Company helps four out of the top 10 insurance companies automate healthcare administration

Machinify, the company transforming healthcare administration with artificial intelligence (AI), today announced a comprehensive suite of apps designed to address the entire healthcare claims lifecycle, from prior authorization through final payment. Machinify applications are currently in production with four of the top 10 U.S.-based insurance payers.

Machinify's new app suite, consisting of Machinify Auth, Machinify Audit, and Machinify Pay, debuts at a time when healthcare costs have spiraled out of control. The U.S. has one of the most expensive health systems in the world, where health insurers pay out nearly $4.5 trillion in reimbursements, equating to $13,400 per person. Of this, it is estimated almost $1 trillion is considered wasteful spending, with approximately $500 billion attributed to administrative complexity and pricing failures. Machinify’s software reduces cost and waste while providing patients with more timely access to the care they need.

This new application release comes as Machinify bolsters its go-to-market strategy, having recently announced the appointment of a new Executive Vice President of Sales, Vikas Aligh. Vikas, who will focus on bringing Machinify’s transformative AI solutions to all payers, joins the company with over 20 years of sales leadership experience across SaaS, automation, and AI applications.

“There is an enormous opportunity to leverage AI to change the economics of healthcare. Machinify is leading the way, bringing together purpose-built AI, enterprise-scale software, and deep domain expertise into one connected offering,” said Prasanna Ganesan, Machinify founder and CEO. “Today, our solutions remove hundreds of millions of dollars in administrative costs from the healthcare system, benefiting not only payers, but providers and, most importantly, patients.”

Automating Healthcare Administration

At the foundation of Machinify’s cloud-based software system is a powerful AI engine leveraging the latest in optical character recognition (OCR), natural language processing (NLP), and large language models (LLMs) used in making smart decisions across the claims lifecycle. Trained on billions of claims and millions of medical records to learn the language of medical coding, Machinify's AI engine is able to validate pre-pay and post-pay requests against complex policies and enable accurate resolution, authorization, and payment. This creates dramatic efficiencies, increasing auth and claim processing accuracy while reducing wait times and frustration for providers and patients.

Today, Machinify's AI engine powers three applications optimizing the end-to-end healthcare claims lifecycle:

• Machinify Auth: A comprehensive system that automates the submission and processing of all provider authorization requests, Machinify Auth provides instant approval for most requests in just minutes — with auto-approval rates above 80%. In cases where clinician review is required, Machinify Auth shortens review times by 50% or more.
• Machinify Audit: An end-to-end system that identifies potential clinical, coding, or billing issues on incoming claims, automatically analyzes the corresponding medical records against clinical and coding guidelines, and ensures accurate payment. Machinify Audit, which reduces claims review time by over 50%, enables payers to significantly increase the accuracy of their audit program while doubling review capacity, resulting in lower provider abrasion and superior economics.
• Machinify Pay: Machinify Pay enforces coding, contractual, and payment policies at wire speed to accurately price claims and automate claim corrections, resulting in significantly increased up-front accuracy and reduced manual rework both pre-payment and post-payment. Once a manual-intensive process, Machinify Pay automates 40% of recoveries with no human review for a Top-10 U.S. payer today. And it’s not just time savings for the payer, as this app also uncovered $125 million in additional recoveries.

Collectively, Machinify’s apps have delivered hundreds of millions of dollars of annual cost savings, reducing the administrative burden on both payers and providers, while enabling patients to get faster treatment. Machinify also received HITRUST certification, ensuring that all sensitive data is fully protected and is SOC2 compliant.

“Machinify gets rid of administrative inefficiencies that run rampant in the industry, costing payers and patients unnecessarily,” said Dharmesh Thakker, General Partner at Battery Ventures and the lead investor in Machinify. “The healthcare industry has been slow to adopt new technology, but with the results Machinify’s customers have experienced and ease of implementation, payers can’t afford to wait. Doing so will cost them billions in unnecessary costs.”

To learn more about how Machinify is dramatically transforming healthcare administration, please visit www.machinify.com.

About Machinify

Machinify is an AI-powered software company that automates the healthcare claims lifecycle from prior authorization through final payment. The company is headquartered in Palo Alto and is backed by Battery Ventures, Matrix Partners, and GV. Go to www.machinify.com for more information.

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There is an enormous opportunity to leverage AI to change the economics of healthcare. Machinify is leading the way, bringing together purpose-built AI, enterprise-scale software, and deep domain expertise into one connected offering. Prasanna Ganesan, CEO