BOSTON — athenahealth has announced a revenue cycle management roadmap with more than 80 artificial intelligence features built into its athenaOne platform, targeting administrative work across the ambulatory revenue cycle.
The Boston-based healthcare technology company said the AI features are designed to address common sources of revenue cycle friction, including patient insurance errors, coding, prior authorization and claim denials.
Early results from features already live in athenaOne show a 30% increase in recovered payments on coding-related denials, a 16% reduction in insurance-related denials and AI-powered voice agents completing prior authorization calls in under an hour, according to the company.
“athenahealth’s AI works quietly in the background within our existing workflows — providers and staff don’t have to change how they work. It’s been a gamechanger: less manual work, better visibility, and more reliable, on-time payments,” said Larami Oliver, vice president of revenue cycle management at Heart & Vascular Care.
athenahealth said more than half of its customers already meet or exceed best-in-industry revenue cycle management performance benchmarks, which the company attributed to the scale of its network, payer integrations and insights from processing claims across its single-instance software platform.
Among the new and expanded capabilities is Automated Insurance Selection, which is available now and uses AI to identify the correct insurance package from an image of a patient’s insurance card. The company said the feature reduces insurance-related denials by nearly 16% compared with manual selection.
Another available feature, AI Copay, uses appointment context to generate an expected copay. athenahealth said the feature is, on average, 39 percentage points more accurate than non-AI workflows that rely on eligibility transaction results.
The company also said Voice AI, available as part of athenaOne Authorization Management, uses AI agents to place more than 23,000 prior authorization calls each month. athenahealth said the feature delivers status updates 96% faster than human agents, typically in less than one hour, and will be expanded to referrals and claim status.
Express Coding, an add-on capability currently in beta for more than 500 clinicians, is expected to become broadly available in July. athenahealth said the feature automates coding for more than 51% of charges in the beta group and fully automates coding for nearly one-third of their claims.
The company also plans to scale expanded payer surveillance and anomaly detection throughout 2026. The capability uses AI monitoring to identify payer rule changes and update claim processing rules. athenahealth said it already identifies more than 5,800 payer rules annually through human review and expects AI to further improve clean claim and denial rates.
Expanded Denial Resolution Automation, available now, uses AI to generate claim corrections for coding denials. The company said the capability has driven a 30% increase in recovered payments compared with manual claims corrections alone. athenahealth said the feature will expand this year to include automated resubmission, payer portal appeals and AI-powered recommendations on whether a denial should be appealed or resubmitted.
“Our goal is to ensure our practices receive every dollar of revenue that they are entitled to for the services they perform,” said Paul Brient, chief product and operations officer at athenahealth. “We have built our business on being the best in the industry at this. With AI, we can keep raising the bar — solving problems that once seemed out of reach while reducing the administrative burden on our practices.”
