Alaffia Health, a health tech business that works with payers and third-party administrators to minimize fraud and help clinicians conduct reviews more efficiently, has raised $10 million in series A funding to advance its research and development.
The company uses Ask Autodor, its generative AI tool, to help medical coders navigate an avalanche of insurance claims. The tool is built upon models like GPT-4 by OpenAI and is integrated with internal, proprietary transformer-based models.
Founder and CEO TJ Ademiluyi said these medical professionals can work 10 to 20 times faster depending on a claim’s complexity using its AI copilot.
“This means they can get through more reviews and not feel so restricted in terms of getting through a backlog of claims,” he told Fierce Healthcare. “They can also be more proactive in terms of doing more robust reviews on a prepayment basis, versus a pay-and-chase model that increase abrasion across the ecosystem.”
Alaffia’s approach helps eliminate fraud in the system, said Adun Akanni, a co-founder and chief operating officer for Alaffia Health, as well as Ademiluyi’s sister. Its technology not only tracks how many units of immunizations or chemotherapy are billed but whether the units are actually being administered.
The brother-sister duo said Alaffia's health plan partners are most excited about its cost-saving capabilities. The company works with Medicaid, Medicare Advantage and commercial partners for plans with up to 2 million covered members. They said one plan has achieved nearly $15 million in savings, and Alaffia is looking to work with more “tech-forward” plans.
In turn, providers are happy as they get reimbursed quicker and reduce worker burnout.
“Every claims analyst should have, at a minimum, a copilot that can help them pull various data from different sources that were once siloed,” said Ademiluyi.
Right now, that means pulling claims data, provider contracts, clinical guidelines and policy documents in real time, but could eventually include documentation summarization.
That has resulted in rapid revenue growth for Alaffia. In 2021, the company said its revenues increased by 24 times that year alone. Now, the co-founders said its revenues have increased four times over again.
The $10 million in new funds will be put toward applied research and development. With the series A round's close, Alaffia has now raised more than $17.6 million to date.
FirstMark Capital led the latest funding round, with participation from GingerBread Capital, Anthemis, Aperture Venture Capital, 1984 Ventures, ERA’s Remarkable Ventures Fund and Tau Ventures. Amish Jani, founder and partner at FirstMark, will join Alaffia’s board of directors.