[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 : 61 points
Date : 2025-03-06 14:47 UTC (1 days 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.
| trollbridge wrote:
| Large hospital systems with EPIC can often get near-instant
| insurance approvals. Interestingly, they've done this without
| using AI.
|
| A few examples are Cleveland Clinic which has instant
| approvals for a wide variety of specialties with most of the
| insurances they're panelled on. For another example,
| OhioHealth had both instant approvals and instant
| copayment/deductible estimates at the point of service back
| in... 2013 (at least with Medical Mutual).
|
| Back office workers are skilled workers who often know how to
| do things like navigate an insurer who denies things they
| shouldn't be denying. How is an automated system going to do
| that?
| jermaustin1 wrote:
| Same with my doctor/hospital system as well. They use Epic.
| I will request an appointment, and I know within a minute
| of clicking accept that insurance has accepted the
| appointment, and how much I will owe.
|
| Only once did I not get approved (for a sleep study), so I
| called the doctor's office, and they got me approved within
| a couple more minutes after pushing something else, and I
| got a new estimate in my portal and via text letting me
| know it was covered.
|
| If the insurance kicked back that appointment and some AI
| was responsible for getting it approved on the doctor end
| (AI is definitely used on the insurance end), who do I
| call?
|
| I'm all for AI helping you out, possibly extracting useful
| information from paper forms, but we haven't used paper
| forms in a LONG time.
|
| I'm not a doctor, but my wife is a Licensed Marriage and
| Family Therapist, and she's tried at my insistence to use
| some of the AI software for her practice, and it all falls
| flat to the point she will not try anymore and has sworn
| off AI completely. She doesn't use Siri, her browser blocks
| the google AI results, and most of her research is in her
| medical books anyway.
|
| AI is the future, but today is the present.
| 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?
| trollbridge wrote:
| Not sure if you are familiar with payor systems or not, but
| an EMR/EHR basically gathers all the information sent to a
| payor system and prepares it in the format the payor wants.
|
| A good EMR/EHR does the same thing with referrals and
| authorisations, and bigger hospitals will have direct real
| time links to insurers to approve those referrals. Most of
| them happen instantly. The ones that aren't require manual
| review from a medical practitioner who workers for the
| insurer.
|
| I do not understand how a cobbled-together LLM based system
| will do this better than the existing EMRs.
| mexicocitinluez wrote:
| Most of them sell to the C-suite first (money, reports, and
| compliance) and due to that those areas often get the most
| focus. I believe it's why a large portion of EMR's suck
| balls.
|
| So yea, teh central question in most systems isn't "Is this
| patient getting better" it's "Can I bill this visit?"
| 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
| redeux wrote:
| > rather than just adding another point solution--or worse,
| overwhelming them with multiple fragmented tools ...
|
| > This tailored approach
|
| It really is AI slop all the way down now isn't it?
| 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.
| trollbridge wrote:
| Is part of your value proposition that your product will
| replace some of the staff?
| 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.
| taikon wrote:
| So I'd still need to do a full chart review? I'm not sure it
| would save me any significant amount of time.
| 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.
| ciguy wrote:
| Yes some of them are sacred sites for the Mayan peoples.
| User23 wrote:
| I'm thinking GP is saying that maybe human sacrifice
| rituals aren't the best look for a medical tech startup?
| vladsanchez wrote:
| Still have to change WebFlow's Entropy Site Template Title ;)
| 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:
| At this point a world where no one needs to work would be
| dystopian. Are we going to rely on the benevolence of our
| increasingly for-profit government. On the benevolence of our
| oligarchs to allow us the labor the robots aren't capable of
| doing yet? I see the 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.
| choilive wrote:
| The insurance companies have already enshittified the
| medical back office to levels beyond comprehension.
| daveguy wrote:
| Yeah, but why "extract value" out of every note? Seems
| like a better application for open source and non
| profits.
| ansong99 wrote:
| These are topics that we at Cenote also mull over. Right now
| how we see things are:
|
| 1. If we perform worse, we won't deliver any value to the owner
| and we'll soon be out of a business
|
| 2. It's our bet that AI agents can actually perform these
| monotonous, detailed tasks very well and that this will free up
| humans to take on higher value work.
|
| 3. That higher value work being: calling patients, educating
| them, helping facilitate patient care. This is ultimately the
| work the owners we talk to are excited for their teams to take
| on!
| harvey9 wrote:
| Depends on how you perform worse (if you do so). It takes a
| while for medical errors to occur (in human or automated
| systems ) and then there is a lag before consequences for the
| patient, and not all negative outcomes lead to complaints or
| lawsuits.
| mexicocitinluez wrote:
| You're not alone.
|
| I work in healthcare and it's a sea of bullshit all the way
| down.
|
| And most of the time they're being started by kids right out of
| school with ZERO clinical experience.
| achillesheels wrote:
| Good luck with HIPAA! Maybe, unsolicited advice and all, target
| patient recruitment CROs first? They seem to be "edgier" than big
| hospicorp... _peace_
| maz1b wrote:
| As a full stack engineer + doctor, always good to see innovation
| and ideas in this space. Best of luck.
| ansong99 wrote:
| Thanks, we appreciate the support :)
| aitchnyu wrote:
| Umm, how did you learn each profession and how many hours per
| week do you spend on each?
| prawn wrote:
| In the screenshot on your site alongside the "No more typos"
| feature, you have a typo: "United Helathcare". Also an error in
| the 'extraction' of the phone number ("-55-").
| ansong99 wrote:
| Thx for pointing these out !
| mexicocitinluez wrote:
| Do you not see the irony in that?
| ilrwbwrkhv wrote:
| Put your seat belt on fellas. The future is coming when your
| stomach cancer will go unnoticed since AI is doing the work. A
| correction will happen and then these will get banned.
| trollbridge wrote:
| Emergency injuries should be handled in an ER, where patient care
| comes first. They won't bother trying to get your insurance
| information until after you've been treated and stabilised.
|
| As far as specialists go... when I go to a specialist, they key
| in my insurance card and have an approval within seconds. Of
| course with a serious injury I'd be at an ER not sitting around a
| specialist's waiting room.
|
| My biggest concern, though, is this will be used to replace back
| office staff and serious mistakes will get made, patients will be
| the ones stuck with figuring out insurance nightmares - there
| won't be any back office staff left to help, and providers will
| be given heavier workloads with less assistance. And no, I don't
| trust LLMs to make medical decisions.
| 1oooqooq wrote:
| > in an ER, where patient care comes first. They won't bother
| trying to get your insurance information until after you've
| been treated and stabilised
|
| speaking from 1st hand experience, you are wrong.
|
| > this will be used to replace back office staff and serious
| mistakes will get made, patients will be the ones stuck with
| figuring out insurance nightmares
|
| on this you're spot on!
| quinnjh wrote:
| Super cool ! What OCR are you using for confidence ? Tesseract?
| Curious how you flag for Humam in the loop.
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(page generated 2025-03-07 23:02 UTC)