What You Should Know:
– Daffodil Health, a healthcare technology company, has secured $4.6M in seed funding to tackle the multi-billion dollar problem of wasted healthcare administrative costs led by Maverick Ventures with participation from Epic Ventures.
– Daffodil Health is the brainchild of a team with over 100 years of combined experience in healthcare and technology, from companies like MultiPlan, Google, and McKinsey. They recognize the urgent need to overhaul the current healthcare pricing and billing system and are committed to making this change a reality.
Streamlining a Broken System
The US healthcare system spends over $1 trillion annually on administrative tasks, a significant portion of which offers little to no value to patients. Daffodil Health leverages AI and large language models (LLMs) to automate these processes, eliminating unnecessary middlemen and streamlining billing procedures.
Automating Out-of-Network (OON) and Reference-Based Pricing (RBP)
Daffodil Health’s initial focus is on automating and applying AI to OON and RBP processes for payers and Third-Party Administrators (TPAs). Their AI-powered solution specifically tackles:
- Automated Claim Repricing: Reprice claims in real-time based on payer or TPA pricing preferences.
- Simplified Configuration: Easily set up complex pricing rules for efficient claim processing.
- Automatic Benchmarking: Automate the benchmarking of repriced claims for accuracy.
- Defensible Rationale Generation: Generate detailed justifications for AI/LLM-powered pricing decisions.
“It is not lost on us that truly reducing healthcare admin spend is difficult. We are also cognizant that numerous well-funded companies and entrepreneurs have had limited success to date in this realm,” said Navin Nagiah, CEO of Daffodil Health. “We also fervently believe that what we are doing, needs to be done. Our first application, a SaaS-based and AI-enabled OON/RBP repricer is an important first step in our mission.”
