and DME companies, including patient access teams, providers, and potentially patients, who manage complex reimbursement workflows and seek to improve approval rates and operational efficiency.
Features
- AI-driven synthesis of patient medical records, payer policies, clinical guidelines, and medical literature for document generation.
- Automated flagging of missing documentation and identification of policy gaps to ensure submission completeness and accuracy.
- Voice AI technology for automated follow-up calls to payers to check case status and advocate for additional reviews.
- Integration capabilities with major CRMs and case management tools for automated data ingestion.
- Line-by-line analysis of patient files against specific payer policies and clinical evidence.
- Generation of fully cited prior authorization and appeal documents incorporating payer-specific language.
- Real-time analytics dashboard displaying pass/fail drivers, ROI metrics, and audit-ready documentation packets.
- Workflow customization to adapt to specific organizational processes and payer requirements.