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 costly and time-consuming tasks: handling insurance denials. According to a report from the group purchasing organization Premier in March, hospitals and health systems collectively spend nearly $20 billion annually on efforts to reverse denied claims.
Waystar’s CEO, Matt Hawkins, expressed the company’s goal of developing software to improve people’s lives during stressful healthcare moments. The newly launched solution, AltitudeCreate, utilizes generative AI to automatically generate appeal letters. This feature is designed to help providers reduce costs and alleviate the burden of manually compiling complex appeal letters by navigating through intricate contracts and records.
Under Hawkins’ leadership, Waystar successfully 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, prompting Americans to voice frustrations and grievances towards the insurance industry on social media.
The billing process for medical care in the U.S. is known for its complexity, where providers submit claims to insurance companies for approval or denial based on reimbursement criteria. Patients often bear the cost if a claim is denied, with more than 450 million claims being denied annually, and denial rates on the rise, as reported by Waystar.
Providers can request insurers to reassess claim denials by submitting appeal letters, a laborious and costly process that does not guarantee a different outcome. AltitudeCreate, Waystar’s latest tool, has been in development for the past six to eight months and is part of the broader suite of AI offerings called AltitudeAI, unveiled by the company. The tool was made available to existing users of Waystar’s denial and appeal management software modules earlier this month at no extra charge, with plans for broader availability in the future.
Hawkins emphasized the importance of automating the claims denial process to address administrative inefficiencies in healthcare, particularly for understaffed provider organizations struggling to manage denied claims effectively.
