Replicate Health
Replicate Health provides AI agents that automate healthcare provider operations, including revenue cycle management, insurance discovery, prior authorization, and credentialing. The platform integrates with major EHR systems and clearinghouses, with human approval gates on every external submission. Ledger, its billing agent, handles AI coding, eligibility checks, claim filing, and underpayment detection.
- Healthcare Technology
- AI Agents
- Artificial Intelligence
- Software Only
Funding
Founders
Founder details are not available yet.
Product
Problem
Healthcare providers face significant administrative burden and revenue loss from manual revenue cycle management, prior authorization, and credentialing processes. Claims take an average of 45+ days to be paid, and credentialing a new physician takes 90–120 days, costing up to $7,500 per month in lost revenue per uncredentialed provider.
Solution
Replicate Health deploys four specialized AI agents to automate provider operations end-to-end. Ledger handles the full billing cycle including AI coding from visit notes, eligibility checks before every claim, clean claim filing, automated denial appeals, ERA posting, and underpayment detection. Authority checks prior-auth requests against eviCore, Carelon, and Evolent approval criteria before filing, and ties auth denials back to the authorization that was needed. Roster tracks every provider credential with daily NPPES checks, OIG exclusion screening, and alerts before licenses or CAQH attestations lapse. Manifest searches for active coverage on self-pay and unknown-insurance patients through discovery networks plus Medicare and Medicaid eligibility. Every agent operates on the same loop of ingest, reason, human review, and submit, with approval gates ensuring nothing leaves a practice without human sign-off.
Target Audience
Primary customers are healthcare practices, including orthopedics, radiology, wound care, skilled nursing facilities, post-acute groups, ambulance, and telehealth mental health practices that work with major EHR platforms and need to streamline revenue cycle management, prior authorization, credentialing, and insurance discovery workflows.
Features
- Ledger agent: end-to-end revenue cycle automation with AI coding, pre-claim eligibility checks, scrubbed claim filing, AI-drafted appeals faxed to payers, ERA posting, underpayment detection against fee schedules, and bank reconciliation that matches deposits to remits from PDF bank statements
- Authority agent: prior authorization automation that checks requests against eviCore, Carelon, and Evolent criteria and ties denials back to missing authorizations
- Roster agent: credentialing tracking with daily NPPES checks, OIG exclusion list (LEIE) screening, and alerts before license, CAQH attestation, or payer enrollment lapses
- Manifest agent: insurance discovery that searches coverage networks plus Medicare and Medicaid eligibility daily, confirming each find with a live eligibility check before handing it to Ledger to bill
- Human-in-the-loop approval gates on every external submission, with configurable automation levels (claims can wait for a biller until switched to automatic)
- Integrations with EHR/PM systems (AdvancedMD, Simpl, EZClaim, PointClickCare, MatrixCare, eClinicalWorks), clearinghouses (Claim.MD, Office Ally, Waystar, Optum/Change Healthcare, Availity), and payers (AmeriHealth, Aetna, Cigna, BCBS, UnitedHealth, Humana, Medicare, Medicaid, Oscar)
- Custom integrations added on request, typically live in under three weeks