Already surpassing best-in-industry benchmarks across the network, athenaOne adds AI capabilities set to cut denials, automate coding, and complete prior authorization calls nearly 100% faster
BOSTON–(BUSINESS WIRE)–athenahealth today announced a revenue cycle management (RCM) roadmap that contains more than 80 artificial intelligence (AI) features built into its AI-native athenaOne platform, aimed at eliminating manual administrative work across the ambulatory revenue cycle and improving outcomes beyond its already best-in-industry levels. The initiative targets the highest-friction points in the revenue cycle — errors with patient insurance, coding, prior authorization, and claim denials — where administrative burden and revenue loss are most acute.
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.
“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.
More than half of athenahealth’s customers already meet or exceed best-in-industry RCM performance benchmarks, a baseline the company attributes to the scale of its network, continuous payer integrations, and the collective insights from processing billions of claims across its single-instance true SaaS platform.
New and Expanding Capabilities:
- Automated Insurance Selection, available now, cuts insurance-related denials by nearly 16% (versus manual selection) by using AI to identify the correct insurance package from a picture of the patient’s insurance card. With registration and eligibility errors accounting for nearly a quarter of denials industry wide, this workflow is critical to reduce claim delays and write-offs and speed payment.
- AI Copay, available now, uses AI to evaluate full appointment context to generate the expected copay. This new feature is, on average, 39 percentage points more accurate than non-AI workflows that simply map in the results from eligibility transactions. As a result, front desk staff and patients see a more accurate copay at check-in, ensuring that practices collect the right amount the first time, avoiding refunds or the need for follow-up billing.
- Voice AI, available now as part of athenaOne Authorization Management, uses AI agents to place more than 23,000 prior authorization calls each month, delivering status updates 96% faster and with greater accuracy than human agents, typically in less than one hour. Faster authorizations speed patient care and cut administrative burden for practices. Beyond prior authorization details, athenahealth is expanding agents’ scope to referrals and claim status to drive even quicker results for practices.
- Express Coding, currently in beta for more than 500 clinicians and expected to be broadly available in July, this add-on capability leverages AI to automate medical coding and expedite the claims process. Express Coding currently automates coding for more than 51% of the beta group’s charges and fully automates coding for nearly one‑third of their claims. This is not computer assisted coding – this is an AI coder designed to deliver consistent, reliable coding support that can match, and in some cases exceed, the performance of human coders.
- Expanded Payer Surveillance & Anomaly Detection, scaling throughout 2026, uses continuous AI monitoring to surface payer rule changes as soon as they are made. In addition, AI monitors every rejection and denial to make same-day updates to athenahealth’s vast library of claim processing rules to prevent future issues. athenahealth already identifies more than 5,800 payer rules annually through human effort, and AI support is expected to further improve clean claim and denial rates beyond today’s industry-beating median rates of 99.3% and 5.3%, respectively, across all athenaOne customers.
- Expanded Denial Resolution Automation, available now, uses AI to generate claim corrections for coding denials. This feature drives a 30% increase in recovered payments versus manual claims corrections alone. The capability is expanding throughout 2026 to add automated resubmission, payer portal appeals, and AI-powered recommendations to identify whether a denial is best 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.”
For more information on athenahealth’s revenue cycle capabilities within AI-native athenaOne, visit athenahealth.com.
About athenahealth
Since 1997, athenahealth has been curing complexity for ambulatory healthcare practices and the patients they serve, empowering them to deliver the best possible care and business outcomes through innovative clinical, financial, and patient engagement solutions. athenahealth connects practices, health systems, payers, partners and patients to create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all. Learn more at www.athenahealth.com.
Contacts
Nikki D’Addario
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