NEW YORK CITY — Hospital for Special Surgery (HSS) in New York City has deployed agentic AI to automate insurance claims processing and launched a 24/7 AI scheduling and triage service, with plans to open a dedicated AI lab on its main campus. The hospital now handles all insurance claims in-house using AI agents, completing approximately 1,100 claims per month.
According to HSS, the AI system has reduced the time required for the appeals stage of insurance claims from 45 minutes to five minutes and increased the success rate of those appeals from 65% to 100% over nine months. The technology was developed in collaboration with enterprise agentic AI developer Ema Unlimited.
The AI scheduling and triage service operates around the clock via web, text, or phone. It uses conversational AI to ask patients clarifying questions about their condition and books appointments with the most appropriate clinician based on location, insurance coverage, and physician availability. Sensitive, complex, or uncertain cases are escalated to human specialists, and every AI decision is auditable, with human staff able to intervene at any point.
Ashis Barad, chief digital and technology officer at HSS, said the AI agent is trained on “all of our context, all of our rules, and all of our knowledge base.” He added, “Agentic AI takes your workflow and collapses it, augments it, supercharges it, and makes it more performant.”
HSS has integrated greater data interoperability to enable patient-facing AI agents to access a patient’s clinical care history, existing clinician recommendations, and current symptoms. This allows the system to determine whether a case requires escalation before notifying the appropriate specialist and informing the patient.
Barad plans to establish an AI lab at the HSS main campus that will be open to all staff and offer training on AI agents. He envisions a future in which 90% of non-clinical health-care tasks could be handled by AI, freeing clinicians to focus on complex, specialized, and sensitive cases. “We’re spending so much time on keyboards and computers right now that we're actually not doing what we should be doing,” he said. “This is going to rehumanize health care.”
All AI initiatives at HSS are reviewed by an AI subcommittee co-chaired by Barad and a senior nursing executive. AI agents that interact with patient care undergo more rigorous scrutiny than those used for backend operations.
No independent assessment was available for this report.