News

Waystar Unveils AI Tool to Combat Health Insurance Denials

• By John K. Waters
• 01/21/2025

Health-care technology company Waystar announced on Monday the launch of a new generative AI solution aimed at addressing the growing financial and administrative burden of health insurance claim denials. The tool, named AltitudeCreate, leverages artificial intelligence to automatically generate appeal letters, a process that hospitals and health systems currently spend nearly $20 billion annually to manage, according to a March report by the group purchasing organization Premier.

The rollout comes amid heightened scrutiny of claim denials, particularly following the deadly shooting of UnitedHealthcare CEO Brian Thompson last December. The tragedy ignited public criticism of the insurance industry's practices, with Americans sharing grievances and personal stories of financial strain caused by denied claims.

"Developing software that makes people’s lives easier during what can be one of the most stressful times of their lives—seeking health care—is at the core of what we’re doing," said Waystar CEO Matt Hawkins in an interview.

Denied claims affect both patients and providers, with more than 450 million claims rejected annually. Insurers determine whether a claim meets their reimbursement criteria, and denials leave patients responsible for out-of-pocket costs. Providers often appeal these decisions, but drafting appeals is a resource-intensive task involving detailed contract reviews and documentation.

AltitudeCreate aims to streamline this process, reducing administrative costs and time for providers. The tool is part of Waystar's broader AltitudeAI suite, unveiled on Monday, which offers AI-powered solutions to tackle inefficiencies in health-care billing and payments.

"Providers are understaffed and don’t always have the resources to follow up on denied claims. With this software, we’re automating that experience and making it less of a burden," Hawkins said.

AltitudeCreate builds on Waystar’s existing denial and appeal management software, which has been available for several years. According to Hawkins, the new AI-powered tool has been in development for six to eight months and reflects the company’s ongoing collaboration with Google Cloud, announced in May. Automating claims denials was one of 12 planned use cases for the partnership.

The feature was rolled out earlier this month to organizations already using Waystar’s denial management software at no additional cost. The company plans to expand access to other providers in the near future.

Waystar’s financial position has strengthened following its $1 billion initial public offering in June, with the company processing over $1.2 trillion in gross claims volume in 2023, touching about half of U.S. patients.

The launch of AltitudeCreate underscores the need to address inefficiencies in the U.S. health-care system, which is often criticized for its complexity and waste. "This is about tackling a major administrative problem in health care," Hawkins said.