In this article, Health-care payments company Waystar has introduced a new generative artificial intelligence tool aimed at assisting hospitals in efficiently addressing one of their most expensive and labor-intensive tasks: combating insurance denials.
According to a report from the group purchasing organization Premier in March, hospitals and health systems spend close to $20 billion annually in efforts to reverse denied claims.
Waystar CEO Matt Hawkins expressed that the company’s goal is to create software that enhances people’s lives during the stressful period of receiving healthcare. The new solution, AltitudeCreate, utilizes generative AI to automatically generate appeal letters. This feature is expected to help providers reduce costs and eliminate the burden of manually compiling complex contracts and records for the letters.
Under Hawkins’ leadership, Waystar completed its initial public offering in June, raising approximately $1 billion. The company managed over $1.2 trillion in gross claims volume in 2023, impacting around 50% of U.S. patients.
Claim denials have gained significant attention nationwide following the tragic death of UnitedHealthcare CEO Brian Thompson in December. Americans took to social media to express their frustrations and dissatisfaction with the insurance industry, often sharing personal negative experiences.
In the U.S., the billing process for medical care is intricate. Providers such as hospitals, health systems, or ambulatory care facilities submit claims to insurance companies, which then approve or deny them based on reimbursement criteria. Patients are often left to cover costs out of pocket when claims are denied. Waystar noted that over 450 million claims are denied annually, with denial rates on the rise.
Providers can request insurers to reassess claim denials by submitting appeal letters, a laborious and costly process that does not guarantee a different outcome.
Hawkins mentioned that despite recent discussions on claims denials, AltitudeCreate has been in development at Waystar for the past six to eight months. The company established an AI-focused partnership with Google Cloud in May, with automating claims denials being one of the planned use cases.
Waystar has offered a denial and appeal management software module for several years. AltitudeCreate is part of Waystar’s broader suite of AI solutions called AltitudeAI, which was also introduced on Monday. The tool was made available earlier this month to organizations already using Waystar’s denial and appeal management software modules at no extra cost, with plans for broader availability in the future.
Hawkins emphasized that in the healthcare sector, where administrative inefficiencies are prevalent due to understaffing, Waystar aims to streamline the claims process through software automation.
