How AI Can Predict Payer Denial Pattern Shifts
Garrick Stoldt frames the relationship between payers and health systems as a constant back-and-forth, with payers regularly changing policies in ways that affect the ability to get paid and slow down the payment cycle. Traditional analysis of these shifts relies on looking retroactively at claims development over time, which creates a lag before health systems can recognize and respond to what is happening. AI can identify changing payer patterns much faster, allowing organizations to deploy counter-solutions before the problem compounds and requires additional staff resources.
The practical consequence of faster prediction is faster remediation. When a payer change is detected early, a process fix or automation can be built to address it before the volume of affected claims grows. That speed advantage is the core value Garrick sees AI delivering in claims denial management beyond its current use in account prioritization and eligibility.
Key Takeaway
Payer policy changes that slow payment cycles and drive denials have historically been discovered only after the damage accumulates. AI that detects shifting payer behavior early lets revenue cycle teams build solutions proactively, reducing both the revenue impact and the staffing burden of reactive denial management.
“It’s like a game of tennis. The payer creates a policy that now creates a problem for us. We need to create some sort of solution that addresses that problem so it doesn’t continue on us. And it’s just this back and forth.”
Garrick Stoldt, Chief Financial Officer, St. Peter's Healthcare System
1:12How Agentic AI Lifts Administrative Burden in Revenue Cycle
1:27How AI Prioritizes Accounts for Revenue Cycle Follow-Up
110 secHow EMR Coding Guidance Prevents Medical Necessity Denials
From the clip to strategy.
The themes our guests cover are the same ones our executive guides and ROI calculators are built around. If this clip resonated, here’s where to take it next.
Claims Denial Management, powered by agentic AI
How ArceeHQ catches denials before they happen, resolves them automatically, and gives your reviewers only the cases that need a human.
See the solutionReducing claim denials with agentic AI
A practical framework for revenue cycle leaders. Covers the operating model shift, what to measure, and where automation actually pays.
Read the guideClaims denial ROI calculator
Model the revenue impact of a first-pass rate improvement at your health system. Plug in your denial volume and payer mix.
Run the calculatorNever miss a clip.
Get new shorts and full episodes delivered to your inbox the day they drop. Plus exclusive bonus content for subscribers.
- Real-world strategiesOperational playbooks and proven approaches from RCM leaders delivering measurable results.
- Executive connectionsBe part of a trusted network of executives shaping the future of revenue cycle and patient finance.
- Agentic AI insightsDiscover how AI-driven automation is reshaping denial prevention, patient financing, and financial assistance.
Let’s redefine financial engagement together.
See how ArceeHQ can supercharge your revenue cycle. We’ll walk through the platform, discuss your specific systems and goals, and show measurable lift you can expect in the first 90 days.