Health payer platforms and prior authorisation

Claims systems for health insurers 3 companies

Health insurers and government health programmes keep every member, plan and claim in a core system that decides what is paid.

HealthEdgeHealthEdge, with engineers in Bengaluru and Hyderabad, sells HealthRules Payer, the core claims system of many American health plans.Bengaluru · HyderabadHired recently

Gainwell TechnologiesGainwell, with engineers in Bengaluru, runs the Medicaid systems of American states: sign-ups, claims and payments.

IHX (Perfios)IHX, part of Perfios, with engineers in Bengaluru, runs India's health-claims exchange between hospitals and insurers, and uses AI to check claims.

The tech, explainedHealth plan administration system Medicaid management information system (MMIS)National Health Claims Exchange (NHCX)

AI approval of treatments 2 companies

Before some treatments, the insurer must approve them. These companies use AI to make that decision in minutes instead of days.

Cohere HealthCohere Health, with engineers in Hyderabad, uses AI to approve treatments in advance, often in minutes.HyderabadHiring now

Autonomize AIAutonomize AI, with engineers in Bengaluru, sells AI agents for insurers' decisions on treatments, claims and cover.BengaluruHired recently

The tech, explainedPrior authorisation

How it all worksMedical billing and claimsOne bill, from the clinic's code to the plan's payment.

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What's changing

Treatment approvals in minutes.

New American rules require insurers to answer approval requests faster and electronically. AI tools now approve routine requests in minutes, while doctors review the rest.