Humata Health, a startup focused on reducing friction in prior authorization between payers and providers, has raised $25 million.
Winter Park, Fla.-based Humata was founded in 2023 by industry veteran and serial entrepreneur, Jeremy Friese, M.D., who served as an interventional radiologist and physician leader at Mayo Clinic for many years before founding Verata Health, a venture-backed AI technology company that was acquired by Olive in 2020. At Olive he served as president, Payer Market.
The new funding was led by Blue Venture Fund (representing the majority of BCBS plans) and LRVHealth (representing nearly 30 health systems and payers) with participation from Optum Ventures, .406 Ventures, Highmark Ventures and VentureforGood.
With this funding, the company said it plans to broaden the scope of its proprietary generative AI technologies, expand its customer base of providers, and begin partnering with payers and delegated entities to deliver complementary solutions that help them streamline prior authorizations.
More than 42,000 physicians at 225 hospitals across the country already use Humata Health’s end-to-end technology to automate the manual process of prior authorizations.
The Centers for Medicare and Medicaid Services (CMS) recently issued a rule that will require insurers to provide authorization decisions in 72 hours for urgent requests and seven calendar days for standard requests.
“As a physician executive at Mayo Clinic, I learned both the challenging complexities and importance of the prior authorization process. That’s why I founded Verata Health and now Humata Health to deliver a solution that combines the power of AI, automation and connectivity between payers and providers to create a frictionless process,” said Friese in a statement. “With a large and growing customer base of providers already, this investment validates our vision of solving prior authorization on both sides of the proverbial fax machine. Raising this investment from strategic investors that represent some of the nation’s largest and most innovative providers and payers is a testament to our approach and rapidly accelerates our trajectory to have a positive impact for patients and the healthcare system.”
Humata Health says its AI engine employs machine learning to offer informed recommendations for crucial clinical documents that should be included to improve submission quality. As a result, payers are required to do less work and providers see improved first-pass approvals. Bi-directional integrations with the most common EHRs and clinical documentation systems, and broad payer connectivity at state, regional and national levels facilitate automation across all interactions for seamless processing, the company said.
“Highmark is excited to partner with Humata to continue their work of transforming the prior authorization process,” said Carl Daley, CFO of Highmark Health, in a statement. “Their solutions help providers to focus more on patient care rather than paperwork. We are excited to see how their continued innovation will further improve the process for our providers and health plan.”
