Denials are one of the most complex — and expensive — challenges in healthcare revenue cycle, costing providers $62B in delayed or lost revenue each year.
The impact is real. Providers spend $20B annually attempting to overturn denials, resulting in:
- Delayed cash flow
- More manual rework
- Frustrated teams
- Care that’s disconnected from accurate reimbursement
Waystar is changing that. By uniting one of the industry’s largest financial and clinical datasets on our single, AI-powered software platform, Waystar will empower organizations with clearer visibility, smoother workflows, and a direct link between care and proper payment.
Read on to learn what your organization could do by bridging the gap between clinical and financial intelligence in revenue cycle management.
1. How does combining clinical + financial data improve revenue cycle performance?
Pairing clinical and financial intelligence ensures that all important data is collected upfront to maximize the chance that transactions and claims will be paid by payers the first time.
By removing data silos and connecting clinical and financial teams, we can:
- Streamline workflows
- Enhance documentation quality
- Improve patient care and provider reimbursement
2. How does connecting care to claims bridge the gap + accelerate payments?
Linking the critical stage between care delivery and claim submission improves efficiency and revenue cycle performance. Specifically, this connection:
- Expands visibility across the revenue cycle
- Prevents revenue leakage
- Helps improve patient outcomes
- Ensures providers are paid fully and accurately
3. What specific Waystar solutions bridge the gap between clinical + financial data?
Clinical Documentation Integrity prioritizes cases with high potential for documentation correction opportunities and streamlines the query review and response process for physicians. As an industry leader, Waystar’s CDI solution shows the complete clinical picture of a patient so clients can:
- Enhance documentation integrity
- Capture more revenue
- Elevate quality metrics
Utilization Management evaluates the entire patient record to drive accurate patient status determination for the right case at the right time. This leads to appropriate earned revenue capture and focused case-review processes. By facilitating appropriate status changes as early as possible, Waystar’Utilization Management:
- Supports timely, appropriate care decisions that improve patient outcomes and care quality
- Drives accuracy in the medical record
- Strengthens compliance
- Improves financial performance
Prebill Anomaly Detection helps health systems close revenue gaps by pinpointing the most financially impactful documentation, coding, and quality opportunities post-discharge but before claim submission. It ensures accurate reimbursement, safeguards margins, and drives efficiency through targeted, financially focused CDI reviews, ultimately:
- Streamlining physician engagement
- Improving documentation accuracy
- Helping organizations capture the full value of the care they deliver
4. What’s one example of why it’s critical to bring clinical + financial data together?
“It’s crucial to get back to that root cause,” says Priti Shah, SVP of Product Management at Waystar. “In the mid revenue cycle, CDI nurses work really long hours to make sure things are documented just the right way. Then the coders come in, and then that claim goes out. The nurses almost never get to see the impact of that claim.
“Now, when we close the loop after a claim is denied or approved, we can deliver a ‘cookie-crumb trail’ that helps them make better decisions in the future. For example, teams can ask and answer:
- How could we have documented this better?
- Where did we go wrong in the coding?
- What query should we have sent the physician so they could get documentation right the first time?”
“Closing the loop is powerful because we can start influencing clinical decisions and clinical documentation upfront — and that will ultimately streamline and optimize that entire process,” says Shah. “What’s more, once you routinely deliver this feedback, you start seeing trends. You can act faster because you’re continuously improving documentation quality.”
5. How does pairing deep clinical insights + payer data improve denial management?
Waystar AltitudeAI™ has already dramatically improved processes within Denial + Appeal Management — slashing wasted effort, improving denial overturn rates, and reducing the time it takes to create appeal packages by up to 90%.
“Having been on this journey for years, we’ve made real progress in removing inefficiencies and trying to prevent denials before they happen,” says Waystar CTO Chris Schremser. “This year alone, our platform has prevented somewhere around $5.6 billion in denials already. But despite our efforts, denials remain high, and we know they are avoidable.”
By pairing deep clinical insights and payer data, Waystar can surface the upstream drivers of denials. That will enable accurate prediction and identification of:
- High-impact cases
- Coding improvements
- Financial opportunities
THE POWER OF CLINICAL + FINANCIAL DATA
IN ONE PLATFORM
Waystar data, 2025
“We believe clinical data and financial data must come together to transform what’s possible in healthcare,” says Schremser. “By combining financial and clinical data, we can absolutely improve workflows and visibility, eradicate denials at the source, and ensure optimal reimbursement.”
Dive deeper: Accelerate reimbursement by connecting care to payment
Watch our on-demand webinar to uncover all the benefits of uniting clinical intelligence and financial data on a single, AI-powered platform.
