Using LLMs to automate insurance approval for healthcare clinics
Title: Tivara: Using LLMs to automate insurance approval for healthcare clinics | Y Combinator

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### Using LLMs to automate insurance approval for healthcare clinics



Tivara

Founded:2024

Team Size:2

Location:

### Active Founders

### Tej Seelamsetty, Founder

Founder and CEO of Tivara. I started my entrepreneurship journey at 18 years old: As soon as I could sign a personal guarantee, I started flipping houses to (successfully) pay for college. Building software to automate the tedious aspects of my own due diligence opened my eyes to the magic of code. Since then, I led growth (10x-ed revenue) at Fair Square (W20) and worked as a consultant at Bain. I studied computer science and financial engineering at WashU.



### Aumesh Misra, Founder

Co-founder and CTO of Tivara. I've spent 4 years building software at Microsoft and Compound (YC S19). I was the 8th engineer at Compound and helped grow the company to over $2B AUM. Prior to this, I researched and developed software for novel medical imaging devices at Stanford.



### Company Launches

[### Tivara 🏥💰 — Automating insurance approval workflows for doctors](

[Tivara]( mission is to help doctors deliver care to patients faster. We’re starting by using LLMs to automate submitting prior authorization requests (and getting their approval) on behalf of providers.



Prior authorization is a process by which physicians must justify their treatment plan of a patient to that patient’s health insurance carrier as “medically necessary.”

Right now, medical groups employ a team (1 employee focused on prior authorizations per 1-5 physicians) to handle this process with insurance carriers manually. These teams are frequently operating over capacity; some of the practices we’ve talked to are so backlogged that a request isn’t even submitted until up to a week after a doctor’s order is placed.

**Figure 1: 94% of Physicians Report Delayed Patient Care due to Prior Authorization (Source: American Medical Association Survey of 1,000 Doctors)**



As you can imagine, insurance carriers are incentivized to delay and/or deny approval as much as they can. Some carriers are so egregious that they’re incurring fines in the tens of millions for morbidly delaying the care of sick patients. A patient who is exhibiting signs of colon cancer definitely shouldn’t have to wait months (or even days) for a colonoscopy.

At the end of the day, we do two things:

1.  Help doctors deliver care faster
2.  Make doctors more money (reduce OpEx)

Who we are:
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Great friends from college.

[Tej]( – Ran growth (10x-ed revenue) at Fair Square (W20) and was an AC at Bain. Paid for college by flipping houses. Studied CS at WashU.

[Aumesh]( – Ex-Microsoft and was the 8th engineer at Compound (S19). Built medical imaging software used by Stanford. Also studied CS at WashU.

Our ask
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Are your parents, siblings, or extended family members doctors who run their own practice? You can help us with an introduction! Please shoot [tej@tivara.com](mailto:tej@tivara.com) a note.


