Waystar continues to rapidly build out new generative AI capabilities and advanced automation to tackle revenue cycle management workflows. The company is now using AI and automation to help uncover lost provider revenue from payer payment adjustments, which are often referred to as 'take-backs'.
It's estimated that recoupments—payments that were already received and recorded as revenue, only to be taken back by insurers—cost healthcare providers more than $1.6 billion every month. Providers also face growing claim denials, with one report indicating that providers lost over $48 billion in net revenue in 2025 to final denials and uncollected patient responsibilities.
"Payers are struggling in recent years with higher utilization and medical loss ratios increasing, and they're using denials as a way to help manage their operating environment, their balance sheet. Providers are impacted by that. We often focus on denials, and it's a massive problem—$40 billion-plus a year in denied claims across hundreds of millions of claims that initially get denied, but we don't always focus on this issue of 'silent denials', this payer take-back that occurs oftentimes months or even years after a claim is initially adjudicated and payment is remitted to a provider," Matt Hawkins, Waystar CEO, told Fierce Healthcare in an interview giving a first look at the new AI solution.
The company developed an AI capability as part of its Waystar AltitudeAI suite, which helps providers streamline workflows and improve financial performance, to help detect unjustified payer recoupments, giving providers more visibility to pursue appeals.
Waystar works with 30,000 clients, representing over 1 million distinct providers, and its platform processes over 7.5 billion healthcare payment transactions.
The company's large proprietary dataset and scale enables it to use AI and automation to identify recoupment activity and match those adjustments to originating claims to help uncover systemic drivers of revenue leakage, according to the company.
"We're bringing AI to work to scan the claims dataset, scan the remittance dataset, and then present all of that information very rapidly in an easy-to-consume format to enable the provider to successfully contest that 'hold-back'," Hawkins said.
Hawkins says Waystar's AI solution reduces reconciliation time by more than 80% and provides 100% visibility into payer recoupments, so providers can quickly identify take-backs and pursue appeals they previously had to write off.
Payer recoupments can often be a 'black box' as most providers lack visibility into the payer adjustment process. Identifying and researching payer adjustments is often a highly labor-intensive process that requires dedicated staff to challenge them. Providers often cannot determine which claims were affected, why funds were recouped, or how to respond. As a result, organizations often absorb substantial write-offs and experience unpredictable cash flow, according to Waystar.
Recoupments are accelerating, growing at twice the rate of overall claim volume over the last three years, Hawkins said.
"We know that payers are using 'take-backs,' or what we call recoupments, as a tactic as they interact with providers. This takes a long time for providers to go in, look at the small print, have someone on their staff go in and review and go back into their history to try to reconcile and find answers or context around that particular 'take-back'," Hawkins said. "Through our early adopter program that we have among some large hospitals and health systems, we're seeing a substantial reduction in time that is required to address these payer 'take-backs' or recoupments.
According to Waystar, one health system, with approximately $4 billion in annual revenue, that was an early adopter of the AI solution, identified $32 million in hidden recoupments. That work would have taken the equivalent of 27,000 hours of manual reconciliation across thousands of transactions annually or 13 full-time employees, Hawkins said.
"That's real identified savings at a fraction of the time because we can do it in moments, not minutes or hours. It's a prime use case for LLM capability," Hawkins said.
Currently, the AI solution does not automate the entire recoupment appeal process, but as the program expands and adoption grows, the company plans to add more capabilities to make the process even more automated.
Waystar says it developed the AI solution in partnership with a dozen clients, including large health systems and ambulatory providers, who identified recoupments as an urgent and underserved challenge.
"Recoupments were a black box for our team — every single one required manual investigation through remittance data, taking hours to research," said Munday Letournea, who leads billing operations and cash posting for Novocure, an oncology company with more than 1,300 employees. "Waystar's Recoupment Manager cut that to minutes and gave us something we've never had: a clear view of what's being taken back and why. That changes how we prioritize, how we appeal, and ultimately how much revenue we recover."
There is an age-old tug-of-war between providers and payers and now AI is being deployed on both sides. Payers are concerned that AI-enabled coding leads to inflated spending, while providers argue that AI helps to accurately document the care clinicians are providing.
Hawkins asserts that AI technology can bring more transparency, insight and visibility into the claim and payment process. Waystar is building out AI capabilities to reduce manual work and reduce friction points in the revenue cycle process, he noted.
"We are not antagonistic toward payers, and we know that payers are working to avoid fraud, waste and abuse, miscoding or potentially over-coding. What's really exciting about what Waystar is doing, I think for the first time, we're presenting a unified, end-to-end platform that systematically reduces friction, that creates agentic capabilities on the platform and AI that can be consumed by providers. Most providers are not equipped to resource or harness the power of AI themselves, but they want to be able to utilize it," he said.
Hawkins added, "In the long term, as we help providers with Waystar's platform, what we see occurring is more and more payers saying to the clients that we work with, 'You're presenting to us an accurate claim.' Waystar has a first-pass claim acceptance rate that is nearly 99% across our platform. That's not an example of friction—that's an example of reduction of friction. As we continue to do that, we think we'll see more payers reaching out directly to us saying, 'How can we work more closely together so that we can begin to think through things like real-time claim adjudication, faster remittance and acceptance of the claim, and then remittance of the payment?'"
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, according to Hawkins.
"Every new innovation that we launch is a march toward that vision, that platform. We expect to launch several agentic capabilities this year," he said.
The company, which went public nearly two years ago, brought in revenue of $1.1 billion in 2025, up 17% year-over-year, with net income of $112 million as it swung to a profit for the full year. Waystar expects to see its revenue grow to $1.274 billion to $1.294 billion this year.