CoverSelf Secures $8.2m to Drive Healthcare Claims, Scale Operations

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By Dipo Olowookere

A unified platform for healthcare claims and payment integrity, CoverSelf, has obtained an $8.2 million seed round to expand its operations in the United States and drive healthcare claims and payment accuracy.

It was gathered that existing investors in the firm, BEENEXT and 3one4 Capital, led the funding round, with Z21 ventures and healthtech leaders coming in to invest in the organisation.

CoverSelf intends to use the fresh capital to build generative AI capabilities and increase headcount in sales and marketing as the business scales, especially at a time when the exponential growth of costs in healthcare remains hotly debated.

Over $4.1 trillion is spent on healthcare every year in the US alone, with administrative spending accounting for approximately one-quarter of the total amount.

In the last 12 months, the company has piloted the platform and successfully proved the platform’s readiness and effectiveness.

This has translated to two deployments for insurers where the platform processes 25 times more claims in the same time window than was done earlier.

Also, the platform has identified significant savings even after other vendors process claims. CoverSelf is in advanced discussions with 2 of the top 15 plans to collaborate. The current pipeline includes five of the top 15.

Traditional 3rd party payment integrity solution vendors exploit payment inaccuracies, which negatively impacts the provider’s experience and trust in payers and ends up ballooning waste and improper payments. With CoverSelf, payor payment integrity teams can reduce healthcare costs transparently and collaboratively with providers.

“The current claims integrity systems are very complex, and the deployed technologies are antiquated. Significant software innovation is needed to address the broken system that is currently creating out-of-control healthcare costs and waste.

“The cobbled-together software solutions result in scattered data and the inability to make real-time business decisions.

“Administrative complexity costs billions annually, an open and collaborative platform can significantly reduce the repetitive administrative costs,” the co-founder of CoverSelf, Rajasekhar Maddireddy, commented.

“Our solution offers multiple points of integration and intervention for all pre and post-pay payment integrity, effectively reducing waste.

“CoverSelf is empowering subject matter experts (SMEs) with a modern UX/UI that’s super easy to work with and aids them by eliminating technical dependencies thereby maximizing efficiency, and fostering rapid innovation.

“Speed to release has shifted from weeks to mere hours, thanks to our collaborative approach and operational efficiency,” the co-founder of the company, Raghavendra Pawar, also said.

Also commenting, the Managing Partner at BEENEXT, Dirk Van Quaquebeke, said, “CoverSelf’s vision to democratize the healthcare claims and payment integrity industry with their fully open and transparent solution built with a spirit of collaboration is truly inspirational,” while the VP for Investments at 3One4 Capital, Sonal Saldanha, noted that, “By bringing the payment integrity solution in-house, CoverSelf shifts the control of payment integrity from traditional outside vendors to payers. As payers start using CoverSelf, they will progressively need fewer external payment integrity vendors. Ultimately, CoverSelf will be the only payment integrity platform anyone will ever need.”

CoverSelf was established in 2021 by seasoned US healthcare domain experts to democratize the healthcare claims and payment integrity industry by creating a first-of-its-kind fully open and transparent solution that empowers payment integrity teams in health insurance companies (payers) to transparently resolve health claims with hospitals and medical practices (providers).

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