Xsolis AI solutions and services have saved Beacon Health System more than $95 million

Healthcare systems and providers are increasingly experiencing frustration around the loss of income due to claims management. According to the Journal of AHIMA, on average, hospitals face a yearly loss of $5 million due to health care claim denials, amounting to 5% of their net patient revenue. To compound an already overwhelmed claims system, providers are dealing with high patient volumes, resulting in more claims to process on top of existing labor shortages and a strained workforce. Nurse staffing shortages mean less time can be allocated to thorough case reviews, creating misalignment between authorization requests and medical necessity decisions. For these reasons, it’s no surprise that 70% of providers that face staff shortages also experience increasing denial rates.

Staffing shortages in the revenue cycle can cause more denials, increased days in accounts receivable and decreased productivity, all of which can negatively impact an organization’s operational and financial performance. Al technology can reduce avoidable denials as well as streamlining other essential functions in case management, revenue cycle and utilization review through standardization and consistency and by harnessing predictive analytics.

Adopting AI technology for efficiency

Through a partnership between Xsolis, the industry-leading AI and predictive analytics software provider, and Beacon Health System, a not-for-profit health system with 146 care sites, Beacon reduced administrative waste leading to operational improvements resulting in more than $95 million in savings.

The Xsolis software helps hospitals align medical necessity decisions with health plan approvals by using AI to identify cases with justified clinical merit—building the case for appropriate reimbursement, including appeal and revenue recovery, and pulling retrospective findings forward to impact how future denials are handled. Through a proprietary data management platform, complex denials are reviewed 3–5 times more efficiently than typical methods and provide actionable denial management analytics including admitting or discharge diagnosis, procedure, length-of-stay, or downgrade and denial outcomes.

Beacon Health System initially implemented Xsolis’ AI platform in May 2019 as the first AI solution for the health system. The goal was to better manage a high volume of critically ill patients with chronic illnesses and to utilize Xsolis’ Denial Management Services to better identify root causes of denials. Since implementation, the technology has also allowed its utilization review team to support 140% more patients a day, despite staffing challenges.

Beacon Health System is also connected with three of its payer partners in the AI platform. With shared, real-time use of Xsolis’ Care Level Score^™, it provides an objective view of medical necessity, to align both parties earlier on the appropriate patient status and reimbursement for each patient. Beacon Health teams now directly assign clinicals within the platform, and they also utilize Precision UM with a large national health plan. Precision UM is a process that streamlines appropriate cases based on historical payer-provider alignment, eliminating the need for unnecessary back-and-forth communication via faxes, emails or phone calls.

Shared use of objective data and predictive analytics between health systems and health plans can increase alignment on appropriate reimbursement earlier in the process and foster a more collaborative dynamic. Improved hospital operations and alignment with health plans have resulted in more than $95 million in savings from April 1, 2019 to December 31, 2023. 

This strategic partnership underscores both the health system’s commitment to setting industry standards for utilizing technology in healthcare, and Xsolis’ commitment to solving some of the most pervasive challenges in healthcare systems today.

The innovative power of AI beyond utilization review and claims management

In January 2025, Beacon Health System announced it is piloting Xsolis’ generative AI solution to further streamline medical necessity reviews. Xsolis’ generative AI tool enables clinicians to streamline reviews, documentation and other administrative tasks.

Xsolis has been leveraging human-in-the-loop AI practices to develop AI solutions that streamline medical necessity decision-making in healthcare for over a decade and will deploy its new generative AI solutions alongside its existing Dragonfly platform and predictive AI models, which have already saved health systems and health plan customers more than $1.5 billion.

“With Xsolis’ enhanced generative AI capabilities, our team will be even more productive and able to focus on delivering exceptional care to the right patients in the right care settings at the right time,” said Heather Wagner, MBA, BSN, RN, Director of Utilization Review and Case Management at Beacon Health System.

AI-driven improvements begun by industry-leading pioneers like Xsolis and forward-thinking health systems and leaders like Beacon Health System can create a ripple effect for more efficiency and savings throughout healthcare organizations.

Joan Butters, CEO and co-founder of Xsolis states, “Beacon Health System is a great example of how health systems can implement comprehensive, AI-driven strategies and tools for more efficient, effective, and sustainable operations. Our latest generative AI offering will take productivity to the next level as Beacon Health System continues to deliver seamless, high-quality care for the communities they serve.”  

Conclusion

Xsolis is a trusted partner to over 500 hospitals, including many of the country’s top health systems and forward-thinking AI and health tech leaders.

Xsolis’ innovative, cutting-edge AI technology delivers healthcare solutions for hospitals by transforming efficiency and delivering demonstrable returns. Xsolis fosters collaboration between healthcare providers and payers through real-time transparency, objective data for increased accuracy and alignment of medical necessity decisions, and more efficient outcomes. For more information, visit www.xsolis.com.