ClaimGlide Automates the Most Hated Process in Healthcare: Prior Authorizations

The Macro: Prior Authorizations Are Healthcare’s Most Expensive Paper Shuffle

Prior authorizations cost the US healthcare system an estimated $35 billion annually in administrative overhead. Every time a physician wants to prescribe a medication, order a test, or schedule a procedure that requires insurer approval, someone in the practice has to submit a prior authorization request. Then they wait. Then they follow up. Then, 15 to 20 percent of the time, they get denied and have to submit an appeal.

The American Medical Association reports that practices spend an average of 14 hours per week on prior authorizations. The typical request takes 1 to 3 business days to process, and some take weeks. Patients wait for treatments they need. Physicians spend time that should go to patient care on bureaucratic processes. Staff burn out from the repetitive, frustrating work.

The process is particularly painful for small and mid-size private practices that do not have dedicated prior authorization teams. A three-physician practice might have one person handling prior auths alongside other administrative duties. When volume spikes, everything falls behind.

Previous automation attempts have focused on submitting requests electronically, which speeds up one step but does not address follow-up, denial management, or the sheer complexity of navigating different payer requirements.

ClaimGlide, backed by Y Combinator, automates the entire end-to-end process from submission through appeals.

The Micro: AI That Makes Phone Calls to Insurance Companies

Nami Lindquist (CEO, Penn M&T undergrad from Bellevue, WA) founded ClaimGlide to attack the full prior authorization lifecycle, not just the submission step.

The platform handles four stages. First, it creates and submits authorization requests with language optimized for payer approval, automatically pulling patient and provider data from EMR systems. Second, it monitors timelines, flags delays, and follows up with payers to prevent requests from falling through the cracks. Third, when denials happen, it automatically generates appeal letters. And here is the standout feature: ClaimGlide can handle entire phone calls to payers for appeals. Fourth, it stores all approval records and confirmation numbers back in the practice management system.

The ability to make phone calls to payers is a significant differentiator. Many payer appeal processes still require phone calls, and practices spend hours on hold waiting to speak with payer representatives. An AI that handles these calls removes one of the most time-consuming and frustrating parts of the job.

The platform integrates with eClinicalWorks, athenahealth, NextGen Healthcare, and ModMed, covering a significant portion of the EMR market for private practices. HIPAA compliance is built in.

Competitors include Infinitus Health (AI phone calls to payers), Rhyme (prior authorization automation), and Olive AI (which pivoted away from this space). ClaimGlide’s end-to-end approach covering submission, monitoring, appeals, and phone calls is more comprehensive than most point solutions.

The Verdict

ClaimGlide is attacking one of healthcare’s most universally hated processes with comprehensive automation. The pain point is well-documented and the ROI is clear.

At 30 days: what is the first-pass approval rate for ClaimGlide-submitted authorizations compared to manually submitted ones?

At 60 days: how successful are the AI-generated appeals and automated phone calls at overturning denials?

At 90 days: what is the time savings per practice per week, and does that translate to measurable revenue recovery?

I think ClaimGlide is well-positioned. Prior authorization automation is one of those markets where the problem is universally acknowledged and the willingness to pay is high. The phone call automation is the feature that separates ClaimGlide from simpler submission tools. If it works reliably, every private practice in the country is a potential customer.