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Develop Health
by Develop Health
· Based in United States →
— Automate prior authorization and predict medication coverage, cost, and requirements at the point of prescription. 5x throughput, more approvals.
Free for providers or a small fee for enterprise accounts
Documentation Provided
Overview
Develop Health is an AI-powered platform designed to streamline medication access by automating prior authorization (PA) and benefit verification processes. It is intended for use by prescribers, ambulatory practices, hospitals, health systems, and digital health providers. The platform aims to reduce the administrative burden associated with obtaining medication approvals, which can delay patient care.
- What it does: Develop Health automates medication eligibility checking and prior authorization. This includes automating benefit verifications, sourcing and filling forms, and submitting them to streamline pharmacy benefit medication access. The system can also manage denial appeals.
- Who it is for: The tool serves prescribers, ambulatory practices, hospitals, health systems, and digital health providers. It is particularly relevant for specialties dealing with a high volume of prescriptions requiring prior authorization.
- How it fits a clinical or practice workflow: Develop Health integrates directly into existing Electronic Health Record (EHR) systems. This allows PA tasks to appear natively within the clinical workflow, aiming to eliminate the need for providers to switch between applications. The platform automates steps such as identifying PA requirements, extracting clinical evidence from patient charts, pre-filling payer forms with citations, and submitting requests through various channels (e.g., direct PBM integrations, FHIR-based APIs, fax, phone).
- Notable capabilities: Key capabilities include real-time benefit verification, AI-driven form completion with clinical evidence extraction, omni-channel submission of PA requests, and denial management with automated appeal drafting. The platform aims to predict medication coverage, cost, and requirements at the point of prescription.
Reviewed by Pouyan Golshani, MD — Interventional Radiologist
What Physicians Need to Know
Healthcare API Support (FHIR/HL7)
Develop Health's Public API exposes capabilities for benefit verification, prior authorization, and provider authorization via an HTTPS JSON REST interface. It integrates with EHRs like athenahealth and Canvas. The platform emphasizes HL7 FHIR compatibility as an emerging standard for healthcare data exchange, supporting bi-directional data flow and webhook notifications for real-time alerts. The CMS Interoperability and Prior Authorization Final Rule mandates FHIR-based PA APIs for certain government-funded health plans by January 1, 2027.
HIPAA-Compliant Infrastructure
Develop Health prioritizes data integrity and maintains high standards of healthcare compliance to ensure secure, private, and accurate transactions. HIPAA compliance requires robust physical, technical, and administrative safeguards, including encrypted data at rest and in transit, access controls, audit logging, and secure cloud infrastructure. Organizations must also have Business Associate Agreements (BAAs) in place with vendors handling Protected Health Information (PHI).
Clinical NLP Capabilities
While not explicitly detailed for Develop Health, Clinical Natural Language Processing (NLP) generally involves extracting information from unstructured clinical notes, identifying entities like medical conditions and medications, standardizing terminology, and enabling relationship extraction and temporal analysis. NLP can enhance clinical documentation, optimize medical coding, support diagnostic accuracy, and accelerate drug development.
De-Identification Tools
De-identification is crucial for protecting patient privacy while allowing data use for research and AI development. This process removes identifiable details (all 18 HIPAA identifiers) to prevent re-identification. AI tools are essential for efficient de-identification of large datasets, often employing NLP techniques to detect and mask sensitive information in clinical documents.
Medical Terminology Support
Medical terminology is the universal language of healthcare, crucial for clear and precise communication among professionals, accurate documentation, and efficient patient care. Understanding medical terminology is essential for accessing and contributing to medical knowledge and career advancement.
Sandbox/Testing Environment
Develop Health offers a sandbox environment as part of its developer resources. Sandbox environments are safe, controlled spaces that simulate real-world healthcare data exchanges using synthetic, non-PHI data, allowing developers to build, test, and refine applications without impacting live systems. They are crucial for validating workflows, gaining hands-on experience, and identifying issues early.
SDK Languages
Develop Health's developer surface includes SDKs and sample code. Common programming languages for healthcare application development, often used with SDKs, include Python, Java, JavaScript, C#, Swift, and Kotlin, chosen for their versatility, performance, and ability to meet healthcare-specific requirements.
