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Sohar Health

Sohar Health

AI-driven clearing house for behavioral health companies

Sohar Health is a SaaS platform for behavioral health companies. It is an API-based solution that offers 99% accurate eligibility verification, and AI-powered medical coding to automate manual workflows, increase patient intake, and generate more revenue.

Sohar Health
Founded:2023
Team Size:2
Location:New York
Group Partner:Gustaf Alstromer

Active Founders

Dr Ashish Mandavia MD

I am a health-tech entrepreneur and CEO at Sohar Health, automating insurance eligibility verification and medical coding for behavioral health companies. With 8+ years of combined experience in health-related startups, strategy consulting, and clinical practice, I have a unique perspective and skill set to drive innovation and growth in the digital health and technology space across EMEA and the US.

Dr Ashish Mandavia MD
Dr Ashish Mandavia MD
Sohar Health

Lucas Gordon

CTO and cofounder of Sohar Health (S23). I have 14+ years experience as a software engineering, most recently as CTO and first employee at Pelago (W18) where I led a team of 40 across software engineering, data engineering and information security. During my time at Pelago I helped take the company from pre-seed to post series B, raising over $80M and positioning the company as the world's leading virtual clinic for substance use management.

Lucas Gordon
Lucas Gordon
Sohar Health

Company Launches

TL;DR

Behavioral health companies are investing significant resources into expensive integrations and manual medical coding efforts to drive uptake and generate additional revenue from payers. Enter Sohar Health. Our API-based platform streamlines insurance eligibility verification and offers AI-powered medical coding, automating manual workflows, increasing patient intake, and generating more revenue. Experience the power of seamless integration and unleash the full potential of your behavioral health company with Sohar Health.

🤯 The problem

Improving behavioral health insurance claim coding accuracy is crucial as 85% of denied claims (worth $40 billion) are preventable. However, determining the eligible codes for patients is a challenge due to complex integrations within the healthcare IT ecosystem. These integrations are costly, time-consuming, and divert engineering resources, hindering product development. Delaying or skipping integrations leads to revenue loss and increased manual efforts for engineers and coding teams, creating a significant barrier for behavioral health companies in a rapidly growing industry, valued at $280 billion in 2020.

🧠 The Solution

Similar to Stripe (YC09) and Plaid, Sohar Health empowers developers by providing direct integrations to payers. Our API-based platform offers two key features: targeted insurance eligibility verification, and AI-powered medical coding. By leveraging our services, behavioral health companies can:

  1. Unlock up to 20% additional revenue through improved coding accuracy and reduced claim denials
  2. Increase their eligible patient population
  3. Reduce the time spent on manual operations by coding teams

👋 Our Backstory

At Pelago (formerly, Quit Genius W18), the leading digital clinic for substance addictions, Ash and Lucas joined forces. Ash is an MD, with a background in digital health, hospital administration, and Health IT strategy consulting. As CTO and employee one at Pelago, Lucas possesses unparalleled expertise in resolving behavioral health integration challenges. With a track record of successfully integrating with 100+ employers, including major players like Evernorth and a Fortune 10 customer, Lucas's firsthand experience and Y Combinator background have been instrumental in securing over $80M in investment funding from seed to Series-B.

Our ask

Introduce us to behavioral health providers (digital or hybrid) in your network. Click here

Connect us to your health plan or payers (e.g. Humana, Cigna, Aetna) that you’re working with. Click here

Interested in hearing more? Feel free to book a meeting here

YC Sign Photo

YC Sign Photo

Hear from the founders

How did your company get started? (i.e., How did the founders meet? How did you come up with the idea? How did you decide to be a founder?)

MEET THE BRAIN & THE HEART OF SOHAR HEALTHSohar Health is the marriage of an engineer’s problem-solving brain and a physician’s healing heart, connecting healthcare providers & payers in a more integrated and centralized way.LUCAS GORDONEx-CTO & CISO of Quit Genius (YC W18)Most recently CTO of Quit Genius, the world’s leading digital clinic for substance addictions, Lucas is uniquely positioned to solve benefits integration problems using all he’s learned along his career journey. He’s one of a handful of people in this market who’s experienced firsthand the pain caused by this problem, and the value of solving it. Lucas holds an MSc in Computer Science from the University of London. He’s designed and built systems to integrate with 100+ employers, including integrations with Evernorth and a Fortune 10 customer. At Quit Genius, he also assumed the role of Chief Information Security Officer, leading the company through SOC-2 compliance audits, achieving HITRUST certification, and attended the Y Combinator program in 2018–helping secure over $80M investment funding from seed to Series-B. It was there he met his co-founder, and their aligned passion for healthcare and technology, combined with their deep knowledge of inherent pain points, sparked the idea that became Sohar Health.DR. ASHISH (ASH) MANDAVIAMedical Doctor & Digital Health InnovatorA former National Healthcare System doctor in the UK, Ash was inspired to jump into the world of startups seven years ago, initially as a product manager, using his clinical knowledge to support a team of engineers to create and build a piece of triage software for ERs in the UK. He moved on to a medical education technology company as employee one and helped scale the organization as product and services director. There, he found a love for the commercial side and moved into business development.This led Ash to taking on the role as EMEA Commercial Director of Quit Genius (YC W18), where he led a team to deliver commercial B2B sales, client success, and partnerships with large employers, private healthcare insurers, and public health systems. It was there he discovered inherent pain points related to integrating with these types of payers, slowing access for people getting the help they need.Most recently, Ash was a strategic consultant  at Simon Kucher and Partners, focusing on market access and reimbursement for Digital Health solutions across the UK, Europe, and the US.

