Ruma Care

Ruma Care is dedicated to streamlining the prior authorization process, initially focusing on clinics that administer high-cost specialty medications. These biologics, which can cost upwards of $80,000 to $150,000 annually per patient, often require administration in specialized infusion clinics. Healthcare providers invest in these medications upfront to secure favorable pricing and maintain safe inventory levels, with the expectation of reimbursement from patients' insurance following administration.

However, due to their high cost, insurers frequently deny these specialty medication requests, with a denial rate of approximately 37% annually. Such denials leave providers financially responsible for the medication costs. Ruma Care addresses this challenge by ensuring clinics receive timely payments, patients receive necessary treatments faster, and care teams spend less time navigating complex insurance procedures.

Ruma Care achieves this through a three-pronged approach: First, the platform extracts specific submission criteria required for drug approval by insurers, considering each medication, diagnosis, and insurance plan combination. Second, it automates the form-filling process for prior authorizations, utilizing the correct forms. Finally, Ruma Care facilitates patient enrollment in copay assistance programs, all within a unified workflow and platform.

By consolidating a process that typically involves navigating over 70 online portals, managing disparate paper forms, and making numerous manual phone calls, Ruma Care offers a single, efficient platform. As the platform processes prior authorizations, its models leverage denial patterns to learn and adapt, gaining insights into the specific information insurers require for approval.