Daffodil Health, a provider of healthcare pricing and administration AI-powered solutions, announced it raised $4.6 million in a seed funding round led by Maverick Ventures, with participation from Epic Ventures.
This funding announcement comes at a time when more than $1 trillion is spent on healthcare admin, much of it wasted and with limited to no benefit to patients. And technologies such as AI and large language models make it possible to uber-automate healthcare processes and make middlemen redundant.
The company was launched by a group of healthcare and technology experts with over 100 years of combined healthcare and software experience at companies like MultiPlan, Google, and McKinsey. They believe that change in how healthcare navigates pricing and billing is not just possible, but a dire necessity.
The first problem the company targeted is the complete automation and AI enablement of out-of-network (OON) and Reference Based Pricing (RBP) processes for payors and Third Party Administrators (TPAs). And Daffodil is specifically focused on the automation and AI enablement of how to reprice, benchmark and defend a claim that is outside of a plan’s network.
Daffodil’s AI-powered solution enables real-time repricing of claims based on the payor or TPA’s preferred pricing methodology; easy configuration of complex pricing rules; automatic benchmarking of the repriced claims; and generation of detailed and defensible pricing rationale powered by AI/LLM models
The company delivers these features as a cloud-native SaaS solution that is easy to use and will result in both improved productivity and dramatically lower costs. And with early and deep collaboration with digitally forward-looking and innovative payors and TPAs, the application is expected to go live with multiple implementations in the next few months.
KEY QUOTES:
“It is not lost on us that truly reducing healthcare admin spend is difficult. We are also cognizant that numerous well-funded companies and entrepreneurs have had limited success to date in this realm. We also fervently believe that what we are doing, needs to be done. Our first application, a SaaS-based and AI-enabled OON/RBP repricer is an important first step in our mission.”
– Navin Nagiah, CEO of Daffodil Health
“The intricate challenges of out-of-network repricing demand innovative solutions that marry simplicity with efficiency. There is an opportunity for an end-to-end AI driven approach to streamline these processes and achieve remarkable cost savings and enhanced operational efficiency for TPAs and payors.”
– Andrew Boyd, executive vice president and general manager, healthcare solutions at Personify Health, a provider of health plan administration and cost containment solutions
“The out-of-network billing dilemma has hit a fever pitch in recent years. From payors to TPAs and employers, it’s perceived as an oligopoly with no winners. Daffodil is boldly addressing this issue through cutting-edge AI, transforming claims adjudication and slashing administrative costs. With new price transparency laws shaking up the game, it’s prime time to revolutionize claims processing and communication with AI.”
– Prateesh Maheshwari, Managing Director at Maverick Ventures
