A Seamless Implementation of GenAI for Initial Reviews
With a dedicated department overseeing their AI strategy and various AI tools implemented throughout the health system, Beacon Health System is at the forefront of integrating AI solutions to improve patient and financial outcomes. Their most recent success is with the implementation of Xsolis’ GenAI solution to streamline medical necessity reviews. The GenAI offering is an enhancement to Xsolis’ Dragonfly Utilize platform. Implemented in February 2025, Heather Wagner, Beacon Health’s Director of Utilization Review and Case Management, notes, “This has been the easiest and most seamless rollout of a tool I’ve ever experienced. The reason is that it doesn’t disrupt any existing processes or daily operations.”
Beacon Health System initially partnered with Xsolis in May 2019 to better manage a high volume of critically ill patients with chronic illnesses. This collaboration has led to over $95 million in operational savings. Implementing Xsolis’ GenAI solution was a natural next step for Heather’s Utilization Review and Case Management Team. Beacon Health deployed GenAI to decrease the administrative burden of reviewing clinical information, ensure consistency in initial review summaries across the nursing team, and confirm the inclusion of all relevant and appropriate clinical data.
Key Results
Enhancing Efficiency and Consistency in Utilization Review
Xsolis’ GenAI solution analyzes the unstructured clinical data of a patient and generates an initial review summary automatically. Utilizing GenAI since February 2025 has resulted in increased efficiency and time savings, reduced administrative work so nurses can focus on clinical decision-making, improved consistency across the nursing team, and enhanced communication and collaboration with payers at Beacon Health. GenAI allows Beacon Health’s nurses to generate initial review summaries efficiently, quickly, and consistently, enabling them to focus their clinical expertise on areas requiring their attention. Heather states, “GenAI has brought unparalleled consistency to our nursing team. Our nurses have geographical assignments, and now they have the same comprehensive information at their fingertips as the nurse who completed the initial review, ensuring continuity of care.”
By utilizing Xsolis GenAI solution, the average time to complete initial reviews has decreased by 69% from 15 minutes per review to 4.7 minutes per review, increasing nurse productivity and capacity.
– Heather Wagner, MBA, BSN, RN
Director of Utilization Review and Case Management
Beacon Health
“GenAI has brought unparalleled consistency to our nursing team. Our nurses have geographical assignments, and now they have the same comprehensive information at their fingertips as the nurse who completed the initial review, ensuring continuity of care.”
Streamlining Payer Approvals
Furthermore, by utilizing the GenAI solution, Beacon Health’s payers are provided with only the most essential patient information, leading to quicker approvals. Heather shared that they are now receiving approvals from three national payers in just two days compared to the previous wait time of four to five days. This significant increase in approval speed has been transformative for Heather’s team and their payer partners as care decisions are accelerated and follow-ups are reduced.
The benefits extend beyond the front-end process. With approvals received more quickly due to the consistent and concise initial review summaries generated by GenAI, Beacon Health and their payers require less additional work and back-and-forth communication to obtain approvals after the care is provided. Additionally, there are fewer bill holds due to the clearer, payer-ready initial review documentation. The GenAI solution has resulted in significantly improved throughput across the revenue cycle, from documentation to reimbursement.
Heather further explains, “With GenAI, the administrative work is significantly reduced once the patient is discharged. We can immediately send the bill out, confident that the care provided was already approved by the payer. Our team no longer needs to do additional work to ensure approval, allowing us to get paid for services in a much more timely manner.”
Empowering Beacon Health’s Care Delivery Mission
With such exemplary results achieved in only four months, Heather is eager to explore the additional benefits her team can experience by further leveraging Xsolis’ GenAI solution. Aligned with Beacon Health’s overarching mission to deliver exceptional care to the right patients in the right care settings at the right time, this AI-powered offering has empowered the Utilization Review and Case Management Team to concentrate on high-value clinical activities instead of being encumbered by administrative tasks. By streamlining the review process and ensuring consistent, comprehensive documentation, GenAI has enabled Beacon Health to enhance utilization review, improve clinical decision-making, and optimize resource utilization across the health system.
To discover how you can empower your organization to optimize UM workflows and enhance revenue cycle processes, contact Xsolis today.
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