[HN Gopher] Launch HN: Cenote (YC W25) - Back Office Automation ...
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Launch HN: Cenote (YC W25) - Back Office Automation for Medical
Clinics
Hey HN, this is Kofi, Kristy and Ajani, co-founders of Cenote
(https://www.joincenote.com/). We provide medical clinics with AI
agents to speed up their referral intake. Before a specialist
physician can treat a patient, they must collect data about the
patient, determine if the referral meets medical necessity, and see
if insurance will cover the procedure. This involves analyzing
referral documents, coordinating with primary care providers for
missing information, and verifying insurance coverage--before they
can even see the patient. It's a manual back-and-forth process that
is time-consuming, prone to errors, and slows down patient care.
Cenote mostly automates this workflow. ("Mostly", because sometimes
a human-in-the-loop is needed--more on that below). We use LLMs,
OCR, and RPA to extract and validate referral data, check for
medical necessity, and initiate insurance verification--all in
minutes, not hours. This allows specialists to focus on care,
reduce administrative burden, and ensure faster, more reliable
insurance payments. One of us (Kristy) dealt with this after an
emergency medical event she had a couple years ago. The time it
took her to find a clinic that could receive her medical record and
insurance exacerbated her injury. It seemed crazy to have to wait
that long for what turned out to be the dumbest of technical
reasons. The three of us became friends at a book club, got talking
about this, and decided to build software to deal with it. Cenote
automates the back office for medical clinics. When a referral
lands in a specialist's inbox, our software kicks in. We first
parse the document through an OCR. After that, we use an LLM to
detect the pieces of data that our customer has told us they're
looking for. If we detect the referral is missing data, we send a
message back to the referring provider asking for more. Finally, we
integrate with our customer's EHR (Electronic Health Record) via
RPA or API and place the document and extracted data in its
appropriate location. The OCR returns confidence intervals. If the
LLM reasons over OCR that it is not confident about, we flag this
in the UI to the end user and ask a human to review before moving
forward. We entered this task thinking we would have to work on a
lot of fine-tuning / ML infra, but the tech needs turn out to be a
lot more elementary than that. For example, we have spent a lot
more time creating a history-page view of previously submitted
files than we have spent training our own data. Many clinics still
rely on faxed (!) referrals, and even well-funded practices use
obsolete workflows. While we provide a UI for clinics to upload
documents and for human-in-the-loop intervention, our system can
also function in a headless manner. By this, we mean that all core
functionality--data extraction, EHR integration, and even back-and-
forth communication with referring providers--does not explicitly
require a UI for user interaction. In terms of pricing, we charge
an annual SaaS fee and a one-time implementation fee. We don't have
one-size-fits-all pricing on our website yet, but we'll get there
eventually. If you have medical clinic experience, we'd love to
hear your thoughts! And everyone's feedback is welcome. Thanks for
reading!
Author : ansong99
Score : 36 points
Date : 2025-03-06 14:47 UTC (8 hours ago)
| HPMOR wrote:
| This seems really interesting. I'm curious how this compares to
| fully automated EHRs similar to what Modernizing Medicine has
| built for Dermatology practices. Also there's a startup called
| DayDental which does RCM, for dental practices. Additionally, are
| you planning on integrating with large EHRs like Epic/Cerner, or
| is this for smaller EHRs like SimplePractice?
| ansong99 wrote:
| I appreciate the interest! We love the efforts at the federal
| level and by other tech companies to modernize healthcare. We
| see AI agents as the next step in this evolution--where nearly
| all back-office needs can be productized into AI, enabling
| Cenote to provide every clinic with a best-in-class back-office
| team.
|
| To your latter question, we've spoken with many hospital
| networks using Epic that would benefit significantly from our
| software. However, integrating with larger EHRs is notoriously
| labor-intensive, so for now, we're prioritizing more accessible
| clinics.
| Onavo wrote:
| There are so many companies in the transcription -> EMR ->
| insurance automation space. What differentiates you?
| the_sleaze_ wrote:
| In fairness, I think of EMR/EHRs as thin wrappers over
| insurance automation to begin with.
