{"id":70364,"title":"Fairway Health - Process prior authorization faster","tagline":"We use LLMs to analyze long (70+ page), messy medical records and determine if a patient is eligible for a treatment.","body":"### **TL;DR**\n\nFairway 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.\n\n### **What is Prior Authorization?**\n\nPrior 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. \n\n**This process for health insurance is still manual and inefficient:**\n\n1. Patient documents sent to health insurance are a mess and can be a **70-100+ page fax.**\n2. 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.\n\n### **How it works:**\n\nWe 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.\n\n![uploaded image](/media/?type=post\u0026id=70364\u0026key=user_uploads/1096888/fceffbb3-e71a-4523-a0a9-df7c73f34c76)\n\n### **Our ask:**\n\nAre you in health insurance or do you know anyone in health insurance? Ping us at [moses@fairwayhealth.co](mailto:moses@fairwayhealth.co). We would love to get connected and hear if we can help speed up your medical necessity determination process.","slug":"IIu-fairway-health-process-prior-authorization-faster","created_at":"2023-03-16T23:33:50.968Z","updated_at":"2026-05-25T05:50:36.259Z","total_vote_count":304,"url":"https://www.ycombinator.com/launches/IIu-fairway-health-process-prior-authorization-faster","share_image_url":"//bookface-static.ycombinator.com/assets/ycdc/yc-og-image-c440a0ad1dacfb86eeeb343717479cc54d256614449b4ef719977a0a451f8bc8.png","company":{"id":27945,"name":"Fairway Health","slug":"fairway-health","url":"https://www.fairwayhealth.co/","logo":"https://bookface-images.s3.amazonaws.com/small_logos/9c6a5ab354c877fee7eb9b5d62ab08b4f08908c4.png","batch":"Winter 2023","industry":"Healthcare","tags":["Health Tech","B2B","Healthcare","Health Insurance","AI"],"search_path":"https://bookface.ycombinator.com/company/27945"}}