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Prior Authorization Platform Humata Health Closes $25M Investment

Humata Health, the company creating prior authorizations for payers and providers with AI and automation, announced that it closed a $25 million investment. The 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 will broaden the scope of its proprietary generative AI technologies, expand its customer base with the nation’s leading healthcare 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 rely on Humata Health’s end-to-end technology to automate the manual, increasingly complicated process of prior authorizations, which often serves as an important checkpoint to ensure prescribed care is clinically appropriate. The Centers for Medicare and Medicaid Services (CMS) passed a rule that will require insurers to provide authorization decisions in 72 hours for urgent requests and seven calendar days for standard requests – which will result in increased demand for solutions from Humata.

Humata was founded in 2023 by industry veteran and serial entrepreneur, Dr. Jeremy Friese. The company has built proprietary AI to streamline prior authorization for providers and payers that it has augmented with assets purchased through acquisition and continues to expand upon for a comprehensive, end-to-end offering.

“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 Jeremy Friese, MD, Chairman and CEO of Humata Health. “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.”

The Humata Health platform transforms the end-to-end experience of prior authorizations for providers and payers. With its proprietary database, the Humata Health 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. In addition, constant monitoring post-approval detects and flags changes that may lead to downstream denials and write-offs. Bi-directional integrations with the most common electronic health records (EHRs) and clinical documentation systems, and broad payer connectivity at state, regional and national levels facilitate unparallelled automation across all interactions for seamless processing.

“Highmark is excited to partner with Humata to continue their work of transforming the prior authorization process,” said Carl Daley, CFO of Highmark Health. “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.”