| ansong99 wrote:
| I'd actually love to hear more--can you expand on this point
| here?
| ansong99 wrote:
| For sure. At Cenote, we're obsessed with ensuring our software
| delivers real value to clinics, rather than just adding another
| point solution--or worse, overwhelming them with multiple
| fragmented tools. As mentioned in another thread, many of these
| clinics aren't the most tech-forward, and we've found that in-
| person discussions often reshape our bundle (e.g., prioritizing
| referral intake over insurance verification). This tailored
| approach ironically simplifies integration and maximizes ROI
| for our customers.
| 6stringmerc wrote:
| Thanks for clarifying that you have little to no interest in
| enhancing the quality of outcomes or success of treatment or
| quality of life for patients! Very telling!
| ansong99 wrote:
| Not our intention at all. Let me know what gave you that
| impression? We generally see the incentives of the owners
| we work with as very aligned with providing the best
| quality of care to their patients, and see our software as
| accelerating delivery of that care
| xenospn wrote:
| Good luck getting into brick and mortar clinics (I really mean
| it!). It is so incredibly hard to get established, small
| businesses to do anything regarding IT or tech. They are all
| incredibly overworked and the last thing they want to deal with
| is tech or learning how to use a new platform.
| ansong99 wrote:
| Yeah some of our first customers have been smaller/brick and
| mortar clinics! We find getting in-person time with these
| owners and personally offering to train staff goes a long way
| in ensuring trust and confidence in using our product. On that
| note we have found conferences and meet-ups super helpful.
| reureu wrote:
| When you say you integrate with EHRs using RPA or API, are you
| using FHIR for the API connection? Or what interop standards are
| you using?
| ansong99 wrote:
| We're doing both RPA and API integrations now - depending on
| what works best for any given EHR/clinic. FHIR connections are
| on the way.
| taikon wrote:
| What if it fails to mention a critically important piece of info?
| Would your company be liable or would I as a physician have be
| liable for its mistake?
| ansong99 wrote:
| Great question. Our software is designed to assist, not
| replace, the physician's role in making clinical decisions. It
| accelerates the time between an inbound referral and patient
| care by extracting and organizing information, but the final
| review always remains with the physician.
|
| To minimize risk, we implement safeguards to prevent
| hallucinations, and our system is built to flag potential
| missing or unclear information rather than override clinical
| judgment.
| browningstreet wrote:
| Cenote?
|
| C Note?
|
| $100?
|
| Really?
| ciguy wrote:
| A cenote is an inland tidal pool connected to the ocean. Mostly
| found along the Riviera Maya in Mexico.
| ansong99 wrote:
| Aha yes we were inspired by this latter definition, which
| explains the turquoise branding on our site.
| Mesmoria wrote:
| And at least in my mind associated with Maya rituals.
| potatoman22 wrote:
| > The OCR returns confidence intervals. If the LLM reasons over
| OCR that it is not confident about, we flag this in the UI to the
| end user and ask a human to review before moving forward.
|
| This seems helpful, but what if the flagging system misses an
| error? Do you measure the accuracy of your various systems on
| your customer data? These are typically the more challenging
| aspects of integrating ML in healthcare.
| MisterKent wrote:
| Maybe I'm alone in this, especially on this site.
|
| I'm beginning to become disillusioned with these things. We're
| replacing like 1000s of jobs with a system that will almost
| certainly do a worse job than before. And the money is split
| between hospital shareholders and VC.
|
| I get that there's an efficiency (market) gain here. But these AI
| startups that target existing sector automations seem like
| they're most just attempting to drive wealth inequality in a
| period of already terrible westh inequality.
| choilive wrote:
| Is a world where nobody needs to work a utopia or dystopia?
| daveguy wrote:
| That you don't see a world where no one works as a dystopia
| is dystopian. Are we going to rely on the benevolence of our
| increasingly for-profit government. On the benevolence of our
| oligarchs? A lot of promise of post-scarcity, but I haven't
| seen anything close to the technology it would require. Just
| greed. Corner cutting and rent collection for profit. I'd
| rather not see our medical back offices enshittified.
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