Rate Limits & Pricing
Develop Health provides documentation on rate limits. Generally, APIs enforce rate limits to ensure system stability and equitable resource distribution, with applications exceeding thresholds being throttled and returning a '429 Too Many Requests' error. Develop Health states it is free to health systems and provider clinics.
Certification Program
Develop Health does not explicitly mention its own certification program for developers. However, healthcare certifications are available for professionals to enhance skills and career readiness, validating competence in various areas like patient safety or health equity.
Physician Tip
Leverage Develop Health's API to automate time-consuming tasks like benefit verification and prior authorization, freeing up staff to focus on patient care. The platform's ability to integrate with EHRs and handle asynchronous results via webhooks can streamline workflows significantly. Utilize the sandbox environment for thorough testing of new integrations and features to ensure smooth implementation and avoid disruptions to patient services. While the platform handles compliance, always ensure your internal practices align with HIPAA regulations when handling patient data through any integrated system.
Develop Health's API is designed for integration with EHRs such as athenahealth and Canvas, using an HTTPS JSON REST interface. It supports HL7 FHIR compatibility for modern healthcare data exchange, enabling bi-directional data flow and real-time webhook notifications. The platform's API-first approach to prior authorization allows direct connections to pharmacy benefit managers (PBMs) and payers, covering a high percentage of insurance plans through a multi-channel approach.
Details
| Category | Developer Tools & APIs |
| Pricing |
Free for providers or a small fee for enterprise accounts
|
| Deployment | Multi-tenant SaaS, EHR-embedded, API-based |
| API Available | Unknown |
| Target Size | All care settings and specialties, including IDN/health systems, telehealth-only providers, pharmacy chains/outpatient pharmacies, multi-specialty group practices, and provider-led networks (ACO, CIN, IPA, MSO). |
| Compliance | |
| BAA Available | Unknown AI-estimated |
| HIPAA Compliant | Unknown AI-estimated |
| FDA Status | Unknown AI-estimated — unknown |
| Integrations | |
| EHR | Not specified |
| Specialties | All specialties |
Social Proof
| Customers | unknown |
What the Web Says
Develop Health is an AI-powered platform designed to automate medication access, primarily focusing on eligibility checking and prior authorization for pharmacy benefits. It aims to streamline workflows for healthcare providers by integrating with existing Electronic Health Record (EHR) systems and handling tasks like benefit verification, prior authorization submissions, and denial management. The company emphasizes reducing manual administrative work, accelerating approval times, and increasing first-time approval rates for medications.
Overall: PositiveStrengths
- Automates benefit verifications and clinical eligibility checks.
- Automatically sources, fills, and submits prior authorization forms.
- Increases first-time approval rates and reduces delays in accessing medications.
- Natively integrates with major EHRs, allowing use without switching screens.
- Reduces manual work by up to 90%.
- Accelerates prior authorization approval times to under one day.
Limitations
- No specific negative reviews or opinions from physicians, healthcare IT, tech reviewers, Reddit, G2, or Capterra were found in the search results.
- General challenges in healthcare AI adoption include the need for robust governance, integration into existing workflows, and addressing concerns about data privacy and security.
- Some Reddit discussions highlight general difficulties in healthcare app development, such as HIPAA compliance complexities, integration issues with EHRs (e.g., Epic), and higher development costs and timelines compared to other industries.
- The broader AI prior authorization software market is described as overcrowded, with many vendors not significantly improving physician burden.
- Capterra's ranking system has been criticized for being influenced by paid placements rather than solely honest evaluations.
Based on reviews from: Elion, AI Tool For Medical documentation, APIs.io Providers, Develop Health Blog, Develop Health Website, Automated Prior Authorization Software: 2026 Evaluation Guide - Develop Health, Reddit (r/healthIT, r/QuantifiedSelf), American Medical Association, Capterra, Allo
Last updated: 2026-10-04
Ratings & Reviews
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Press & Coverage
PR Newswire
Develop Health Launches Integration with athenahealth to Automate Prior Authorization at the Point of Care
Develop Health announced its integration with athenaOne, an athenahealth EHR, to automate prior authorization and medication access, aiming to reduce administrative burden and accelerate patient care. The platform automates benefit verification, PA form completion, and status tracking directly within the EHR workflow.
