Waystar Holding Corp. (WAY), a health-care payments company, unveiled AltitudeCreate on Monday — a new generative AI tool aimed at simplifying one of the industry’s most time-consuming and expensive processes: appealing insurance claim denials. According to CNBC, hospitals and health systems annually spend close to $20 billion attempting to overturn denied claims, a process that involves sifting through complex contracts and medical records to compose appeal letters.
The launch of AltitudeCreate comes at a time when insurance claim denials have surged to the forefront of national discourse, particularly following the tragic shooting of UnitedHealthcare CEO Brian Thompson in December, which sparked widespread public frustration with the insurance sector on social media. In the U.S., when medical care is received, providers submit claims to insurance companies, which may approve or deny them based on specific criteria. Denials can leave patients financially responsible for their care, with over 450 million claims being denied each year, and denial rates are on the rise.
Waystar CEO Matt Hawkins emphasized to CNBC the company’s commitment to improving the healthcare experience, stating that AltitudeCreate aims to reduce both the cost and stress associated with managing claim denials. The tool automatically drafts appeal letters, which traditionally require significant human effort, thus potentially saving time and resources for healthcare providers.
This AI innovation is part of a broader suite named AltitudeAI, which Waystar unveiled alongside AltitudeCreate. The development of this tool, which has been in progress for six to eight months, aligns with Waystar’s strategic partnership with Google Cloud announced in May, aimed at exploring AI applications in healthcare, including the automation of claims denials.
Waystar’s involvement in the healthcare sector is extensive; after its IPO in June, where it raised approximately $1 billion, the company managed over $1.2 trillion in gross claims volume in 2023, impacting about half of all U.S. patients. Hawkins pointed out that while claim denial issues have recently come under greater scrutiny, Waystar has been working on denial and appeal management for years.
AltitudeCreate has been initially rolled out to existing users of Waystar’s denial and appeal management modules at no extra charge, with plans for broader availability in the future. This move is seen as a step towards reducing administrative waste in healthcare, especially given the current climate where provider organizations are often understaffed and overwhelmed by the demands of following up on denied claims.
By leveraging AI to tackle these administrative burdens, Waystar not only aims to enhance operational efficiencies for healthcare providers but also to contribute to a more patient-centric healthcare system where the focus can return to care rather than billing disputes.
Price Action: As of the latest update, Waystar shares were trading down $0.88, or 2.35%, at $36.62. Despite this decline, the company’s market cap remains substantial at $6.45 billion. Over the past 3 months, Waystar has experienced an impressive 31.98% growth in its stock price,
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