How did you decide to apply to Y Combinator? What was your experience applying, going through the batch, and fundraising at demo day?

The ethos and ambition towards growth and becoming a $1b+ company at Quit Genius was a strong motivator to take Sohar Health through the YC accelerator program. The company has accelerated by 12 months in a 10 week period and this is mainly due to the strong guidance from our group partners and accountability that we have shown to our peers and colleagues. We have developed significant traction among customers and our product is loved by our customers. YC has pushed us to become the most accurate eligibility verification tool in the behavioral health market and we now run upwards of 60,000 eligibility checks per month. The fundraising process has moved faster than our initial expectations and we feel that the feedback and support given prior to the raise has allowed us to enter those conversations with more confidence and purpose.

How have you kept in touch with the YC community and continued to use YC resources & programs since the batch ended?

From in-person events across the bay area to the founder matching program, we have managed to embed ourselves in the YC community and learn from this amazing network of founders. As we complete our Seed round, we hope to follow the guidance laid out in the post-batch manual and Series A fundraising guide to continue our growth trajectory and our journey towards becoming a unicorn in the health tech space.

What's the history of your company from getting started until the present day? What were the big inflection points?

Lucas and I caught up at the start of 2023 when he had exited Quit Genius (YC W18) and I was on paternity leave from my strategy consulting role. We had discussed this burning platform issue on several occasion and recognized that we were in a unique position to solve it. We initially focused on employer eligibility verification for digital health companies, but quickly became aware, through customer discovery, of an even greater challenge to tackle in Real Time Eligibility (RTE) and Coverage of Benefits (COB) determination in the behavioral health space. This was an inflection point and gave us the confidence to pursue a pre-seed round, led by Concept Ventures and allowed us to build our eligibility verification tool and automated AI coding feature. We gained further proof points of the value of our product with strong initial customer traction, booking $118K ARR in the past two months.

What is the core problem you are solving? Why is this a big problem? What made you decide to work on it?

One of the biggest reasons behavioral health companies can’t grow faster is that 11% of every patient get denied for insurance reimbursement which directly hits revenue, employee cost and marketing cost. A large proportion of these claims denials are related to eligibility inaccuracies. With our 99% accurate eligibility checker, we reduce these denials to 2%.To determine a patient’s eligibility for a behavioral health service, you could use an existing electronic checker or amass a manual administrative team. Standard automated eligibility checks in the market can only achieve a 50 - 60% accuracy level for mental and behavioral health. The reason these vendors don’t work is that they do not take account of payer carve outs - when insurance companies carve out behavioral health coverage to third party insurers.With our deep understanding of the complex integrations within the payer ecosystem, we can get our automated accuracy check up to 99% and essentially significantly reduce the chance that a patient’s claim will be denied by their insurer.

What is your long-term vision? If you truly succeed, what will be different about the world?

We believe in patients accessing healthcare without limits.What if providers were free from the barriers & burdens that waste money and time, and instead could focus on the things that help patients regain and maintain their health? What if signing up for appointments with service providers were easier to manage and integrate? What if there was an easy, cost-effective way to simplify providers’ operations? What if providers had more time to deliver excellent care and weren’t focusing on how to work with insurers? Sohar Health is the marriage of an engineer’s problem-solving brain and a physician’s healing heart, connecting healthcare providers & payers in a more integrated and centralized way.\We’ve felt the devastating effects of ineffective healthcare on a very personal level, and we have a focused vision of getting better care to more people, quickly and seamlessly. What if clinical services, delivered in bricks and mortar practices or remotely, were able to be the lifeline of hope they were intended to be for millions of patients across the US? Smoother integration.Fewer barriers.Less waste.Improved health.Greater productivity.Effortless connection between payers & providers.What if?It’s time to fully connect and integrate via Sohar’s clearing house for the modern healthcare system