Humata Health

Humata Health provides a focused business-to-business solution for the healthcare industry, specifically targeting the complex and often manual process of prior authorizations. The company operates by deploying its proprietary artificial intelligence and automation platform to create a more seamless workflow for both healthcare providers and insurance payers. Revenue is generated by offering this end-to-end technology to its clients, which include over 225 hospitals and 42,000 physicians.

Founded in 2023 by Dr. Jeremy Friese, Humata Health emerged from the founder's direct experience with the inefficiencies of the prior authorization system. Dr. Friese, a former interventional radiologist and physician executive at Mayo Clinic, previously founded Verata Health, another AI company focused on prior authorization that was acquired by Olive in 2020. Following the shutdown of Olive AI, Humata Health acquired its prior authorization business, augmenting its own proprietary technology. This journey reflects a persistent effort to solve a significant pain point in healthcare administration.

The company's core service is an AI-driven platform that automates the prior authorization process from start to finish. It integrates bi-directionally with common electronic health record (EHR) systems. When a provider orders a procedure, the platform first determines if an authorization is necessary. Using machine learning, it then automatically gathers, indexes, and bundles the precise clinical documentation required by the patient's health plan and the specific procedure. The system flags potential reasons for denial and can submit the completed clinical package with a single click. After submission, the platform automatically monitors the status and only requires human intervention if a denial or peer-to-peer review is necessary. A key achievement has been the implementation of "touchless" prior authorizations, where over 70% of requests for certain procedures were approved without any staff involvement after the initial order.

In June 2024, Humata Health secured a $25 million Series A funding round. The round was led by Blue Venture Fund and LRVHealth, with participation from other strategic investors including Optum Ventures, Highmark Ventures, and .406 Ventures. This capital is intended to further develop the company's generative AI technologies and expand its partnerships with both providers and payers, positioning the firm to meet the increased demand for efficiency driven by new CMS mandates for faster authorization decisions.

Keywords: prior authorization automation, healthcare revenue cycle management, RCM, clinical documentation, payer-provider connectivity, medical billing AI, utilization management, EHR integration, healthcare administration, generative AI in healthcare, touchless authorizations, Jeremy Friese, Verata Health, Blue Venture Fund, LRVHealth, Optum Ventures, Highmark Ventures, Allegheny Health Network, medical pre-certification, claims denial prevention