Basys.ai
Also known as: basys.ai
Payer side agentic AI for prior authorization and utilization management: encodes payer policies with generative AI, auto approves up to 90 percent of requests, and routes complex cases to clinicians. Mayo and Eli Lilly backed.
basys.ai is a payer side agentic AI platform for prior authorization, utilization management, clinical auditing, and fraud, waste, and abuse review. Its engine, trained on over 10 million patient records and claims through its Mayo Clinic data partnership, automates encoding of payer policies with generative AI and can auto approve up to 90 percent of prior authorization requests while directing complex cases to clinicians, with a generative AI chat feature answering member and provider transparency queries. Founded in 2022 by Harvard health data science graduates Amber Nigam and Jie Sun, backed by Eli Lilly, Mayo Clinic, and Nina Capital, and distributed through a Smart Data Solutions partnership reaching health plans and TPAs. Processes requests over FHIR with X12 data exchange, positioned as integration light for health plan deployment.
Vendor details
Canonical URL
https://basys.ai
Category
Healthcare agent
Funding status
$2.4M seed (2023) after oversubscribed pre-seed led by Nina Capital with Eli Lilly, Mayo Clinic, Two Lanterns, AMV, and Chaac participating
Company status
independent
Use cases & customers
Primary use cases
Target customers
Deployment options
Integrations
FHIR standard for request processing and real time data connections; X12 standard for HIPAA compliant data exchange; positioned as plug and play, integration light; Smart Data Solutions partnership embeds it in payer clearinghouse workflows.
Sources & related URLs
Capability coverage
6.0 / 14 capabilities · 43%
| Integrations & Tool CallingFHIR standard request processing with real time data connections and X12 standard HIPAA compliant data exchange, positioned as plug and play, basys.ai payer page 2026-07-22 | Full |
|---|---|
| Workflow OrchestrationAutomates the prior authorization decisioning pipeline end to end with auto approval and routing, though scope is a single decision workflow rather than cross system orchestration, basys.ai materials 2026-07-22 | Partial |
| Knowledge Grounding & RAGAutomated generative AI encoding of payer policies is the core technology, trained on over 10 million patient records with specialized disease area expertise in MSK, surgery, and cardiology, basys.ai materials 2026-07-22 | Full |
| Human Oversight & GuardrailsDocumented escalation split: appropriate cases auto approved while complex cases are directed to clinicians, with interpretability and a transparency chat for members and providers, basys.ai and partner materials 2026-07-22 | Full |
| Security, Identity & GovernanceHIPAA compliant exchange via the X12 standard and secure positioning stated first party, but no named attestations in retrieved materials, basys.ai materials 2026-07-22 | Partial |
| Observability & AuditabilityInterpretable and explainable decisioning is a stated design goal with a transparency chat surface, though no audit console is documented, basys.ai materials 2026-07-22 | Partial |
| Memory & State PersistenceNo documented persistent memory capability, basys.ai materials 2026-07-22 | Unable to verify |
| Deployment & Data ResidencySaaS delivery; no self host or residency options documented, basys.ai materials 2026-07-22 | Partial |
| Prebuilt Agents, Templates & PacksSingle decisioning engine across UM modules without an agent or template library, basys.ai materials 2026-07-22 | Unable to verify |
| Triggers & Channel CoverageReal time processing driven by incoming authorization requests over FHIR; no broader trigger or channel machinery documented, basys.ai materials 2026-07-22 | Partial |
| Model Flexibility & RoutingHybrid generative AI plus deep learning engine documented, without customer model choice, basys.ai materials 2026-07-22 | Partial |
| APIs, SDKs & MCP ExtensibilityNo customer facing API, SDK, or extensibility surface documented beyond standards based intake, basys.ai materials 2026-07-22 | Unable to verify |
| Testing, Debugging & OptimizationNo customer facing testing or evaluation tooling documented, basys.ai materials 2026-07-22 | Unable to verify |
| Browser & Computer UseOperates over FHIR and X12 data exchange, not browser or computer interface control, basys.ai materials 2026-07-22 | Unable to verify |
Pricing
Contact sales
What is public
No pricing is published. Positioning emphasizes achieving target savings for health plan partners, with distribution direct and via Smart Data Solutions.
Variable cost rationale
Payer UM platforms typically price per member or per authorization volume; basys.ai does not publish its basis.
Sales call required
Yes — required for paid access
Free / trial
None public
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