9 Startups Fixing Healthcare's Prior Authorization Problem

Much of the AI entering prior authorization is built for speed: faster submissions, faster back-and-forth with payers, faster appeals. A growing group of founders thinks that's the wrong target. A request that goes out in four minutes with a missing code or a thin clinical justification still gets denied.

Jim Norman, MD, an endocrine surgeon and founder of clinical-coding company Talix, argues the industry has optimized the wrong end of the process. Norman now leads Plainvue, which automatically applies complete, accurate ICD-10 codes to follow-up lab orders at the point of care. The goal is to stop avoidable authorization and payment denials before they happen.

Norman sees value in faster tools but said they amount to "accelerating a broken workflow." The bigger opportunity, he said, is making sure an order is complete, correctly coded, and properly justified before a request is ever submitted.

Summer Musa, a data scientist and founder of Onkor, sees the same problem. Onkor builds prior authorization and revenue cycle management software for multi-site specialty healthcare organizations.

"Submission speed got attention because it's easy to measure and easy to demo," she said. "You can show a packet going out in four minutes instead of 40. You can't show the denial that didn't happen."

Prevention only works if the tool fits how practices already operate. Musa said the tools that succeed in production are the ones that don't ask practices to change how they work.

"The ones that work in production don't look impressive in a demo," she said. "Narrow workflow, proper EHR integration, a human review step people use."

Here are nine companies tackling different parts of the prior authorization problem, from clinical and coding intelligence to medication access, payer workflows, interoperability, and downstream payment integrity.

Sector: AI-powered clinical intelligence platform automating prior authorization, utilization management, payment integrity, and payer-provider collaboration for health plans and risk-bearing providers

HQ: Boston, MA

Year Founded: 2019 

Key Leaders: Siva Namasivayam, Co-Founder and Chief Executive Officer; Dr. Brian Covino, Chief Medical Officer; Krishna Kottapalli, Chief Growth Officer

Number of Employees: ~1,000

Stage: Private, Series C

Financial Snapshot: Cohere Health has raised about $213 million total. Its $90 million Series C round was led by Temasek, following a $50 million round in Feb 2024 led by Deerfield Management.

Notable Investors: Temasek, Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners

Key Products: Cohere Unify, a platform enabling collaboration between health plans and providers through personalized workflows and real-time performance data; Cohere Validate, an AI-powered near real-time clinical and coding validation solution, part of its new Payment Integrity Suite.

Recent Highlights: In March 2026, the company was No. 38 on the sixth annual Inc. Regionals: Northeast list, a ranking of the region’s fastest-growing privately held companies. Cohere Health acquired ZignaAI in September 2025, bringing the company's payment integrity and revenue optimization technology into Cohere's Payment Integrity Suite, which combines clinical intelligence with claims validation.

Sector: Clinician-led clinical AI platform for health plans, automating payer workflows including utilization management, prior authorization, payment integrity, and risk adjustment

HQ: New York, NY

Year Founded: 2022 (formerly known as Co:Helm)

Key Leaders: Abdel Mahmoud, MD, Co-Founder and Chief Executive Officer; Tahseen Omar, President and Chief Operating Officer; Zahid Mahmood, Co-Founder  

Number of Employees: 51-200

Stage: Series B

Financial Snapshot: Anterior has raised a total of $64 million, including a $40 million round announced February 12, 2026, and a $20 million Series A in June 2024 led by New Enterprise Associates (NEA)

Notable Investors: NEA and Sequoia Capital, along with new backers FPV and Kinnevik

Key Products: Anterior's AI platform is embedded in the clinical workflows used by health plans for prior authorization, payment integrity and risk adjustment reviews. The company also pairs the technology with a clinician-led team through its “Forward Deployed Clinician” model and has integrated with HealthEdge's GuidingCare system.

Recent Highlights: Anterior's platform reports a clinical accuracy rate of 99.24%, validated by KLAS Research. The company supports organizations covering 50 million lives and has deployed with payers such as Geisinger Health Plan. About 40% of Anterior's team are clinicians, reflecting its "do no harm" design philosophy.

