New AI can autonomously help physicians generate appeal letters for denied claims

Author(s):

Todd Shryock

Key Takeaways

Waystar AltitudeAI™ aims to streamline denied claim appeals using AI, potentially recovering substantial payments for providers.
The U.S. healthcare system loses $350 billion annually to administrative waste, with $20 billion spent on claim appeals.
Generative AI in Waystar's platform enhances productivity, precision, and efficiency in claims, appeals, and payment workflows.
Waystar's AI platform processes over five billion transactions annually, covering approximately 50% of patients nationwide.

Company aims to make claims appeals easier and quicker for physicians by having AI do much of the work

AI can help with denied claims: ©Stewart Miles - stock.adobe.com

Payers deny more than 450 million claims each year, and doctors spend untold hours writing appeals to get paid, but a new AI-powered innovation could change that.

Waystar announced the launch of Waystar AltitudeAI™, a comprehensive set of AI capabilities for providers, including AltitudeCreate™, a new generative AI innovation focused on appealing denied claims. By autonomously generating appeal letters, Waystar aims to help providers recover a substantial portion of payments tied to the hundreds of millions in annually denied claims, ultimately enabling faster and more accurate health care payments.

According to Waystar, the U.S. health care system annually loses $350 billion to administrative waste. Recent reports estimate that hospitals and health systems spend $20 billion annually trying to overturn denied claims, with denial rates rising. Additionally, claim denials are associated with reduced access to care and lower patient satisfaction. The company says that providers are eager to invest in AI that demonstrably reduces administrative waste, enhances operational efficiency, and improves interactions with payers and patients.

“More than half of denied claims ultimately get overturned, but the appeal process is time-consuming, complex, and error-prone for providers,” said Matt Hawkins, Chief Executive Officer of Waystar, in a statement. “Generative AI unlocks a new era of productivity and precision, transforming how the industry simplifies claims, appeals, and payment workflows. With Waystar’s AI-powered software platform, providers of all sizes are better equipped to appeal denied claims with unprecedented efficiency, accuracy, and ease.”

Waystar has a decade-long track record of deploying AI pervasively across its software platform to address administrative waste in health care. Waystar AltitudeAI™ leverages insights from Waystar’s extensive payments network, which facilitates over five billion annual transactions for approximately 50% of patients nationwide. AltitudeCreate™ is the latest generative AI innovation introduced within Waystar AltitudeAI™ to transform the claim denial workflow.

The announcement was made at the J.P. Morgan Healthcare Conference.