Waystar tackles $40B denials problem with new AI capability

With the help of AI, Waystar is hoping to uncover over $40 billion in provider revenue reclaimed by payers each year through post-payment adjustments.

These payment recoupments, also known as "silent denials," are a widespread problem for healthcare providers. According to an analysis of the healthcare payment software vendor's proprietary data, these denials have increased at twice the rate of overall claim volume in the last three years.

The recoupments can also occur months or even years after payers reimburse providers, with little explanation. Lack of insight into silent denials has made it difficult for providers to determine which claims were affected, why payers recouped payment and how to respond.

"Providers have been losing billions to recoupments they couldn't see, couldn't trace, and couldn't recover -- until now," Matt Hawkins, Waystar's CEO, said in an announcement today.

Waystar unveiled a new AI-powered tool designed specifically to tackle silent denials and recover reimbursement for providers. The Recoupment Manager solution will use the company's AltitudeAI, a comprehensive set of AI capabilities that power its flagship end-to-end revenue cycle management software platform.

Launched in early 2025, AltitudeAI uses generative AI to simplify healthcare payments, accelerate reimbursements and ease administrative burdens. The tool has been applied to various areas in the revenue cycle, including denials and appeals management.

Now, Waystar is leveraging its AI capabilities and its data spanning over 7.5 billion healthcare payment transactions to provide visibility into silent denials, which it says have "remained largely undetected and unrecovered."

Waystar says the tool will identify recoupment activity across payers, providers and care settings to match the adjustments to originating claims. It will also help to determine systemic drivers of revenue leakage, the announcement stated.

Early adopters of the new solution are seeing results, with reconciliation time falling by more than 80%. One health system has already surfaced $32 million in recoupments it had previously missed or could not identify.

Waystar said that it developed this solution with input from dozens of its clients, from large health systems to nationwide ambulatory providers.

"Recoupments were a black box for our team -- every single one required manual investigation through remittance data, taking hours to research," Munday Letourneau, billing operations and cash posting lead for Novocure, an international oncology company with more than 1,300 employees, said in the announcement.

As an early adopter, Letourneau said the solution has reduced the administrative burden of recoupment management to minutes, while providing a clearer view of what payments have been recouped and why.

"That changes how we prioritize, how we appeal, and ultimately how much revenue we recover," Letourneau continued.

The Recoupment Manager is part of Waystar's goal of creating an autonomous revenue cycle using AI capabilities, including agentic AI. The company aims to provide agentic AI, machine learning, robotic process automation and other forms of AI to automate and manage revenue cycle tasks end-to-end with minimal human intervention.

The combination of AI agents in this autonomous state seeks to create a self-learning engine that can then act within workflows, make decisions and improve outcomes.

More revenue cycle management vendors are tapping into agentic AI to provide autonomous functions to providers who report high administrative burdens amid rising denial rates.

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.