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"AI-powered contract and remittance analytics to detect insurance underpayments"
TL;DR: Fuse offers AI-powered analysis of healthcare contracts and payments to help providers detect underpayments and collect the revenue they’re owed from insurers.
Founded by Sho Sugihara & Oscar Wilsby
The Fuse team specializes in complex financial data analytics. They previously co-founded a business that grew from $0 to $6M ARR in 12 months, developing large-scale data models for payment and credit analytics that outperformed major players like Experian.
Sho (CEO) met Oscar during their first week of undergrad at Cambridge. He’s a repeat entrepreneur and closed a $100k contract within a year for his first company, and has worked on data analytics projects for some of the largest providers and insurers in the world at McKinsey.
Oscar (CTO) was an academic who completed a PhD and postdoc in Machine Learning at Cambridge. He’s worked in research divisions for companies like McLaren F1, and brings expertise in building top performing data models in highly regulated industries.
❌ Problem
The founders “aha” moment came when healthcare provider execs repeatedly told them they had no idea if their revenue was accurate. One even described their insurance claims process as a “black hole”.
Several factors contribute to this issue:
- Growing usage of AI. Insurers are using sophisticated models to analyze claims and find ways to subtly underpay.
- Too many contracts: An average hospital has over 50 contracts with insurers with varying reimbursement rates for the same procedure, making payment accuracy verification costly and near impossible.
- M&A wave: Mergers are forcing providers to consolidate contracts and revenue tracking systems, adding further complexity.
As a result, providers spend months analyzing revenue and chasing payments, forfeiting up to 11% of topline revenue if they cannot afford the overhead to do so.
With provider operating margins already negative since COVID-19, the situation creates severe margin compression and cash flow risk.
Solution
Fuse uses LLMs to extract data from the stacks of contracts that dictate provider payment terms from insurers. They reconcile the data against remittances to identify underpayments and auto-generate appeals.
The founders mission is to level the playing field for providers with AI-powered contract analytics. Beyond this, Fuse wants to aid the transition towards Value-Based Care by powering sophisticated contract modeling as payment models become even more complex.
Learn More
🌐 Visit www.fuseinsight.com to learn more.
🤝 If you know senior finance execs in healthcare systems or partners at healthcare PE firms, please connect with the founders via email!
👣 Follow Fuse on LinkedIn.
