Healthtech · Health Data & Interoperability · 50–200 · North America #b029_14

Context

We run a clinical data exchange that sits between insurers and provider organizations, handling record requests and release of information.

Industry

Healthtech · Health Data & Interoperability

Size

50–200 employees

Region

North America

Tools budget

$1K–5K per month

Needs

Claims & prior authorization. Insurers request charts for payment and quality work, and the back and forth with providers is still slow.

Today: denials and claims work sits alongside chart retrieval, mixing tools and staff review · Urgency: this year

Document AI & extraction. Records we exchange are often unstructured, and we want automatic extraction of the relevant pieces.

Today: release of information requests flow through an EHR-integrated portal with staff review · Urgency: this year

Privacy & data protection (GDPR/HIPAA). Release of information must respect minimum necessary rules, and proving that per request is tedious.

Today: encryption, multi-factor sign-in and requester identity checks built into delivery portals · Urgency: this year

Who decides

head of operations · security review

Expects from suppliers

Understands insurer and provider record workflows; Minimum necessary filtering; Clear pricing for mid sized vendors

Not a fit

Patient facing consumer apps; Tools without medical record experience

Stack

cloud: AWS-class hyperscaler, EHR system in place

Buying triggers

scaling transaction volume, regulatory change