The Waystar team celebrates its IPO on Nasdaq
2024 Nasdaq, Inc. / Vanja Savic
Health care payments company Waystar announced Monday a new generative artificial intelligence tool that can help hospitals quickly tackle one of their most costly and tedious tasks: combating insurance denials.
Hospitals and health systems spend nearly $20 billion annually reversing denied claims, according to a March report from purchasing organization Premier.
“We think if we can build software that improves people's lives during an otherwise stressful moment when they're seeking medical care, then we're doing something good,” Waystar CEO Matt Hawkins told CNBC.
Waystar's new solution, called AltitudeCreate, uses generative AI to automatically write objection letters. The company said the feature could help providers reduce costs and save them the hassle of wading through complex contracts and records to assemble letters manually.
Hawkins led Waystar through its initial public offering in June, where the company raised about $1 billion. The company processed more than $1.2 trillion in gross claims volume in 2023, affecting approximately 50% of U.S. patients
Claim denials have become a hot topic across the country following the fatal shooting of UnitedHealthcare CEO Brian Thompson in December. Americans flooded social media with posts about their frustration and displeasure with the insurance industry, often sharing stories about their own negative experiences.
Read more CNBC reports on AI
When a patient receives medical care in the United States, a notoriously complex billing process begins. Providers such as hospitals, health systems, or home care facilities submit a bill, called a claim, to an insurance company, and the insurer approves or denies the claim based on whether or not it meets the company's reimbursement criteria.
If a claim is denied, patients often have to cover the costs out of their own pockets. More than 450 million claims are denied each year, and denial rates are increasing, Waystar said.
Providers can ask insurers to reevaluate denials of claims by submitting an appeal letter. However, writing these letters is a time-consuming and costly process that does not guarantee any other outcome.
Hawkins said that while there has been a lot of discussion recently about denying claims, AltitudeCreate has been in the works at Waystar for six to eight months. The company announced an AI-focused partnership with Google Cloud in May, and automating claim denials was one of the 12 use cases the companies planned to explore.
Hawkins added that Waystar has also had a denial and appeal management software module for several years.
AltitudeCreate is a tool available within a broader suite of Waystar's AI offerings called AltitudeAI, which the company also unveiled on Monday. AltitudeCreate launched earlier this month at no additional cost to organizations already using Waystar's denial and appeal management software modules, the company said.
Waystar plans to make the feature more widely available in the future.
“Given all of this administrative waste in healthcare, where providers are understaffed and don't even have the time to follow up on a denied claim, we are using software to help automate this process,” Hawkins said.
Comments are closed.