Ruma Care

Ruma Care automates prior authorizations for clinics that administer high-cost specialty medications. These biologics, costing $80-$150K+ annually per patient, are often administered in infusion clinics. Medical providers purchase these drugs upfront to secure pricing deals and maintain safer inventory, with reimbursement reliant on patient insurance. However, insurers deny these expensive medications at a 37% annual rate, leaving providers to cover costs if denied. Ruma Care addresses this issue by ensuring clinics receive payment, patients receive timely treatment, and care teams reduce time spent on insurance disputes. Ruma Care achieves this through three key methods: 1. Extracting submission criteria for each medication, diagnosis, and insurance combination to secure drug approval from insurers. 2. Automating the form-filling process for prior authorizations by retrieving the correct forms. 3. Enrolling patients in copay assistance programs within a single workflow and platform. This transforms a traditionally cumbersome process involving 70+ online portals, disparate paper forms, and manual phone calls into a streamlined platform. As prior authorizations are processed, Ruma Care's models learn from denial patterns to determine precisely what insurers require for approval.