Healthrise, a health care consulting and technology firm in Farmington Hills, today announced the launch of Navigator AI, an embedded artificial intelligence layer within its Denials Navigator platform designed to improve cash flow for hospitals.
Navigator AI is designed to accelerate insurance denial resolution, improve decision accuracy, and support faster financial impact across health care revenue cycle operations.
According to Healthrise, hospitals continue to operate on margins as thin as 1 percent to 3 percent, yet a significant share of revenue loss occurs before claims are ever denied.
Meanwhile, denial rates are rising as a result of Medicaid and legislative shifts leading to increased payer complexity, tightening authorization requirements, and growing administrative burdens — driving more rework and higher costs to collect.
Healthrise analysis shows up to 30 percent of preventable revenue leakage is driven by pre-bill and early-cycle breakdowns, including documentation gaps, coding inconsistencies, eligibility errors, and missed charge capture opportunities. Once claims are corrected or denied, rework costs can range from $25 and $118 per claim, compounding administrative burden and delaying reimbursement.
Navigator AI is designed to address these upstream challenges by embedding real-time intelligence directly into the denial workflow.
“Denials are not the problem, they’re the symptom,” says David Farbman, CEO of Healthrise. “The real failure point is upstream, where preventable errors enter the revenue cycle long before a denial occurs. Navigator AI helps organizations identify root causes earlier, shift from reactive resolution to proactive prevention, and improve overall financial performance.”
Navigator AI functions as a real-time assistant within Denials Navigator, delivering case-level insights, root-cause identification, and resolution recommendations directly in the workflow. It summarizes denial cases, identifies likely drivers, recommends next steps, and surfaces related patterns to support faster, more consistent decision-making.
Unlike general-purpose artificial intelligence tools, Navigator AI is purpose-built for revenue cycle operations and trained on denial workflows, payer behavior patterns, and real-world resolution strategies, enabling more relevant insights and faster time to decision, according to Healthrise.
Denials Navigator connects denial patterns to link issues back to upstream workflow, documentation, and payer rule breakdowns, helping organizations understand not only what is denied, but why it is occurring at the source.
Healthrise says the platform reflects a broader shift in health care finance toward prevention-led revenue cycle strategies, as organizations place greater emphasis on identifying and correcting errors earlier in the billing cycle to reduce downstream rework and denial volume.
“What we’re seeing is a fundamental reset in how revenue cycle performance is defined,” says Farbman. “Organizations making the most progress aren’t just resolving denials more efficiently, they’re preventing the errors that create them. Prevention is becoming the performance metric that matters most.”
For more information, visit healthrise.com.
