Waystar Announces AI Program Designed to Help Appeal Denied Claims

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As people in the industry become more comfortable with the technology, AI is being used to find potential solutions for more and more issues in the healthcare industry. The technology is controversial, however, and concerns have been raised about its usage. While the main issue is that it will replace humans in working spaces, another major concern is that AI will be used to take the decision-making process away from people and turn it into an automated system.

This is a significant concern with health insurance companies. Patients seem to be greatly concerned that these companies may use AI to automate the claims process, resulting in higher levels on denials. While these concerns have yet to be confirmed, one company is using AI to do the exact opposite.

Waystar announced a new set of AI-powered tools designed to perform a variety of tasks, including appealing denied claims.¹ According to the healthcare payment technology company, this product can help recover up to $450 million a year in denied claims.

Waystar AltitudeAI also promises to help simplify the process. For many providers and patients, the appeals process is simply to complex and difficult, especially for those handling a medical crisis.

In a press release, Waystar CEO Matt Hawkins said, “More than half of denied claims ultimately get overturned, but the appeal process is time-consuming, complex, and error-prone for providers. 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."

According to Waystar, administrative waste in healthcare can result in up to $350 billion in waste each year. Billions of that is tied directly to claims denials, which also negatively impact the public’s perception of the entire healthcare industry.

In September of last year, Waystar partnered with Modern Healthcare to produce a report on the ways that AI can be used for healthcare payments.² According to the report, 75% of respondents stated that the use of AI in healthcare payments has already returned a positive ROI. AI has also led to measurable improvements across operations, and a majority of respondents said they have plans to further implement the technology.

About two-thirds of respondents stated that they expected generative AI to be a key investment in the coming months.

In a press release issued at the time, Hawkins said, “At Waystar True North, we showcased the power of harnessing AI, including Generative AI in the Waystar Innovation Lab™ to hundreds of top healthcare leaders across the nation. Our research and ongoing discussions with healthcare leaders reveal a clear trend: Generative AI has immense potential to simplify healthcare payments. We are grateful to be a leader in innovation with a core focus on delivering demonstrable ROI across the Waystar software platform."

Sources

1. Waystar Unveils Transformative Generative AI Innovation to Help Providers Recover Billions of Dollars Tied to 450 Million Annual Denied Claims. Waystar. January 13, 2025. https://www.prnewswire.com/news-releases/waystar-unveils-transformative-generative-ai-innovation-to-help-providers-recover-billions-of-dollars-tied-to-450-million-annual-denied-claims-302348765.html
2. New Research from Waystar and Modern Healthcare Reveals AI's Transformative Impact on Healthcare Payments. Waystar. September 24, 2024. Accessed January 14, 2025. https://www.prnewswire.com/news-releases/new-research-from-waystar-and-modern-healthcare-reveals-ais-transformative-impact-on-healthcare-payments-302257029.html