New AI tool to fight health insurance denials could save hospitals billions, and help patients

According to one, hospitals and health systems spend about $20 billion a year trying to eliminate denied claims. March report From group purchasing organization Premier.

Waystar CEO Matt Hawkins told CNBC, “We think if we can develop software that improves people’s lives in an otherwise stressful moment when they’re dealing with health care. , so we’re doing something good.”

Waystar’s new solution, called AltitudeCreate, uses generative AI to automatically draft appeal letters. The company said the feature could help providers cut costs and save the headache of digging through complex contracts and records to manually put together letters.

Hawkins led Waystar through it. Initial public offering in June, where it raised nearly $1 billion. The company manages more than $1.2 trillion in cumulative claims volume in 2023, touching nearly 50% of patients in the US.

Denial of the claim has since become a hot-button issue across the country. Deadly shooting UnitedHealthcare CEO Brian Thompson in December. Americans Flood on social media with posts about their frustration and displeasure about The insurance industryoften sharing stories about their negative experiences.

When a patient receives medical care in the US, it begins a notoriously complex billing process. Providers such as hospitals, health systems or ambulatory care facilities submit an invoice to the insurance company, called a claim, and the insurer will approve or deny the claim based on whether it meets the company’s reimbursement criteria. Lands or not.

If a claim is denied, patients are often responsible for covering out-of-pocket costs. Waystar said more than 450 million claims are denied each year, and the denial rate is increasing.

Providers can ask insurers to reconsider a claim denial by submitting an appeal letter, but drafting these letters is a time-consuming and expensive process that doesn’t guarantee a different outcome.

AltitudeCreate has been working at Waystar for the past six to eight months, Hawkins said, while there has been a lot of discussion recently about the denial of the claims. The company announced AI-focused. Partnering with Google Cloud in May, and automated claims denial was one of 12 use cases the companies planned to explore.

Hawkins added that Waystar has also had a denial and appeal management software module available for several years.

AltitudeCreate is a tool available in Waystar’s broader suite of AI offerings called AltitudeAI, which the company also unveiled Monday. AltitudeCreate was introduced to organizations using Waystar’s denial and appeal management software modules earlier this month at no additional cost, the company said.

Waystar plans to make this feature more widely available in the future.

“Given all the administrative waste in healthcare where provider organizations are understaffed and don’t have time to follow up on a claim when it’s denied, we’re bringing software that are what helps automate that experience,” Hawkins said.