CoverSelf’s customizable platform simplifies the healthcare claims system

September 15, 2022:- The U.S healthcare system is infamously labyrinthine, with a prolonged claims process that results in frequent blunders and high administrative costs. Founded in Bangalore, CloudSelf is building a cloud-native platform to enhance payment integrity (or the process of making sure healthcare claims are settled accurately) by being additionally transparent and customizable than legacy systems. The startup revealed today it had raised $4.8 million in seed funding directed by BEENEXT Capital and 3one4 Capital.

Legacy systems present a substantial obstacle to payment integrity because many are black boxes, or have no transparency into their internal workings or systems, CoverSelf co-founder Rajasekhar Maddireddy conveyed to TechCrunch.

Claims and payment platforms recognize inaccuracies in claims and payment contracts, including mismatches with existing policies and guidelines. This suggests these platforms should continuously update policy and procedures data, Maddireddy explained. But as legacy systems are black boxes, it is difficult for information to be shared among various parties in the payment integrity process. It also hinders innovation and results in the potential leakage of intellectual property, causing payers to be reluctant to share use cases.

Launched in 2021, CoverSelf wants to provide an open and easily customizable system that allows payers, vendors, and providers to collaborate by enabling real-time data sharing while protecting IP. The startup is currently pre-launch but has already partnered with leading healthcare companies.

Maddireddy said the platform could take different deployment approaches depending on what clients what. For example, it tested its payment and claims accuracy platform by partnering with a top private health insurance provider. CoverSelf showed that the provider had a 9% inaccuracy rate in claims that would have otherwise gone unnoticed.

Prior to CoverSelf, Maddireddy and co-founder Raghavendra Pawar were initial employees at U.S. healthcare startup HealthLucid (Maddireddy was its foremost employee). Pawar has also functioned at healthcare organizations like Cotiviti and Prime Healthcare, devouring 16 years in the industry.

During their term at HealthLucid, a Blue Cross Blue Shield (BCBS) company requested them to build a self-manageable platform for claims and payment probity. A Fortune 500 company also reached Pawar to question if he knew any self-manageable and open platforms for claims and payment integrity. The two saw the requirement for a platform like CoverSelf.

“Current retailers are black box and don’t enable collaboration,” Maddireddy displayed. “Because of that, people are reinventing the wheel multiple duration and increasing the healthcare cost.”

He added that vendors’ benefit of black box platforms forces payers to be too dependent on them by controlling transparency into the root causes of inaccurate claims. This implies they can’t tell hospitals and doctors what is generating errors, resulting in lengthy and expensive cycles of rejections and appeals.

CoverSelf’s platform was created to adapt to increasingly complex payment models and modifications to compliance necessities, code sets, and guidelines.

Users can construct on top of CoverSelf’s domain-specific platform with pre-built code sets and industry libraries, authorizing them to scale quickly while remaining on top of new code sets and policies. CoverSelf’s platform also contains claims verification APIs for payers and providers.

CoverSelf’s competitors possess startups like Rialtic and HealthEdge, and legacy techniques Cotiviti, Change Health, Optum, and Multiplan.