Precision payments startup Anomaly gets $ 17 million to cut wasteful spending


Anomaly, a startup using artificial intelligence to improve payment accuracy in healthcare, has raised $ 17 million in Series A and seed funding.

Founded in 2020, Anomaly’s platform uses machine learning to find irregularities in medical billing to avoid overpayments and billing errors, thereby reducing friction between payers and providers in the claims payment process.

The Series A funding round was led by RRE Ventures and included participation from Link Ventures and previous investors Madrona Venture Group, Declaration Partners and Redesign Health.

Excess spending frequently contributes to payer-provider friction when insurance companies overpay the provider and then try to recover the overpayment afterwards, according to Anomaly co-founder, president and chief operating officer Jacob Shiff. his discovery – the “pay and hunt” method.

Value-based models of care, where the claims payment process requires payers to code contractual exceptions and exclusions for individual provider partnerships, can introduce additional complexities that increase the likelihood of inappropriate payments, Shiff said. at Fierce Healthcare.

According to a 2019 report published in JAMA, these payment errors represent more than $ 300 billion a year in unnecessary spending, or about 10 cents for every dollar spent.

“Imagine if that was the case with your credit card – if every month you received your statement and 10% of your charges were just incorrect,” Shiff said. “It really is the status quo in healthcare today. “

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Using machine learning, Anomaly’s AI sifts through millions of claims and learns irregular spending patterns as new data arrives. The company offers two products, Anomaly Prevent and Anomaly Preempt, which notify suppliers of billing errors in real time and research ways to minimize leakage of future claims, respectively.

Anomaly’s current team of 12 employees includes big names, including Jeff Alter, former CEO of UnitedHealthcare and executive vice president of Anthem, who is now president of Anomaly, as well as chief engineering officer of Foursquare. and Redesign Health and founder of Partenaires Découverte Santé.

“Health insurers are under immense pressure to both control costs and maintain excellent working relationships with providers, but nothing complicates these relationships more than reimbursement disputes,” Alter said in a statement. . “The problem of inappropriate payments is constantly evolving and requires continuous learning of AI to solve it, which is why Anomaly is in the best position to make a difference in the market.”

The $ 17 million raised in Series A and roundtables will be used to expand their team, develop technology and partner with more payers, the company said.

Shiff was unwilling to reveal which payers Anomaly has partnered with or how much money these companies have saved in overpayments, but said the startup’s early partners are “really excited” by the results they’ve achieved so far. ‘now.

“Our vision is for Anomaly to be an integral part of the healthcare payment system, operating transparently, performing our analytics to enable healthcare payments to flow accurately,” he said. “And by working with some of the most important players in the healthcare ecosystem, we can become a truly turnkey part of this system.”

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