CoverSelf Healthcare Payment Integrity Platform Raises $4.8M

The company is trying to ease the burden of technology that has led to fraud and abuse

US payers have complex and diverse payment models, which are complicated by ever-changing regulatory and compliance requirements and frequent industry changes to code sets and guidelines, CMS policies, accentuating the lack of consistency between lines of business such as Medicare, Medicaid, commercial and self-insured plans.

This has resulted in a very heavy reliance on technology to keep up with all the changes, resulting in what Rajasekhar Maddireddy, co-founder of CoverSelfa cloud-based platform for healthcare claims and payment integrity, called a “black box” scenario among and between current suppliers.

“A black box is a legacy system where there is an absolute lack of transparency into the inner workings of a platform or system. The first of many problems is that there is a heavy reliance on screw the service provider for any changes in processes and workflows,” he explained.

“Furthermore, when information is transmitted to multiple business users, information is often lost during translation, which can sometimes result in sub-par output quality. Black box systems are also hampering the speed of innovation and pace to market by an exponential amount, again a result of delayed vendor release cycles. »

Which causes that the system is fragmented, redundant and dysfunctional, and this leads to a massive amount of administrative waste, reporting inaccuracies, fraud and abuse that can cost taxpayers billions of dollars.

That’s the problem CoverSelf is trying to solve, and now it has new funds to do it, having announcement a $4.8 million seed round led by BEENEXT and 3one4 Capital earlier this week.

Founded in 2021, CoverSelf’s SaaS platform is used by vendors, payers, and partners, such as EHRs, revenue cycle management vendors, clearinghouses, and data integrity service providers. payments, and allows them all to collaborate with each other to reduce complexity and administrative costs.

“CoverSelf’s primary vision is to make our users a meaningful beneficiary of the generational architectural change occurring in information technology today, and to address healthcare claims and payment integrity with a unified and holistic approach,” said CoverStory co-founder Raghavendra Pawar.

“We aim to simplify and democratize the healthcare claims and payment integrity industry by creating a fully open and transparent solution that can be developed in the spirit of collaboration rather than causing duplication of effort to address the more than $900 billion in administrative waste and abusive payments in the United States”

CoverSelf will use its new funding to grow its enterprise platform and operations at scale, which means rolling out a self-service claims and payment integrity platform to all its stakeholders in the near future. It will also grow its employee base from 45 to around 100 by next year, specifically strengthening its sales, product and technology teams.

“We have a core team comprised exclusively of subject matter and domain experts with extensive industry experience. The CoverSelf team therefore actively onboards customers who have the same vision as us: to reduce healthcare costs. and transition to fully future-proof cloud-focused technology companies,” Pawar said.

“With this new round of funding, at CoverSelf, we aim to empower these ambitious organizations to take the leap into a futuristic world, providing them with the additional resources and onboarding support they need.”

The company’s ultimate goal, Maddireddy said, is to be the single source of truth in the marketplace for all matters relating to claims and payment integrity, and to create and serve as the benchmark in the whole of this industry.

“With this, we aim to create a global impact on the needs of the hour – reducing healthcare costs and ensuring that continuous and growing coverage is available for the right people at the right time,” a- he declared.

“We also aim to make a meaningful beneficiary of the generational architectural shift underway in today’s IT world and address healthcare claims and payment integrity in a unified and holistic way to address the more than $900 billion in administrative waste and improper payments in the United States each year.”