Healthcare providers hope to prevent claim denials from happening in the first place, but getting to that proactive state has been a challenge amid rising denial rates and complicated payer rules. FinThrive believes AI could get providers there.
The healthcare revenue cycle management SaaS company announced today its new Denials Prevention Manager, which uses AI to flag claims at high risk of payer denials based on historical claims data. The tool then provides revenue cycle teams with recommended actions to prevent that denial.
This new tool also uses machine learning to analyze payer-specific billing patterns, FinThrive highlighted in the announcement.
Additionally, the company said it has bolstered its flagship product, FinThrive Fusion, with this "higher-quality claims data" to power the RCM-specific data intelligence platform's AI capabilities.
"We're giving providers the ability to anticipate payer behavior, take action to prevent denials before they occur, and protect revenue before it falls through the cracks," said Hemant Goel, CEO at FinThrive.
According to revenue cycle data from Kodiak Solutions, claim denial rates increased in 2025. Initial denials rose to 11.60% and clinical denials climbed to 2.60%, contributing to a dramatic 25% surge in net revenue leakage to $48.4 billion.
The major challenges stem from highly variable payor behaviors -- particularly commercial payers denying higher-value inpatient claims -- and the difficulty of overturning clinical denials, which dropped to a 42.1% success rate, the data revealed.
Preventing denials upfront is critical because it avoids the costly, time-consuming appeals process and preserves cash flow, whereas chasing denied claims after the fact drains administrative resources, delays revenue realization and often results in permanent revenue loss.
However, shifting away from the traditional reactive approach to denial management has been difficult for providers, especially as payers bolster their own AI tools to manage claims.
Still, providers believe that AI is the answer to their challenges, too. A 2025 survey from Experian Health found that 67% of healthcare financial leaders think AI can improve the claims process, and 69% of those with AI solutions reported reduced claim denials or improved resubmission success rates. Yet only 14% of respondents reported using AI to help reduce claim denials.
According to FinThrive, AI will move providers to that proactive state of denial prevention. The company said in its announcement that its new AI capability learns from real-world adjudication outcomes from billions of institutional and professional claims, rather than relying solely on payer policies.
This will help providers stay abreast of payer behavior changes and shifting payment practices, while the AI continuously learns from them, FinThrive stated. When claims are released, the company explained, they flow into FinThrive Fusion, contributing to the intelligence platform's data foundation.
The introduction of AI for denials prevention comes as FinThrive undergoes financial restructuring. The company's lenders re-engaged restructuring counseling last month after it reported a software slump and worse-than-expected earnings, The Wall Street Journal reported. FinThrive had already restructured about $1.8 billion in debt in 2024.
Since that time, FinThrive has shifted its focus from revenue cycle automation to creating a layered intelligence model. Like many of its competitors, the company has also introduced agentic AI to executive multistep tasks across revenue cycle areas independently.
Jacqueline LaPointe is an Executive Editor at Xtelligent Healthcare Media, covering revenue cycle management, healthcare payers, health policy and health IT since 2016.