Sector: Clinical AI company using a "Clinical Reasoning Engine" to accelerate medication access and automate prior authorization within health systems

HQ: San Francisco, CA

Year Founded: 2022

Key Leaders: Co-founders Rishabh Jain and Sriram Somasundaram

Number of Employees: ~125

Stage: Series A

Financial Snapshot: $80 million raised in Series A funding, reportedly valuing the company at around $600 million

Notable Investors: Spark Capital and Transformation Capital (co-leads), with participation from Conviction, McKesson Ventures, General Catalyst, and Y Combinator

Key Products: The Clinical Reasoning Engine analyzes patient data, interprets drug criteria, extracts relevant evidence and coordinates workflows across EHRs, payer guidelines and pharmacy operations to speed medication access.

Recent Highlights: More than 2 million patients are already accessing medications faster through the platform, and over the past year the company expanded from four to more than 45 health system partners, now working with 50% of the top 20 U.S. health systems, including Yale New Haven Health, Ochsner Health, MetroHealth, UCI, Vanderbilt Health, Mount Sinai, Henry Ford Health System, UCSF Health, and UCLA Health. The platform has reduced treatment denials by over 30%.

Sector: AI-powered network automating the prescription-to-treatment process (insurance authorization, financial assistance, pharmacy routing, connecting doctors, pharmacies, payers, and biopharma

HQ: New York, NY

Year Founded: 2023 (originally launched as Tandem)

Key Leaders: Sahir Jaggi, CEO and Founder (named to Forbes 30 Under 30 Healthcare list in 2025)

Number of Employees: 51-200

Stage: Series C

Financial Snapshot: Forus raised $150 million in a Series C round at a $3 billion valuation, bringing total funding to $300 million. This followed a $160 million round at a $1 billion valuation in May 2026, and a $30 million Series A in 2024 under the Tandem name.

Notable Investors: Thrive Capital, General Catalyst, Accel, Bain Capital Ventures, and other leading investors

Key Products: The platform is embedded into provider workflows and uses AI to handle prior authorizations, benefits verification, appeals after insurance denials, financial assistance enrollment, specialty pharmacy coordination, pharmacy routing and patient communications. Each prescription is assigned its own AI agent to manage these steps. 

Recent Highlights: Forus now has nationwide reach, used by thousands of medical practices and health systems in all 50 states, supporting people in 85% of U.S. residential zip codes. Forus initially launched in dermatology, where more than a third of providers nationally have now adopted the platform. The company collaborated with the American Gastroenterological Association (AGA), combining AGA's clinical expertise with Forus's medication access data to identify barriers patients face after a prescription is written.

Sector: AI automation platform for specialty drug access, automating the administrative side of infused and injectable drug delivery for providers

HQ: San Francisco, CA

Year Founded: 2024

Key Leaders: Will Yin, CEO and Co-Founder; Rohit Rustagi, COO and Co-Founder 

Number of Employees: 11-50

Stage: Seed and Series A combined

Financial Snapshot: $40 million raised in seed and Series A financing

Notable Investors: Greylock, SignalFire, Maverick, and SV Angel

Key Products: An automation platform for specialty drug administration, covering intake, benefits verification, prior authorizations, and revenue cycle management, with AI agents that automate tasks from patient referral through infusion and reimbursement.

Recent Highlights: Since launching its agents in January 2025, Mandolin is live with major infusion providers, specialty pharmacies, and health systems, including Vivo, FlexCare, OI Infusion, and TwelveStone, deployed at 700+ clinics and serving over 250,000 new patients annually. The specialty drug market it targets represents $250 billion in drug spend in 2024, expected to reach $1.5 trillion within eight years, and represents 75% of drugs in the FDA's approval pipeline.

Sector: AI-powered "Care Readiness Platform" automating prior authorizations, benefit checks, and insurance eligibility monitoring for specialty healthcare providers

HQ: New York, NY

Year Founded: 2023 

Key Leaders: Jeffrey Morelli, Co-Founder and CEO, founded alongside Pavel Asparouhov and Sagar Jajoo

Number of Employees: 51-200

Stage: Series A

Financial Snapshot: $27 million in total funding, including a $22 million Series A co-led by Accel and Bain Capital Ventures, following a previously unannounced $5 million seed round led by the same firms

Notable Investors: Accel and Bain Capital Ventures, with angel investors including co-founders of Ramp, Opendoor, Truework, Speak, and Eight Sleep

Key Products: Silna Health's AI-powered Care Readiness Platform automates prior authorizations, benefit checks and eligibility verification while integrating with EHR systems. The platform supports more than 1,000 payors across all 50 states and is used by ABA therapy providers, rehab centers and occupational therapy clinics.

