Trellis AI

What do they actually do

Trellis AI builds an AI-backed document workflow product for healthcare “pre-service” work. It ingests faxes, emails, PDFs, scanned forms, and EHR exports, extracts key fields into structured records, validates for missing or inconsistent data, and automates prior authorization submissions and follow-ups. Teams can use a hosted dashboard, API, and an email agent (“Abby”) that processes incoming attachments automatically; the company publishes demos and a sandbox to try the workflow end to end [company site and Abby page; HN launch/demo](https://runtrellis.com/, https://runtrellis.com/agent-abby, https://news.ycombinator.com/item?id=41236273).

In production, Trellis focuses on intake → prior auth → denials/appeals: it extracts/structures data, pre-checks requirements, auto-populates payer forms and submits via payer portals, monitors status, and surfaces clinical evidence to draft appeals when needed. Structured outputs and status updates sync back to EHR/RCM systems via integrations. The company markets enterprise safeguards (SOC 2 Type II, encryption, HIPAA options) and a “do not train on your data” policy. Reported impact figures on the site (e.g., large time-to-treatment and throughput gains) are vendor claims not independently verified in public materials [product pages; YC profile](https://runtrellis.com/solution/workflow-automation, https://runtrellis.com/, https://www.ycombinator.com/companies/trellis-ai).

Who are their target customer(s)

• Pre-service / prior-authorization staff at specialty clinics (e.g., oncology, cardiology): High volumes of faxes and PDFs require manual data entry and payer form filling; missing info causes delays and repeated outreach, slowing time to treatment.
• Hospital/outpatient registration and revenue-cycle teams: Messy paperwork must be transcribed into EHRs and billing systems; incomplete data drives denials and rework that ties up staff and cash flow.
• Diagnostic labs (imaging and specialty testing): Orders stall without correct referral/authorization documents; manual intake and validation lead to canceled tests, delayed results, and lost revenue.
• Denials/appeals specialists and clinical documentation teams: Manually gathering evidence and drafting appeal letters slows resubmission and reduces overturn rates.
• Pharma market-access / patient support program teams: Collecting standardized, auditable payer and clinical documentation across providers is fragmented, making reporting and reimbursement support difficult.

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

• First 10: Founder-led pilots with a handful of specialty clinics and diagnostic labs using real inbox/fax feeds via the Abby email agent and public sandbox; demonstrate concrete wins (e.g., fewer manual prior-auth hours, faster submissions) and convert with pilot-to-paid contracts [Abby; HN demo](https://runtrellis.com/agent-abby, https://news.ycombinator.com/item?id=41236273).
• First 50: Codify a repeatable onboarding playbook; scale targeted outbound to pre-service/prior-auth teams and partner with fax/email gateways and EHR connectors to cut integration time; use fast turnaround and referrals from early adopters as references product pages.
• First 100: Lean on channel partners (RCM/EHR integrators, consultants) to reach hospitals and large groups; bring SOC 2/HIPAA documentation and early case studies to pass procurement; productize workflow templates/APIs to lower deployment effort and enable land-and-expand (prior auth → denials → analytics) company site.

What is the rough total addressable market

Top-down context:

Prior authorization volume is substantial (Medicare Advantage handled ~53 million determinations in 2024) and policy groups estimate a large system burden; the AHA pegs PA-related costs around $35B annually in the U.S. [KFF/CMS; AHA](https://www.kff.org/medicare/medicare-advantage-insurers-made-nearly-53-million-prior-authorization-determinations-in-2024/, https://www.aha.org/testimony/2026-01-22-aha-statement-house-ec-subcommittee-hearing-lowering-health-care-costs). Broader RCM spend is in the tens of billions annually, providing expansion headroom MarketsandMarkets.

Bottom-up calculation:

Anchoring on the ~$35B U.S. PA/pre-service burden, if software/outsourcing captures ~10–20% of that administrative spend, Trellis’s near-term U.S. addressable market is roughly $3.5–$7B per year; expansion into broader front-end RCM and IDP could raise the ceiling further [AHA; industry reports](https://www.aha.org/testimony/2026-01-22-aha-statement-house-ec-subcommittee-hearing-lowering-health-care-costs, https://www.marketsandmarkets.com/Market-Reports/revenue-cycle-management-market-153900104.html).

Assumptions:

• Capture rate of 10–20% of current provider-side PA/pre-service administrative spend is achievable via software and managed services.
• Scope is U.S. provider pre-service workflows (intake, PA, registration, appeals) in the near term.
• Providers reallocate a share of staff spend to third‑party automation as integrations mature and compliance requirements are met.

Who are some of their notable competitors

• Waystar (Authorization Manager): Large RCM platform with a prior authorization module that automates form fill, submission, and status tracking within financial clearance workflows—widely deployed across provider systems Waystar.
• Experian Health (Authorizations): Provider-focused prior authorization software that automates inquiry, routes to payer connections, and updates statuses using a maintained payer rules knowledge base Experian Health.
• Availity: Multipayer portal and EHR-integrated authorization workflows for providers; also offers AI-powered utilization management capabilities with payers [Availity](https://www.availity.com/authorizations/, https://www.availity.com/intelligentum/).
• Infinx: PA automation and services for providers across specialties, combining AI, payer integrations, and managed follow-up to accelerate approvals Infinx.
• Notable: Healthcare operations automation platform (intake, referrals, RCM) with case studies on automating prior auth and transcription of faxed referrals Notable.