Waystar continues to rapidly build new generative AI capabilities and advanced automation to address revenue cycle management workflows. The company is now using AI and automation to account for provider revenue lost through payer payment adjustments, or so-called “recaptures.”
It is estimated that recoup (payments already received and recorded as revenue, but only recovered by insurance companies) costs healthcare providers more than $1.6 billion each month. Healthcare providers are also facing an increase in claim denials, with one report finding that providers lost more than $48 billion in net revenue in 2025 due to final denials and uncollected patient liability claims.
“In recent years, payers have struggled with rising utilization rates and rising medical loss rates, and are using denials as a way to help manage their business environments and balance sheets. Providers are feeling the impact. We often focus on denials, and this is a major Although more than $40 billion in claims are denied annually in hundreds of millions of first-time claims, we don’t always focus on this problem of “silent denials,” or payer reversals that occur every few months. Or it could be years after a claim is first adjudicated and payment is sent to the provider,” Waystar CEO Matt Hawkins told Fierce Healthcare in an interview giving a first look at the new AI solution.
The company has developed AI capabilities as part of its Waystar AltitudeAI suite. It helps providers streamline workflows and improve financial performance, helps detect unfair payer recoveries, and gives providers greater visibility for disputes.
Waystar works with 30,000 clients representing more than 1 million individual providers, and its platform processes more than 7.5 billion healthcare payment transactions.
The company says its large proprietary dataset and scale enable it to uncover the full drivers of revenue leakage by using AI and automation to identify collection activity and match adjustments to original billing amounts.
“We’re deploying AI to help providers better combat that ‘withholding’ by scanning claims datasets, scanning remittance datasets, and presenting all that information in an easy-to-use format very quickly,” Hawkins said.
According to Hawkins, Waystar’s AI solution reduces reconciliation time by more than 80% and provides 100% visibility into payer collections, allowing providers to quickly identify collections and pursue disputes that previously had to be reversed.
Payer recoup is often a “black box” as most providers do not have visibility into the payer reconciliation process. Identifying and investigating payer adjustments is often a highly labor-intensive process that requires dedicated staff to challenge adjustments. Providers often cannot determine which claims were affected, why funds were recovered, or how to respond. As a result, organizations often absorb large losses and experience unpredictable cash flows, according to Waystar.
Hawkins said recoveries are accelerating and are growing at twice the rate of overall claims over the past three years.
“We know that payers use ‘take-backs’, or what we call recouping, as a tactic when interacting with providers. It takes a long time for the provider to go inside, look at the fine print, have someone on their staff go in and review it, go back and reconcile the history and try to find the answers and context for that particular ‘take-back,'” Hawkins said. “Through our early adoption programs among some large hospitals and health systems, the time needed to address these payer ‘reversals’ and reimbursements has been significantly reduced.
A health system with approximately $4 billion in annual revenue that was an early adopter of AI solutions identified $32 million in hidden recoveries, according to Waystar. This work equates to 27,000 hours of manual reconciliation across thousands of transactions annually, or 13 full-time employees, Hawkins said.
“This is definitely a fraction of the time savings because it can be done instantaneously rather than minutes or hours, and this is a key use case for the LLM feature,” Hawkins said.
Currently, the AI solution does not automate the entire recall filing process, but as the program expands and adoption increases, the company plans to add capabilities to further automate the process.
Waystar says it has developed the AI solution in collaboration with more than a dozen customers, including large health systems and ambulatory care providers. These customers identified fund recovery as an urgent and underserved challenge.
“Recoveries were a black box for our team. Each required manual investigation of remittance data, which took hours to investigate,” said Munday Letournia, head of billing and cash posting at Novocure, an oncology company with more than 1,300 employees. “Waystar’s Collections Manager cuts that down to minutes and gives us something we never had before: clear visibility into what’s being collected and why. That changes how we prioritize, how we appeal, and ultimately how much revenue we collect.”
There has been a long-standing tug-of-war between providers and payers, and both sides now have AI in place. While payers are concerned that AI-enabled coding will lead to higher spending, healthcare providers argue that AI can help clinicians accurately document the care they are providing.
Hawkins argues that AI technology can bring more transparency, insight, and visibility to the billing and payment process. He said Waystar is building AI capabilities to reduce manual labor and reduce friction points in the revenue cycle process.
“We are not adversarial to payers, and we know they are working to avoid fraud, waste and abuse, and the potential for miscoding and over-coding. What’s really exciting about Waystar’s work is to systematically reduce friction, create agent capabilities on the platform, and “We’re presenting for the first time an integrated, end-to-end platform that makes AI available to bidders. Most providers aren’t ready to have the resources for AI themselves or to harness the power of AI, but they want to be able to leverage it,” he said.
Hawkins added: “Longer term, as we help providers with Waystar’s platform, we see more and more payers saying to the customers we work with, ‘You’re presenting accurate billing.'” Waystar’s first-time application acceptance rate is nearly 99% across the platform. This is not an example of friction, but rather an example of friction reduction. As we continue to do this, I think more and more payers will reach out to us directly and say, “How can we work more closely together to start thinking about things like real-time claims adjudication, faster remittance and claim acceptance, and remittance of payments?” ”
Hawkins said Waystar acquired AI-driven revenue cycle management company Iodine Software last year and is focused on developing new AI models with the goal of creating a fully autonomous revenue cycle in healthcare.
“Every new innovation we launch is a march towards that vision, that platform. We’re launching some agent capabilities this year,” he said.
The company, which went public almost two years ago, posted revenue of $1.1 billion in 2025, up 17% from the previous year, and a full-year profit with net income of $112 million. Waystar expects sales to increase to between $1.274 billion and $1.294 billion this year.
$1.294 billion
