Coverself

Payment integrity platform empowering healthcare payers with configurable rules

Founders

Our Investment Thesis

CoverSelf is building a complete operating system for payment integrity in healthcare, addressing the massive inefficiencies and costs associated with fraud, waste, and abuse in claims processing. The current ecosystem relies on legacy platforms that are costly, inflexible, and non-interoperable, creating high entry barriers, IP leakage risks, and delays due to technical resource dependencies.

CoverSelf solves these issues with a modular, portable, and domain-specific platform. Its proprietary language, CREOL, allows domain experts and not just technical teams, to write and customize payment integrity rules easily, much like using spreadsheet formulas. This ensures IP protection while enabling faster updates, portability across systems, and reduced reliance on developers.

The platform includes preconfigured industry rules, integrated medical code sets, real-time fraud alerts, and a plug-in architecture compatible with legacy and modern systems. Cloud-based and HIPAA-compliant, it auto-updates with the latest medical codes and policy changes, reducing compliance overhead.

Compared to incumbents like Cotiviti and Optum, CoverSelf removes contractual and cost barriers, democratizing access for smaller insurers and TPAs while scaling for larger enterprises. With payment integrity representing a multi-hundred-billion-dollar problem, CoverSelf is positioned to enable a generational shift in healthcare IT by making payment integrity smarter, more efficient, and universally accessible.

Investment Details

Sector
Enterprise SaaS
Status
Active
Invested in
2021
Co-investors
3one4 Capital, BEENEXT
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