Waystar’s New AI Solution Tackles Silent Denials From Payer Take-Backs

Waystar is continuing to expand its use of generative AI and advanced automation to address challenges in revenue cycle management. The company is now applying these technologies to help providers identify lost revenue tied to payer payment reversals, commonly known as ‘take-backs.’

These recoupments (payments that were initially received and booked as revenue but later reclaimed by insurers) are estimated to cost healthcare providers more than $1.6 billion each month. At the same time, rising claim denials are compounding financial pressure, with one report estimating that providers forfeited nearly $50 billion in net revenue in 2025 due to final denials and unpaid patient balances.

As part of its Waystar AltitudeAI suite, the company has introduced an AI-driven capability designed to flag questionable recoupments, giving providers clearer visibility into payer actions and enabling them to challenge those adjustments more effectively. Waystar’s platform serves roughly 30,000 clients, representing well over 1 million providers, and processes over 7.5 billion healthcare payment transactions.

Leveraging its large proprietary dataset and scale, the company uses AI and automation to track recoupment activity and link those adjustments back to the original claims, helping uncover patterns that drive revenue loss.

Matt Hawkins, CEO of Waystar, said the company is applying AI to analyze both claims and remittance data, presenting insights quickly in a clear format that helps providers more effectively challenge withheld payments.

According to Hawkins, the solution can cut reconciliation time by over 80% while offering full visibility into payer recoupments, allowing providers to more quickly detect and appeal take-backs that might otherwise be written off.

Payer recoupments are often difficult for providers to navigate due to limited transparency in how insurers apply adjustments. Investigating these changes typically requires significant manual effort and dedicated staff, and providers frequently lack clarity on which claims were affected, why funds were recovered or how best to respond. Hence, organizations often absorb major write-offs and face inconsistent cash flow.

Hawkins added that recoupment activity has been rising rapidly, growing at twice the pace of overall claim volume over the past three years.

He added that insurers often rely on recoupments – also known as payment reversals – as part of their interactions with providers, noting that investigating these cases typically requires significant time and effort to review detailed records and trace historical context. Hawkins said early adopters, including large hospitals and health systems, have already seen meaningful reductions in the time needed to resolve such payment issues.

According to Waystar, an early adopter health system generating roughly $4 billion in annual revenue uncovered $32 million in previously unrecognized recoupments using the AI tool. Hawkins noted that identifying those funds through traditional methods would have required around 27,000 hours of manual reconciliation across thousands of transactions each year, the equivalent to the workload of about 13 full-time employees.

He added the company is delivering tangible savings in a fraction of the time by completing tasks in moments rather than minutes or hours, which represents a strong application of large language model technology in practice.

Understanding Silent Denials in Healthcare

Silent denials occur when insurers recoup payments from previously approved claims, often months or even years after reimbursement, with little explanation. These payer take-backs have become increasingly common and difficult to track, creating significant financial strain on healthcare providers.

According to industry data, more than $40 billion in provider revenue is impacted annually by these hidden adjustments, making it a critical issue for organizations relying on predictable cash flow.

How Waystar’s AI Solution Works

The new AI capability from Waystar leverages its AltitudeAI platform to analyze vast datasets and identify previously undetected recoupments. By processing billions of healthcare transactions, the system provides real-time visibility into payer behavior and financial discrepancies.