Splendor

What do they actually do

Splendor provides a provider portal and a developer API that automate common insurance operations so staff don’t have to call payers or manually work through portals. Live workflows include eligibility and benefits checks, prior-authorization status monitoring, claims follow-up, and credentialing-related tasks. The system pulls data via a “waterfall” of sources—EDI 270/271 where available, payer portals, and automated/agentic phone calls—and merges results into a single, machine-readable output that teams can act on or feed back into their systems (company site, YC launch).

Customers include provider organizations, billing companies, MSOs/DSOs, and digital health platforms that need reliable, scalable insurance checks and follow-up. Teams can use Splendor as an embedded backend via API or as an operational portal with minimal engineering lift. The product highlights coverage across specialties (e.g., dental, behavioral health) and ongoing monitoring that reduces repeated portal checks and hold time for staff (company site, YC launch).

Who are their target customer(s)

• Small behavioral-health clinic office manager: Spends hours on payer calls and portal logins to verify coverage and track prior auths, delaying scheduling and consuming staff time. Splendor automates eligibility, auth tracking, and returns results in a portal/API to cut manual checks (site, YC).
• Dental practice front-desk manager: Dental benefits have code-specific rules and frequency limits that create surprise balances or denials when not checked carefully. Splendor consolidates payer info and automates specialty checks so staff don’t have to scrape portals or wait on hold (site, YC).
• MSO/DSO operations lead (multi-clinic operator): Scaling across clinics requires repeated provider onboarding, credential tracking, and claims monitoring across many payers, which usually adds headcount. Splendor centralizes and automates credentialing and claims follow-up to reduce that load (site).
• Medical billing/revenue-cycle manager: Teams spend heavy time on claims follow-up and denial appeals due to inconsistent portal/phone responses, slowing cash flow. Splendor’s monitoring and payer-interaction automation reduces repetitive tickets and re-checks (site, YC).
• Product/engineering lead at a digital health platform: Needs reliable insurance checks without building and maintaining fragile scrapers or phone-call systems to dozens of payers. Splendor’s API and portal offload payer integrations and exception handling (site).

How would they acquire their first 10, 50, and 100 customers

• First 10: Founder-led pilots with nearby behavioral-health and dental clinics, implementing the portal/API and waterfall checks hands-on to prove time savings and capture concrete before/after case studies and quotes (site, YC).
• First 50: Codify a repeatable pilot and onboarding playbook, hire 1 AE/CS to run targeted outreach to MSOs, billing shops, and specialty clinic groups, and close via early case studies; add referral agreements with billing firms and lightweight EHR connectors (site, YC).
• First 100: Lean into channel sales with MSOs/DSOs, billing platforms, and digital-health platforms embedding the API; add self-serve onboarding for single-office clinics and a small enterprise team for multi-clinic deals; invest in tighter EHR connectors and marketplace listings (site, YC).

What is the rough total addressable market

Top-down context:

CAQH estimates U.S. spending on nine common payer–provider transactions (including eligibility/benefits, prior auth, and claim status) at roughly $60B in 2022, with eligibility/benefits alone around $42B—directly aligned with Splendor’s workflows (CAQH Index). Broader U.S. administrative spending is hundreds of billions annually, but the transaction slice is the most directly relevant near-term target (JAMA, Health Affairs).

Bottom-up calculation:

Using CAQH’s transaction-level spending as a proxy, the practical U.S. TAM for Splendor’s core workflows maps to the eligibility/benefits, prior auth, claim status, and related lines—about $60B in 2022 that providers largely bear and would pay to automate (CAQH Index). Expanding into broader RCM and hospital billing/denials would pull from an adjacent, larger market sized in the tens of billions more (MarketsandMarkets, McKinsey).

Assumptions:

• CAQH 2022 figures are a reasonable baseline for near-term U.S. transaction spend and mix.
• Providers will allocate a portion of current manual/ops costs to automation vendors when reliability improves and ROI is clear.
• Splendor can address the subset of transactions where manual work persists (non-EDI exceptions, portal/call workflows).

Who are some of their notable competitors

• Availity: Incumbent multi-payer portal and API marketplace used by providers to run eligibility and prior auth across many payers. Splendor overlaps on checks but differentiates with exception handling via portals and automated calls (Availity, Availity API Marketplace).
• Cohere Health: Focuses on clinical decisioning and utilization management for prior authorization, primarily for payers and large providers. Splendor emphasizes pragmatic payer-interaction automation and provider ops tooling (Cohere).
• Eligible: API-first eligibility and claim-status transactions for developers and platforms. Splendor overlaps on eligibility APIs but adds a waterfall of non-EDI channels and ongoing monitoring for exceptions (Eligible).
• Olive: Broad RCM/automation vendor for health systems, including prior auth and revenue-cycle automation. Splendor focuses on smaller clinics/MSOs and the fragile portal/phone exception work (Olive).
• Medallion: Automates credentialing, payer enrollment, and monitoring for provider operations. Splendor’s overlap is credentialing, but its core is live insurance ops like eligibility, auth tracking, and claims follow-up (Medallion).