What You Should Know:
– Ember, the AI-native solution for denial prevention secures $4.3M in seed funding round led by Nexus Venture Partners and Y Combinator.
– Its platform uses deep knowledge of payer policies to cut denials by more than 57% and boost net collections by 25% for health systems.
The Denial Crisis: Fueling Burnout and Financial Loss
Healthcare providers nationwide face an intensifying crisis driven by claim delays and denials, which create significant anxiety for patients, frustration for doctors, and a massive drag on resources.
The problem is growing exponentially:
- Public Concern: 73% of U.S. adults view delays and denials by insurers as a “major problem”.
- Physician Burnout: 89% of physicians cite prior authorization as a contributor to burnout.
- Policy Complexity: Over 50% of billing codes are restricted to a single insurer, meaning providers must manage wildly different and ever-changing requirements for each payer.
Ember’s AI-Native Solution: Preventing Denials Before They Happen
Ember is designed to solve the problem at its root, recognizing that most denials are triggered by technicalities and the impossibility of human administrators keeping up with varied payer policies.
Ember’s platform gets to work the moment a provider signs off on treatment:
- Proactive Compliance: It assigns medical codes, pulls documentation, and ensures the claim complies with payer requirements before submission.
- Unwritten Rules: Ember analyzes trends and behaviors from across the country to identify unwritten rules and practices not found in any public database, which often mean the difference between approval and denial.
- Superior Accuracy: The AI consistently delivers better accuracy than certified human coders and general-purpose AI.
The AI Appeals Engine and Rapid Value
For claims that are denied, Ember’s unique AI Appeals Engine drastically reduces the labor-intensive task of appealing. Ember’s AI agents scour the declined request and patient records, identify the best clinical evidence, and draft a comprehensive appeal in minutes.
The platform is built for rapid deployment and integrates seamlessly with all major EHR, PMS, and payer systems (including Epic, Oracle Cerner, and athenahealth). Providers begin seeing value immediately, with proven results:
- Denial Reduction: More than 57% reduction in denials.
- Net Collection Rate: 25% increase in net collection rate.
- Admin Time Savings: Providers spend 83% less time on admin.
