Healthcare · sub-niche
Prior authorization automation.
Prior auth is one of the most painful workflows in healthcare. AI can break the bottleneck.
Team-sized buildHot — multiple deals per month
Why now
Insurer + provider tension on PA is at all-time highs. Regulatory pressure (CMS rules) is forcing electronic PA workflows.
What the signal looks like
Repos with payer-specific PA criteria libraries, EHR integration adapters, and approval-status webhooks.
Public examples
We name publicprojects + categories only — never founders we track inside the paid product. The buyer’s edge stays inside the product.
- Cohere Health-style PA automation
- Olive AI shape (pre-pivot)
- Payer-specific PA APIs
What this displaces
A fax machine and a 45-minute hold call.
Our build-vs-invest call
Hot category, real budgets. The wedge is one specialty (oncology, GLP-1s, MRI). Fund with payer-side or provider-side GTM. The moat is payer-relationship + criteria-library depth.
Common questions about this niche
- Who pays?
- Providers initially; payers eventually.
- TAM?
- $10B+ in administrative spend.
- Defensibility?
- Per-payer criteria library + integration footprint.
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