New tool will help combat health insurance denials | Wilnesh News

healthcare payment company Weixing A new generative artificial intelligence tool announced Monday could help hospitals quickly address one of their most expensive and cumbersome responsibilities: fighting insurance denials.

Hospitals and health systems spend nearly $20 billion each year trying to overturn denied claims, according to one agency. March report From group buying organization Premier.

“We think if we can develop software that makes people’s lives better during those stressful moments when they’re getting health care, then we’re doing a good thing,” Waystar CEO Matt Hawkins told CNBC.

Waystar’s new solution is called AltitudeCreate and uses generative artificial intelligence to automatically draft appeal letters. The company says the feature can help providers reduce costs and save them the hassle of digging through complex contracts and records to manually piece letters together.

Hawkins led Waystar through its initial public offering in June, which raised about $1 billion. In 2023, the company will process more than $1.2 trillion in total claims, covering approximately 50% of patients in the United States

Claim denials have become a hot-button issue nationwide fatal shooting UnitedHealthcare CEO Brian Thompson said in December. Americans have flooded social media with posts about their frustrations and dissatisfaction with the insurance industry, often sharing their negative experiences.

When a patient receives medical care in the United States, a notoriously complex billing process is initiated. Providers such as hospitals, health systems or ambulatory care facilities submit invoices called claims to the insurance company, which will approve or deny the claim based on whether it meets the company’s reimbursement criteria.

If a claim is denied, the patient is usually responsible for paying out-of-pocket costs. Waystar says more than 450 million claims are denied each year, and denial rates are rising.

Providers can ask insurance companies to re-evaluate claim denials by submitting appeal letters, but drafting these letters is a time-consuming and expensive process that does not guarantee a different outcome.

Hawkins said that while there has been a lot of talk recently about denying the claims, AltitudeCreate has been working on Waystar for the past six to eight months. The company announces the launch of an artificial intelligence-focused Works with Google Cloud In May, automatic claim rejection was one of 12 use cases the company planned to explore.

Hawkins added that Waystar also offers a denial and appeals management software module that has been in use for several years.

AltitudeCreate is a tool within Waystar’s broader suite of artificial intelligence products, AltitudeAI, which the company also launched on Monday. AltitudeCreate launched free of charge earlier this month to organizations already using Waystar’s denial and appeals management software module, the company said.

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

“With all this administrative waste in healthcare, where provider organizers are understaffed and don’t even have the time to follow up when a claim is denied, we’re introducing software to help automate this experience,” Hawkins said.