2025-12
Business Wire
Develop Health Raises $14.3M to Automate Prior Authorization and Medication Access Using GenAI
Develop Health secured $14.3 million in Series A funding, led by Wing Venture Capital, to expand its AI-powered platform for automating benefits verification and prior authorization. This funding will help the company grow beyond pharmacy benefits into the medical benefit market and deepen EHR and PBM integrations.
2025-08
MedCity News
Develop Health Secures $14.3M to Streamline Prior Authorization
Develop Health, a benefits verification and prior authorization platform, raised $14.3 million in Series A funding to streamline prior authorization processes. The platform uses AI to check coverage, generate answers for PA requests, and notify providers of determinations, reducing administrative time.
2025-08
AI-Tech Park
Develop Health Integrates athenahealth for Prior Authorization
Develop Health's AI-powered platform has integrated with athenaOne to automate prior authorizations, aiming to significantly reduce the time providers spend on administrative tasks. This integration allows for automated benefit checks, form completion, and status tracking within the athenahealth EHR.
2025-12
Develop Health (Blog)
AI Prior Authorization: Real-Time Approvals & Automation in 2026
This article discusses the impact of the CMS Interoperability and Prior Authorization Final Rule, highlighting how AI-driven solutions like Develop Health's are meeting new regulatory mandates for faster PA responses. It emphasizes the role of multi-agent AI systems and real-time benefit verification in improving approval rates and reducing administrative burden.
2026-03
Develop Health (Blog)
PA Software: API-Driven Solutions vs Legacy Hubs
This article contrasts modern API-driven prior authorization platforms with legacy systems, positioning Develop Health as a comprehensive AI-native solution that automates the entire medication access workflow. It highlights the platform's ability to reduce manual touchpoints and accelerate approval cycles through AI-powered autofill and multi-channel payer submission.
2026-03
Develop Health (Blog)
Pharmacy Prior Authorization: Closing the Access Gap in Pharma Deserts
This article addresses the challenges of pharmacy prior authorization, particularly in underserved areas, and how Develop Health's GenAI-native platform is streamlining the process. It notes that automated platforms have reduced real-world cycle times to approximately 20 hours from prescription to approval.
2026-03
Startup Intros
Develop Health: Funding, Team & Investors | Startup Intros
Develop Health is a SaaS platform that automates EHR-integrated benefits verification and prior authorization with AI for medication access. The company has raised $20.0M across two funding rounds, with its most recent Series A in August 2025.
2026-07
Videos
Product demos, reviews, and walkthroughs for Develop Health.
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Frequently Asked Questions
Develop Health provides a suite of APIs and SDKs designed for seamless integration with major EHR platforms. These tools support various data standards like FHIR and HL7, enabling physicians to connect their applications and exchange patient data securely and efficiently.
Develop Health incorporates robust security features and compliance frameworks into its developer tools. This includes end-to-end encryption, access controls, and audit trails to help physician-developers build applications that meet HIPAA, GDPR, and other relevant healthcare data privacy and security regulations.
While open-source alternatives exist, such as various FHIR SDKs, they often require more in-house development expertise and may lack the comprehensive support and pre-built integrations offered by Develop Health. The trade-offs typically involve balancing cost savings with increased development time and maintenance responsibilities.
Develop Health offers a tiered pricing model, often based on API usage, data volume, or the number of integrated users. Typical costs for a physician's practice can vary widely, from a few hundred to several thousand dollars per month, depending on the scale and complexity of their application and integration needs.
Key limitations may include potential learning curves for less tech-savvy physicians, dependency on Develop Health's platform for updates and support, and possible restrictions on the types of data or functionalities that can be accessed through their APIs. Physicians should review the documentation thoroughly to understand these constraints.
Develop Health's platform provides APIs that allow access to de-identified patient data (with proper consent and compliance) which can be used to train custom AI/ML models. They also offer documentation and community forums to assist physician-developers in leveraging these capabilities for clinical decision support.
Develop Health offers specific APIs and SDKs designed to integrate with various medical devices and wearables, facilitating the secure ingestion and management of data from these sources. This enables physicians to incorporate real-time patient data into their applications for more comprehensive care.
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| Last Verified: 2026-10-05 | First Added: 2026-10-04