Waystar Denial + Appeal Management is a core component of Waystar's Denial Prevention + Recovery suite, leveraging artificial intelligence (AI) and automation to simplify the complex process of overturning denied claims and preventing future revenue loss. The cloud-based solution is designed for healthcare providers, including hospitals, health systems, and physician practices, who are struggling with the high volume and cost of claim denials.
Key Capabilities:
- AI-Powered Prioritization: Uses predictive analytics to score and prioritize denied claims based on their predicted cash value and likelihood of being overturned, ensuring staff focus on the highest-ROI accounts.
- Automated Appeal Generation (AltitudeCreate™): A generative AI innovation that autonomously creates appeal letters, drastically reducing the time and resources spent on manual drafting. It leverages a library of over 1,100 payer-specific appeal templates.
- Streamlined Workflows: Provides customized, exception-based workflows that automatically route non-workable denials, allowing staff to concentrate only on claims requiring human intervention.
- Root Cause Reporting: Offers robust analytics and reporting to identify the underlying causes of denials, enabling providers to implement process improvements and prevent future errors before claim submission.
- Seamless Integration: The Appeal Wizard and other features integrate directly into existing Practice Management (PM) or Electronic Medical Record (EMR) systems, maintaining the existing system as the source of truth and ensuring a disruption-free implementation.
By automating the appeals process and providing actionable denial intelligence, Waystar helps healthcare organizations accelerate reimbursement, reduce Accounts Receivable (AR) days, and improve overall financial performance.
