🛎 TL;DR

After helping hospitals implement AI workflows at Palantir, our team has built a product to help healthcare providers automate how they manage insurance claim denials. This is desperately needed by the 40% of hospitals in the US that have negative operating margins each year.

Within a month of launching, Guardian has helped recoup >$150,000 in claim value for providers.

🏥🚨 Hospitals are Dying

While he was in college, the hospital where Pranav’s mom worked in Philadelphia went bankrupt - Bernie Sanders actually picketed outside in protest.

The last two years at Palantir, Mayank and Pranav have been working with some of the biggest health systems in the country who, despite their size, had hundreds of millions in unpaid claims and were shutting down hospitals.

Insurance companies are using AI to deny more claims. We’re on a mission to arm the providers and fix a system where 40% of hospitals are losing money.

🤖 Fighting Denials with AI

Denial management is a manual and painstaking process. Healthcare providers have a long string of tasks to complete — (1) call payers, (2) write appeal letters, (3) scrape patient charts for missing diagnoses and authorizations, (4) check for clerical errors, (5) check clearinghouses for patient eligibility and provider enrollment – the list goes on. There are so many tasks and systems required to work a denial that most healthcare providers end up writing off 5-20% of their accounts receivable.

Our platform serves as a one-stop shop for denials management, where AI agents manage claims from end-to-end.

1. Data Model: Guardian integrates with Clearinghouses, Payer Portals, and EHRs. Billing teams no longer have to switch between systems.
2. Claim Status & Denial Cohorts: Looking at payer policies / contracts and trends in payer behavior, Guardian triages claims that are worth pursuing and determines a specific path to resolution.
3. Automating Denial Resolution: Our growing denial resolution suite automates payer phone calls, claim corrections and re-submissions, and a dozen other rote tasks in a denied claim’s lifecycle.

👨‍💼👨‍💼 The Team

Mayank and Pranav were two of the first members of Palantir’s Commercial Healthcare Team. They’ve worked together to improve hospital operations at some of the largest health systems in the country.

After implementing AI programs at health systems the last several years, they look forward to democratizing AI across US healthcare and avoiding heartbreaking hospital and clinical practice closures.

🤝 Our ask: 💰 Our Offer:

We do risk-free, rapid denials + AR age assessments for hospitals and medical practices. Give us your unpaid claims and we’ll run them through our software to find slam-dunk cases which payers have mis-processed - we’ve consistently found over $100K in low-hanging fruit when we’ve done this.

Reach out at founders@withguardian.ai or grab time at withguardian.ai.