Waystar, one of the Healthcare technology vendors, is a good example of how transaction processors can create new offerings from their data exhaust. The vendor processes 2.5 billion transactions a year in healthcare billing and collections, all on a single data platform, for about 40% of U.S. patients. That data allows the company to leverage machine learning, other forms of AI, and RPA to help take costs out of the system and apply them to better patient care.
Nobody ever accused the U.S. healthcare system of being simple, and that’s reflected in the data about it. Waystar works with 500,000 care providers, 1000 healthcare provider organizations, and 5000 payers and health plans. With all those sources Waystar provides a clearinghouse for billing and collections data, but in order to analyze it and apply AI they have to retrieve, match, standardize, federate, and transform the data with rule engines. After that, they can apply all sorts of algorithms, like the one to predict how much a procedure will cost at one of the large health systems using their technology. Their AI and RPA platform is called “Hubble”. It doesn’t allow a view into other galaxies, but it does allow a view into the future of your insurance claims. Let’s learn the main features of Hubble:
Patient Financial Clearance
Detect hidden insurance coverage and automate prior authorizations, reducing the cost to collect as well as surprise bills for patients. Identify patients who are eligible for financial assistance.
Revenue Integrity
Automatically identify incorrect and under-coded claims, including DRG anomalies, before a claim is submitted.
Claim Management
Ensure claims are submitted correctly to payers, reducing denials. Automate claim status checks to save team resources.
Denial Management
Identify denials with the highest likelihood of being overturned to increase yield.
Patient Financial Experience
Determine the ability and probability of a patient to pay. Create tailored communications on informed timetables to increase collections.
Agency Management
Gain insight into the performance of outsourced collection agencies to improve returns.
