The tool, accessible via GitHub, offers billing staff actionable recommendations and continuously improves claim resolutions by learning from their feedback.
Microsoft has introduced the Claims Denial Navigator, an AI-driven tool designed to help rural hospitals manage denied insurance claims and improve revenue collection.
Accessible via GitHub, the tool provides billing staff with actionable recommendations and continuously learns from their feedback to optimize claim resolution. Denied claims pose a significant financial challenge for smaller hospitals, with the average cost of managing denials reaching USD 330,000 annually. Rural hospitals experience an 18% denial rate, compared with 10% in urban hospitals, slowing cash flow and raising administrative costs. The Claims Denial Navigator streamlines resolution for Medicare, Medicaid, and commercial claims without transferring hospital data externally.
Scott McEachern, CIO of Southern Coos Hospital & Health Center in Oregon, said, “Our revenue cycle team leveraged the denial management app during the transition to a new electronic health record system, reducing the legacy rundown timeline by several months. Participation in the RHAIL program also highlighted the value of developing low-cost, targeted applications in critical operational areas like revenue cycle.”
Dr. Jim Weinstein, Senior VP at Microsoft Health—Innovation, added, “Systemic financial pressures threaten the survival of rural hospitals. The Claims Denial Navigator is a major step forward—an AI tool that helps rural providers recover revenue more efficiently, strengthen financial stability, and continue delivering essential care to their communities.”
Microsoft is partnering with the Texas Office of Rural Clinics and Hospitals (TORCH) and the Washington State Hospital Association to support deployment and monitor outcomes. Consulting partner Slalom will assist with broader adoption through its Public and Social Impact team.
The tool is part of Microsoft’s Rural Health Resilience Program and Rural Health AI Innovation Lab (RHAIL), initiatives aimed at improving financial sustainability and equitable access to healthcare in rural communities.
