Prime Highlights:
Waystar introduces AltitudeCreate, an AI tool to automate insurance claim appeals.
The solution could save hospitals billions by reducing the time and cost of fighting claim denials.
Over 450 million claims are denied annually, with rising denial rates.
Key Background:
Waystar, a prominent healthcare payments company, has introduced a generative AI solution aimed at addressing one of the most costly and time-consuming challenges faced by hospitals: fighting insurance claim denials. The new tool, called AltitudeCreate, automates the process of drafting appeal letters for denied claims, which traditionally require extensive manual effort and resources.
Hospitals and health systems currently spend an estimated $20 billion annually attempting to overturn denied claims, according to a March 2024 report by Premier, a group purchasing organization. By automating the creation of appeal letters, Waystar’s new feature promises to reduce operational costs and the administrative burden on healthcare providers, helping them to manage complex claims processes more efficiently.
AltitudeCreate is part of Waystar’s broader AI initiative, AltitudeAI, designed to streamline healthcare payments and claims management. This tool leverages generative AI to automatically generate appeal letters, alleviating the need for providers to manually sift through intricate contracts and patient records.
The new AI-driven tool is already available to hospitals and health systems that use Waystar’s existing denial and appeal management software, with no additional costs for these organizations. Waystar plans to expand the tool’s availability to a broader range of healthcare providers in the near future. With over 450 million claims denied annually and denial rates steadily increasing, the need for more efficient solutions in claims management has become increasingly urgent. Additionally, recent public scrutiny of insurance companies, particularly following the tragic shooting of UnitedHealthcare CEO Brian Thompson, has amplified concerns over the fairness of insurance practices.
Waystar CEO Matt Hawkins emphasized the company’s commitment to alleviating stress and improving the healthcare experience for both patients and providers. As healthcare systems grapple with administrative inefficiencies and understaffing, AI-driven solutions like AltitudeCreate aim to ease the burden and reduce the escalating costs of claim denials.