Ruma Care automates prior authorizations - we’re starting with clinics that administer the most expensive specialty medications.
Biologics are expensive medications that cost 0-50K+ per year per patient, and often need to be administered in specific settings called infusion clinics. Medical providers buy these drugs up front to secure pricing deals and safer inventory - they are reimbursed for the cost of the medications through the patients’ insurance.
Because they’re so expensive, these specialty medications are denied by insurers at a rate of 37% each year. When they are denied, providers don’t get reimbursed for the medication and are left covering the costs. Ruma Care solves this so clinics get paid, patients get treated faster, and care teams spend less time fighting insurance.
We do this in three ways:
1. For each medication, diagnosis, and insurance combination, Ruma extracts the submission criteria required to get the drug approved by insurers.
2. We pull out the correct forms, then automate the form-filling for prior authorizations.
3. Lastly, we enroll patients in copay assistance programs, all in one workflow and platform.
We turn a process that traditionally spans 70+ online portals, disparate paper forms, and manual phone calling into a single, streamlined platform. As we process prior authorizations, our models learn from denial patterns to understand exactly what insurers need to see to get a prior authorization approved.