Anomaly Insights, an AI-powered payer intelligence company, announced Wednesday that it raised $17 million in funding.
The company’s platform analyzes healthcare transactions to identify payer behavior patterns, policy changes and adjudication deviations. It helps predict at-risk payments so providers can proactively ensure claims are paid accurately. It also detects new denial patterns and identifies revenue opportunities. Currently, Anomaly is being used across more than 20 health systems.
Specifically, the company seeks to solve the issue of “not knowing whether a healthcare encounter will be paid for or not before it happens,” said Mike Desjadon, CEO of Anomaly.
“That inability doesn’t exist in any other industry and leads to almost $1T a year in denied payments, rework, administrative spend, labor costs and tremendous patient pain. Nobody built this system on purpose, but somebody benefits from it,” he said. “Providers and payers are both trapped in an adversarial, zero-sum fight that costs American healthcare an estimated $500 billion a year in pure billing and administrative waste. Nobody wins that war permanently. And patients are nowhere in that equation.”
The $17 million round was led by Sound Ventures and included participation from Alumni Ventures, Link Ventures, Redesign Health and RRE Ventures. In total, Anomaly has raised $34 million.
“Providers lose billions every year to an information asymmetry that has defined payer-provider dynamics for decades,” said Juliette Bolea, investor at Sound Ventures and Anomaly Insights board member. “Anomaly flips that dynamic, arming providers with the data and AI to negotiate from a position of strength. We invested because this is not an abstract market problem: every one of us is a patient eventually. When we change how payers and providers interact at scale, providers can focus on care, and patients are the ones who benefit.”
The financing will be used to expand the company’s workforce and scale its platform. In addition, Anomaly aims to broaden its focus from revenue cycle management into managed care.
Ultimately, the company aims to provide a better payment foundation for both providers and payers, Desjadon said. It hopes to create a “fundamentally different” way of negotiating and implementing contracts.
“Think of a clear contract, with agreed rules adjudicated in real time by a neutral third party (us) with a ‘TSA precheck’ on every encounter. … The immediate goal, to serve our ultimate goal, is to give every health system and provider organization in this country access to the intelligence they need to understand how their payers actually behave, and act on that understanding in every claim they submit, every denial they contest, and every contract they negotiate,” he said.
Photo: Richard Drury, Getty Images
