Fairway Health

TL;DR

Fairway Health is an AI assistant for health insurers to quickly process patient treatment authorizations. We use LLMs to analyze long (70+ page), messy medical records and determine if a patient is eligible for a treatment.

What is Prior Authorization?

Prior Authorization is a process where physicians must obtain approval from a patient’s health insurance plan before a specific treatment or medication is delivered. This process can take an average of 2-14 days, with some cases taking upwards of 15-31 days. This prevents patients from receiving necessary treatments in a timely manner. The entire healthcare industry is also projected to spend $36 billion each year in administrative costs for this process.

This process for health insurance is still manual and inefficient:

1. Patient documents sent to health insurance are a mess and can be a 70-100+ page fax.
2. Health insurance companies have to allocate more headcount to try and manually check these documents against their medical necessity criteria, costing them millions each year.

How it works:

We speed up the medical eligibility determination for health insurers. We ingest patient documents + criteria from health insurance plans and use LLMs to output an approval/denial decision with justification based on an evaluation of each sub-criteria. We also highlight the context within the medical document that informed the decision to allow for easy review.

Our ask:

Are you in health insurance or do you know anyone in health insurance? Ping us at moses@fairwayhealth.co. We would love to get connected and hear if we can help speed up your medical necessity determination process.