New York-based startup Anterior raised $40 million this week to address one of healthcare’s most hated pain points: administrative clinical work within health plans, especially prior authorization.
The round brings the company’s fundraising total to $64 million since its founding in 2023. Investors include Sequoia Capital, NEA, FPV and Kinnevik.
For decades, patients have become accustomed to a system in which they have to wait days or weeks to get approval for care, driving up costs, degrading the patient experience, and exacerbating a clinical burnout crisis. Clinicians and payers often spend hours navigating approval processes, but large language models, when responsibly designed and monitored by clinicians, can automate about 90% of this administrative work, according to Abdel Mahmoud, CEO of Anterior.
“Doctors become AI supervisors rather than paperwork processors,” he said.
He noted that general-purpose large language models can support some health plan tasks, but lack the precision and integration needed for routine use in healthcare. Previous focuses on tailoring AI to payer workflows, with additional oversight and controls to make them usable in daily operations.
Basically, the startup focuses on the “last mile” that makes large language models usable in healthcare, solving for accuracy, security, integration and auditability, Mahmoud explained. He argued that AI sometimes fails for payers not because of the models, but because of the implementation. Previous integrates engineers and clinicians directly with customers to adapt the technology into existing workflows, test its results, and help staff use it in practice.
The platform also offers modular actions (such as reading faxes, interpreting medical records based on guidelines, and converting policy PDFs into decision logic) that health plans can combine to automate their staff workflows at scale.
“In essence, we have an AI clinical reasoning platform,” Mahmoud said.
Previous charges its health plan customers based on the value its technology creates, so prices vary by use case and may also include task-based fees, such as for automatically approved prior authorization.
In the startup’s implementation with Geisinger Health Plan, its system is approving cancer care for patients in about 155 seconds, compared to weeks it previously took, Mahmoud said.
“That means a cancer patient can get approval for their care while still sitting in the consultation room,” he stated.
This not only leads to faster decisions, but also lower costs due to reduced administrative work and less staff time spent on approvals.
Mahmoud sees Anterior’s competitors in two categories: The first is point solutions for specific health plan workflows.
“We have a lot of respect for what they do. We might cross paths on some workflows, but Anterior is building something broader: a clinical AI brain that works across the full range of health plan workflows, from prior authorization to care management, payment integrity and risk adjustment,” he explained.
The second group is large technology companies. Mahmoud says Anterior’s relationship with companies like Anthropic and OpenAI is more “copetitive” than competitive, as it sees them as potential partners.
Looking ahead, Mahmoud said the new funds will go toward expanding Anterior’s implementations with health plans, creating additional integrations and expanding teams working with customers to implement the technology.
Photo: Sakchai Vongsasiripat, Getty Images