Executive Summary

Healthcare and other highly regulated organizations — roughly 600,000 potential customers in the U.S. alone — still rely on manual, document‑driven audit processes that consume dozens to hundreds of staff‑hours per case and expose them to escalating payor and government fines; this creates a sustained $18.0B addressable market (600,000 orgs × $30K ACV). Compliance teams, revenue cycle managers, and external audit firms struggle to locate and validate evidence scattered across EHR free‑text notes, scanned PDFs, and billing systems, which increases error rates and audit failures. A practical product would be a compliance‑grade platform that ingests data via FHIR and common EHR connectors, applies clinical NLP and generative‑AI to extract and map evidence to claims, and runs configurable, auditable workflows with chain‑of‑custody, human‑in‑the‑loop validation, and automated reporting for remediation. Early pilots should target payor and Medicare/Medicaid audit scenarios where ROI is easiest to quantify, with demonstrable reductions in manual review time (we would conservatively target 50–90% reductions depending on documentation quality) and an ACV model around $30K for single‑site deployments with expansion into enterprise licensing. This market is attractive now because standardized APIs (FHIR), rapid improvements in clinical NLP, and intensifying regulatory scrutiny are converging to make automation both technically feasible and commercially urgent. To stand out against medium competition from GRC incumbents and point solutions, the product must emphasize legal defensibility (audit trails, attestations, SOC/HIPAA compliance), specialty‑tuned NLP models, transparent model outputs, and tight EHR integrations rather than generic extraction. Be honest about challenges: long healthcare sales cycles, the cost of integration and validation across specialties, and the need to manage model hallucination and regulatory acceptance; these require a focused go‑to‑market (start with high‑risk payor audits) and rigorous validation to win trust.

Market Opportunity

Manual audit failures: digitize audits with automated, compliant workflows targets a $18.0B = 600,000 healthcare & regulated organizations x $30K ACV total addressable market with medium saturation and a year-over-year growth rate of 12%+ CAGR for compliance & audit automation software across regulated industries.

Key trends driving demand: Generative-AI & NLP -- enables automated extraction of evidence from free-text clinical notes and PDFs, lowering manual review time.; Cloud/EHR APIs -- growing availability of standardized interfaces (FHIR) accelerates integration and data access for audits.; Regulatory pressure -- payor and government audits increasing frequency and fines, driving demand for defensible audit trails..

Key competitors include AuditBoard, NAVEX Global, MetricStream, ServiceNow (using platform as workaround), Manual spreadsheets & paper (adjacent workaround).

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Manual audit failures: digitize audits with automated, compliant workflows

Executive Summary

Market Validation

Market Opportunity

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