New York-based startup Anterior raised $40 million this week to tackle one of healthcare’s most widely loathed pain points: administrative clinical work inside health plans, especially prior authorization.
The round brings the company’s overall fundraising total to $64 million since its founding in 2023. Investors include Sequoia Capital, NEA, FPV and Kinnevik.
For decades, patients have grown used to a system in which they have to wait days or weeks for care approvals — driving up costs, degrading the patient experience and exacerbating a clinical burnout crisis. Clinicians and payers often spend hours navigating approval processes, but large language models, when designed responsibly and overseen by clinicians, can automate roughly 90% of this administrative work, according to Anterior CEO Abdel Mahmoud.
“Clinicians become supervisors of AI rather than processors of paperwork,” he remarked.
He noted that general-purpose large language models can support some health plan tasks but lack the accuracy and integration required for routine use in healthcare. Anterior focuses on adapting AI for payer workflows, with added oversight and controls to make them usable in day-to-day operations.
Essentially, the startup focuses on the “last mile” that makes large language models usable in healthcare — solving for accuracy, safety, integration and auditability, Mahmoud explained. He argued that AI sometimes fails for payers not because of the models, but because of the implementation. Anterior embeds both engineers and clinicians directly with customers to tailor the technology to existing workflows, test its outputs and help staff use it in practice.
The platform also offers modular actions — such as reading faxes, interpreting medical records against guidelines and converting policy PDFs into decision logic — that health plans can combine to automate their staff’s workflows at scale.
“At the core, we have a clinical AI reasoning platform,” Mahmoud stated.
Anterior charges its health plan customers based on the value it technology creates, so pricing varies by use case and can also include task-based fees, such as per auto-approved prior authorization.
In the startup’s deployment with Geisinger Health Plan, its system is approving cancer care for patients in roughly 155 seconds — versus the weeks it previously took, Mahmoud said.
“That means a cancer patient can get their care approved while they’re still sitting in the consultation room,” he declared.
This not only leads to faster decisions, but also lower costs due to reduced administrative work and less staff time spent on approvals.
Mahmoud views Anterior’s competitors in two categories, the first being point solutions for specific health plans workflows.
“We have a lot of respect for what they do. We might intersect on some workflows, but Anterior is building something broader: a clinical AI brain that works across the full range of health plan workflows, from prior authorization to care management to payment integrity to risk adjustment,” he explained.
The second group is the Big Tech companies. Mahmoud says that Anterior’s relationship to companies like Anthropic and OpenAI is more “co-petitive” than competitive, as he sees them as potential partners.
Looking ahead, Mahmoud said the new funding will go toward expanding Anterior’s deployments with health plans, building additional integrations and scaling the teams that work with customers to implement the technology.
Photo: Sakchai Vongsasiripat, Getty Images
