Candid Health

“In most of those cases, the provider submitted the claim wrong.”

“I 100% think we could because if you think about what we're doing, we're pre-adjudicating the claim. We know how the payer's, we know what the payer wants on their claims. We know, like, what their rules are for how to submit a claim. And there's a bunch of no…”

“Phase two is essentially instead of having to have a really, like, Analytically oriented person digging through claims data and finding out the rules. It's actually like, how do you suggest the rules? Okay. These are the patterns of issues we're seeing. Consid…”

“Yeah, actually, I know there's a large payer, ah, that I know manually processes one in eight claims because their adjudication system doesn't do it. It's a large payer. We'd all know the name of it.”

“The rules engine, I think is probably the brain of what we're doing is probably the most valuable part of what we're building, and it's how we can submit, in some cases, 99% of claims correctly the first time.”

“We grew six X this year and the team is around 50 people and have about a hundred customers now.”

“What is really powerful about where we are today is we have this incredibly rich data set That we essentially have the end-to-end operational loop that we control. So we control the preparation, we control the submission, we control the entire cycle of how you…”

“The actual useful application of machine learning is the tip of a very large iceberg, and we're building the infrastructure under the ocean right now of, like, the infrastructure for how do you do all that automation correctly and the machine learning correctl…”

“And it sounds like medical insurance billing is a pretty small problem, but I guess it's about two hundred eighty billion dollars a year.”

“And in many cases, these are customers who have like, 2030, 40% of their claims were being denied. For reasons they didn't have visibility into.”

“Cluster your claims. Find which ones were denied for the same reason. Make one call. Don't call for all thousand of the ones were denied. That's smart. Take that rule, put it in the rules engine, and don't make that mistake anymore.”

“Easily. At the end of the day, there's no software. They're throwing bodies at the problem. The last innovative thing we did in this industry was offshore it.”

“We were the first company in the country to identify that this very large payer had put a bug into their rule system. And they fixed the bug based on, like, us pointing out, hey, you guys, something seems to have happened here.”

“They have this, like, very messy data model, very messy systems, and they're just throwing stuff into things like a JiraQ for offshore to fix, whereas we're actually going through with a fine-tooth comb, root-causing claims, and then codifying the rules engine…”