Penguin AI snaps up $30 million to simplify prior verification, coding and claims
This week, another startup trying to solve multi-million dollar healthcare management problems.
Palo Alto-based Penguin AI ended a $29.7 million funding round led by Greycroft. Some of the startup's other investors include UPMC Enterprise, Snowflake Ventures, Watershed Ventures, Watershed Ventures, Dober Capital, Canvas Prime and Plun and Play.
Founder and CEO Fawad Butt said the company was founded last year to improve the expensive, inefficient management workflow of healthcare.
He noted that the United States spends about $1 trillion on administrative workflows for health care each year. He added that a few processes include most of the costs of prior authorization, claim handling, medical coding and risk stratification.
Penguin aims to relieve this burden through its AI-powered agents, aiming to automate and simplify these workflows.
Butt said many of Penguin’s provider customers are attracted by the startup’s medical coding and revenue cycle management tools.
As for the payer customers, he said they thanked the tools that simplified the prior authorization. Penguin’s agents categorized the requests, met the evidence of the payer’s guide, and then made recommendations for human reviewers.
“Now, the whole process for humans is down to half, to two minutes, not the time of the past – 25 to 30 minutes. In fact, accuracy has risen because machines can see things and remember things that humans cannot,” Butt explained.
He acknowledges there are many other healthcare-focused AI agents on the market and says Penguin is unique, which is not a key solution in a sense. Butt notes that many other startups focus on just one workflow, such as documentation or coding.
In his opinion, Penguin is building a comprehensive, medical-specific AI platform that provides multiple use cases for payers and providers, all supporting multiple use cases. It's like an epic trying to build a healthcare backend, he said. ”
Bart noted that he was once the “biggest buyer in health care” because his previous roles included Optum's chief data officer, UnitedHealthCare's chief data and analytics officer, and Kaiser Permanente's chief data officer.
“I've been buying and building in this space for a long time. The challenge I'm seeing is that no one is building a platform for healthcare. The people who build the platform are general-purpose technology companies like Azure, AWS and AWS and GCP – they're building a platform for financial services or automotive services to put lipstick on it, but you can use it on medical care. But for me, healthcare is a unique business,” he declared.
Butt said when building platforms for other industries, it will always require extensive customization to meet the unique needs of healthcare when it comes to data management, compliance and privacy.
In the crowded market of points solutions, Penguin bets that a comprehensive platform will help differentiate it from noise.
Photo: Weiquan Lin, Getty Images
