Machinify Leverages AI Services to Tackle Healthcare Claims Lifecycle

The rapidly growing AI in healthcare market has created a trove of healthcare-focused start-ups working to address niche areas within the sector. One such area is the demand for simplifying healthcare administration workflows. Palo Alto-based Machinify is looking to address the complicated world of healthcare billing through its AI-services offering. Machinify was recently acquired by New Mountain Capital as part of its strategy to build a healthcare-focused conglomerate that already generates $500 million in ARR.

Machinify’s Offerings

Machinify was founded in 2016 by Tony Miranz, Alain Rossman, and Prasanna Ganesan. Prasanna is a repeat entrepreneur who previously co-founded the digital streaming service VUDU that was later acquired by Walmart. After navigating healthcare complexities firsthand, Ganesan recognized the opportunity to apply advanced AI to one of the industry’s most inefficient areas: the claims lifecycle. Alain Rossmann himself is a serial entrepreneur who had set up 10 companies of which three went public, and four, including Machinify, were acquired.

Machinify was built around the idea that healthcare payers need systems that don’t just process data but continuously learn from it—turning every claim into an opportunity to optimize care and cost. Its platform uses AI to automate and optimize the healthcare payment lifecycle, enabling payers to identify overpayments, streamline prior authorizations, and make accurate payment decisions faster. Its core platform is built on a foundation of LLMs trained on massive volumes of clinical and billing data. It delivers three main capabilities: real-time auditing of claims before they’re paid, intelligent processing of prior authorizations to avoid treatment delays, and payment optimization workflows that ensure proper reimbursement.

Unlike traditional claims solutions that rely on static rules or retrospective audits, Machinify’s system is proactive and adaptive. It functions as a continuously learning loop—capturing feedback from each decision and updating models to improve accuracy over time. The company claims its technology supports claims processing for over 160 million covered lives across more than 60 U.S. health plans, positioning it as a key infrastructure player in the shift toward intelligent payment systems in healthcare.

Machinify’s Financials

Machinify does not disclose its financials. It remains privately held and had raised $10 million in Series A funding in 2018 from Battery Ventures, GV (formerly Google Ventures), and Matrix Partners to build out its AI platform. In January 2025, it was acquired by private equity firm New Mountain Capital. The acquisition brought Machinify under the same umbrella as The Rawlings Group, Apixio’s Payment Integrity business, and VARIS. New Mountain Capital had acquired the other entities to build a comprehensive healthcare intelligence platform spanning clinical data, claims adjudication, and payment integrity. Financial terms of Machinify’s acquisition were not disclosed. The combined group of these four entities has more than $500 million in ARR. Some estimate that the new entity will be worth $5 billion. The merger is still subject to regulatory compliance.

Machinify operates in a crowded and evolving landscape that includes general-purpose AI firms like H2O.ai and DataRobot, as well as healthcare-focused players such as Apixio, Edifecs, and HealthEdge. While many competitors emphasize analytics or retrospective audit support, Machinify differentiates itself by offering end-to-end AI automation across the entire claims lifecycle, with a strong focus on real-time decision-making, payment optimization, and integration into payer workflows. Its ability to combine deep clinical context with machine learning at scale sets it apart in a sector that still runs heavily on outdated, rules-based systems.

The model of pairing software with services to solve domain-specific problems within enterprise settings is not very new, and has seen strong market potential. Palantir, for instance, follows a similar approach and has achieved a $200 billion valuation using this hybrid model. Machinify’s ability to apply its platform alongside expert-driven implementation puts it in the similar category of new-age AI services companies. I won’t be surprised if tech giants like IBM, Infosys, TCS, Accenture, Wipro look to acquire Machinify to build their own AI-Services business.

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