Recent Highlights: The platform slashes insurance approval times from weeks to hours and has already helped over 150,000 patients access care. Silna serves customers across physical therapy, autism care, and senior living verticals, with an 89 NPS score in Q1 2025. In 2025, Morelli was named among the Healthcare Technology Report's Top Healthcare Technology CEOs.

Sector: AI-driven (generative AI) platform automating benefits verification and prior authorization to streamline medication access

HQ: Menlo Park, CA

Year Founded: 2022

Key Leaders: Founded by Mel van Londen (CEO) and Benjamin Easton (CTO)

Number of Employees: 11-50

Stage: Series A

Financial Snapshot: $14.3 million Series A round, bringing total funding to $17.6 million

Notable Investors: Wing Venture Capital (lead), with participation from Afore Capital, J Ventures, and South Park Commons

Key Products: The platform integrates with EHRs to verify insurance coverage in real time, generate and submit prior authorization packages, track authorization status and return structured data to the provider's system without manual work.

Recent Highlights: Develop Health is expanding beyond pharmacy benefits (GLP-1s and treatments across addiction, neurology, dermatology, and psychiatry) into the medical benefit market, and deepening integrations with EHRs and PBMs. The company reduces form completion time by over 80% and aims to help over 1 million patients access medications by year-end.

Sector: Prior authorization automation software connecting payers and providers within the healthcare sector

HQ: Columbus, OH

Year Founded: 2014 (formerly Prior AuthNow)

Key Leaders: Joe Anstine, Founder and Chief Executive Officer; Amol Arora, Co-Founder and Chief Medical Officer; Jay Sandhaus, Chief Technology Officer; Mike Blackwell, Chief Product Officer

Number of Employees: ~56

Stage: Series C

Financial Snapshot: Rhyme has raised $57 million total, with its latest round a $25 million Series C on February 14, 2022

Notable Investors: Insight Partners, Panoramic, BIP Ventures, Health2047 Capital Partners, and (per an earlier round) Mayo Clinic Platform Accelerate, Asset Management Ventures, 

Key Products: LiveAuth (the company’s automated software network and technology) is an EHR-integrated solution enabling touchless collaboration between payers and providers. The network features an advanced point-of-care solution designed to eliminate prior authorization rules through a shared payer-provider dashboard. 

Recent Highlights: Rhyme's platform processes 7M+ auths per year, 2,598 hospitals, and 100% of procedure types. The company also works with 300+ of the largest payers and some of the largest health systems in the country. Rhyme is a leading collaborative network, earning back-to-back KLAS Points of Light awards in 2023 and 2024.

Sector: FHIR-enabled health data platform for claims and clinical data acquisition, exchange, and interoperability compute, serving payers, providers, and digital health companies

HQ: Boston, MA

Year Founded: 2017

Key Leaders: Andrew Boyd, Chief Executive Officer; Donald Rucker, MD, Chief Strategy Officer; Nolan Kelly, Chief Commercial Officer; Justin Hatem, Chief Information Security Officer

Number of Employees: 113

Stage: Series C

Financial Snapshot: 1upHealth raised $40 million in its Series C round in early 2023, bringing total funding to $80.4 million

Notable Investors: F-Prime, Sixth Street, Eniac Ventures, Social Leverage, Jackson Square Ventures

Key Products: The 1up Platform provides tools for clinical data integration and API-enabled data connectivity, including 1up Electronic Prior Authorization, 1up Payer-to-Payer Data Exchange, 1up Provider Access, 1up Patient Access, 1up Provider Directory and 1up Formulary. The platform is built on FHIR standards to connect and exchange clinical and administrative data.

Recent Highlights: 1upHealth now covers over 270 million patient lives and more than 8,000 total endpoints, including some of the largest U.S. health systems and payers, and received HITRUST i1 Certification for its 1up FHIR Platform built on next-generation data lakehouse architecture. Most recently, the company announced "1up Gateway" to help health plans simplify compliance with the CMS-0057-F interoperability rule.