Healthcare Claims Processing Shifts Toward AI Automation

CareCloud (CCLD) and InfuSystem (INFU) both described manual claim handling as a cost to cut on their third-quarter 2026 earnings calls in early November. CareCloud says AI healthcare claims automation has already reduced manual claim touches by about 44%. InfuSystem says lowering the cost of processing each claim is what will let it take on more business, including smaller claims.

How AI is taking over manual steps in claim processing

US hospitals, clinics and medical device suppliers get paid by submitting claims to insurers after they deliver care. The full process, from entering patient data and coding to submitting claims, chasing denials and matching payments, is called revenue cycle management (RCM). Traditionally, staff checked each claim, fixed rejected submissions and matched every insurer payment by hand, so the cost of processing a claim was fairly fixed. AI can now validate claims before submission, predict which ones will be denied, match remittances automatically and resubmit rejected claims, leaving people to handle the exceptions. The same staff can process more claims, fewer claims get denied, and the cost per claim falls. Every organization that bills insurers itself carries this cost, so the practice could spread to similar companies.

CareCloud's margin has improved; InfuSystem plans to take smaller claims

After embedding AI across the revenue cycle work it runs for providers, CareCloud cut manual claim touches by about 44%. Its share of claims processed with no human touch rose from 74% to 84%, and its denial rate fell from about 8% to under 4% [1]. Over the same period, revenue grew 9% while direct operating costs rose only 3%, and gross margin went from 47.8% to 50.5% [1]. Management also credited its offshore delivery team for the cost improvement, and did not break out the contribution of AI on its own [1].

InfuSystem rents out infusion pumps and other durable medical equipment, and uses its own payer contracts to bill insurers on behalf of device makers. Two compression-therapy device suppliers added since the third quarter of 2025 accounted for over 76% of Wound Care growth in the first half of 2026 [2]. On the third-quarter call, the CFO said lowering the cost of processing each claim is what will let the company bring in more business more efficiently, including smaller claims from new partners [3]. He also acknowledged that some new business carries lower gross margins, and that the company is working to lower processing costs so it can keep the same EBITDA margin. InfuSystem begins modest additional investment in these initiatives in the fourth quarter and expects volume from new partnerships to show up by mid-2027 [3].

The two companies are at different stages. CareCloud's results already show in its gross margin; InfuSystem's benefit is still a plan, and it is mainly meant to protect margin. Together they indicate that the cost of processing a single claim is starting to shape both margins and the range of business that healthcare billing operations can take on.

Lower claim costs change where profit comes from and which claims are worth taking

As the cost per claim falls, a billing operator's cost advantage depends more on how far it has automated and less on headcount alone. Labor-heavy outsourcers may need to automate or risk falling behind on cost. Device companies that bill insurers themselves may be able to take on small claims that used to be uneconomic and bill for more manufacturers. This inference has limits. TruBridge (TBRG) says its margin gains so far come mainly from moving work offshore, and that AI has not changed competition [4]. AdaptHealth, the closest equipment-billing peer to InfuSystem, disclosed no claim automation on its third-quarter call [5]. Signals to track: whether CareCloud's zero-touch share and gross margin keep rising, and how many new manufacturer partners and how much Wound Care volume InfuSystem adds by mid-2027.

Companies exposed to this shift

• Waystar (WAY): It sells claim automation software to healthcare providers. AI-powered offerings were about 43% of its third-quarter bookings, and it launched a feature that resubmits rejected claims automatically [6]. If more providers buy such tools to cut per-claim cost, Waystar sits on the supply side, though whether demand holds depends on customer purchasing.
• Tactile Systems (TCMD): It bills insurers directly for lymphedema compression pumps, the same kind of documentation-heavy equipment claim that InfuSystem bills for partners. Its AI-enabled order management platform cut medical record review time by about 50% [7]. Changes in per-claim processing cost would affect its billing efficiency as well, but no margin effect has been disclosed.
• TruBridge (TBRG): It provides labor-heavy outsourced revenue cycle services to community hospitals and is building AI tools to predict denials [4]. There is no direct evidence yet that it can turn automation into gross margin the way CareCloud has.

Sources

[1] Drillr · CareCloud (CCLD) · 2026-11-05 · Earnings call

[2] Drillr · InfuSystem (INFU) · 2026-08-04 · 10-Q quarterly report

[3] Drillr · InfuSystem (INFU) · 2026-11-10 · Earnings call

But more importantly, the key here is for us to continue to lower the breakeven point for processing claims so that we can bring in more business more efficiently, even smaller claims with new partners.

[4] Drillr · TruBridge (TBRG) · 2026-04-01 · Earnings call

[5] Drillr · AdaptHealth (AHCO) · 2026-11-03 · Earnings call

[6] Drillr · Waystar (WAY) · 2026-11-02 · Earnings call

[7] Drillr · Tactile Systems (TCMD) · 2026-11-02 · Earnings call

This article highlights industry changes and companies that may be overlooked. It is not a stock recommendation.