PriorAuthNow Raises $25 Million to Expedite Healthcare Authorizations

Funding round is led by Insight Partners to accelerate growth and fuel platform’s network expansion to meet surging demand.

Columbus, Ohio – PriorAuthNow, the only real-time prior authorization network for providers and payors, today announced a $25 million funding round led by New York-based global venture capital and private equity firm Insight Partners. This latest investment brings PriorAuthNow’s total funding to more than $57 million.

With this newest funding, PriorAuthNow will further expand its network to reach both providers and payors looking to streamline the prior authorization process. Additionally, the funding will be used to expand the team to meet a growing market demand. The company manages $61 billion in Provider Net Patient Revenue and has grown more than 300% in the past year. With PriorAuthNow, payors and providers can significantly reduce time and resources spent on the prior authorization process – which can impact up to 40-50% of a provider’s revenue – creating a more cost-effective and frictionless system that improves patient outcomes for all.

Prior authorizations are plagued by a number of challenges – manual processes, lack of coordination between payors and providers, and non-standardized workflows. According to McKinsey, interventions in this antiquated process could deliver $40 billion in annual savings. In a recent study, PriorAuthNow produced remarkably significant time savings for clinical staff, slashing the effort spent on prior authorizations by 91%. A process that routinely took 45 minutes was cut down to just four. In the same study, 25% of the prior authorizations required no human effort at all and overall turnaround time for a prior authorization request was 6.7 days less.

“For decades, the healthcare system has been unduly burdened by prior authorizations,” said Joe Anstine, CEO and co-founder of PriorAuthNow. “We launched PriorAuthNow to reconstruct this process and create a system that generates significant value for both payors and providers alike. We’re taking on the arduous challenge of creating an intermediary between these parties by establishing connections with both sides of the system. Through these more meaningful interactions, we are ultimately helping patients achieve a higher level of care, which has been our driving mission. This latest funding round will help fuel this focus.”

“The current state of prior authorization is archaic, and it often includes a series of disjoint faxes and phone calls done over days to weeks,” said Jon Rosenbaum, Managing Director at Insight Partners. “PriorAuthNow is improving this outdated system by allowing both payors and providers to reduce time and resources on the prior authorization process. This also ultimately drives efficiency for patients and doctors, optimizing treatment and the doctor-patient relationship. We’re excited to be part of this mission and partner with PriorAuthNow as they continue to grow.”

PriorAuthNow is reinventing the process of prior authorizations by creating a platform with direct connection between providers and payors, going beyond simple automation. In what PriorAuthNow calls “intelligent collaboration,” information can flow without friction as the platform integrates with Provider Electronic Health Records (EHR) systems and Payor Case Management systems enabling real-time collaboration and accelerating the time to decision and care for patients. The current process for medical prior authorizations has become an increasingly frustrating and time-consuming burden on clinical staff. The exchange of data between providers and payors is laborious—often involving highly manual tasks—and creates a game of back-and-forth that delays decisions for patients waiting on care. PriorAuthNow is the largest and only integrated prior authorization network for all patient care to drastically cut time and effort invested in the process.

PriorAuthNow continues to build out its network of payors and providers. In January the company announced a strategic alliance with the nation’s largest health information network, Availity, which processes billions of transactions annually. The move draws on the strengths of the respective companies to solve prior authorization at scale as healthcare stakeholders recognize the tremendous benefit.

As part of the transaction, Rosenbaum will join the PriorAuthNow board of directors, and, Scott Barclay, an Insight Managing Director focused on Healthcare, will join as a board observer. In addition to Insight Partners, Panoramic Ventures and Health 2047 were also part of this latest fundraise.

“We are thrilled to partner with Insight to solve one of the biggest challenges in healthcare once and for all: prior authorizations.” said Mark Buffington, Managing Partner at Panoramic Ventures. “Insight’s strategic investment and capabilities will help us to accelerate one of the most promising healthcare information technology ventures in the United States.”

About Insight Partners

Insight Partners is a leading global venture capital and private equity firm investing in high-growth technology and software ScaleUp companies that are driving transformative change in their industries. Founded in 1995, Insight Partners has invested in more than 400 companies worldwide and has raised through a series of funds more than $30 billion in capital commitments. Insight’s mission is to find, fund, and work successfully with visionary executives, providing them with practical, hands-on software expertise to foster long-term success. Across its people and its portfolio, Insight encourages a culture around a belief that ScaleUp companies and growth create opportunity for all. For more information on Insight and all its investments, visit insightpartners.com or follow us on Twitter @insightpartners.