WhatAn automated service that reviews Explanation of Benefits documents against actual procedure costs and contract terms, flagging overcharges and billing errors for self-insured employers.
SignalMultiple commenters note that individual bills are rarely logically defensible under scrutiny, and the layering of profit margins causes costs to grow exponentially — yet nobody systematically audits these at scale.
Why NowMachine-readable insurer pricing files are now mandated and becoming available, and LLMs can now parse the messy, inconsistent formats of EOBs and medical billing codes at a cost that makes per-claim auditing economically viable.
MarketSelf-insured employers spending $1T+ on healthcare annually; existing claims auditors like Cotiviti focus on insurers, leaving a gap for employer-side tools. Even a 2-3% savings rate on audited claims is enormous.
MoatNetwork effect from processing millions of claims builds a proprietary benchmark database of what procedures actually cost vs. what gets billed, making the system smarter with each customer.
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