How an AI Outage Risked Six Figures and the Strategy to Avoid It

Hi and happy Tuesday,

In February 2024, a national outage shut down electronic claims, attachments, and pharmacy transactions. Cash flow stopped so abruptly that UnitedHealth advanced 3.3 billion dollars to keep providers afloat. That event showed how quickly a single tier can paralyze revenue.

Today, I will show how an AI platform breakdown hit a large DSO, what it cost, and the controls to prevent it from happening twice.

What broke (and why it hurt)

• Eligibility stalled. Coverage checks routed through a single AI/API didn’t return → front desk flew blind.

• Attachments failed. Notes, imaging, and failed-therapy proof didn’t travel → denials shifted to info requested / medical necessity.

• 835s lagged. Remits delayed → posting, reconciliation, and appeals slipped.

Net effect: cash slowed, manual work spiked, and the backlog risked a six-figure wobble.

A 7-step outage playbook

Trigger this playbook if: Submissions sit in queue > 30 min or the same payer rejects attachments twice or 835 remits stop for 1 business day.

1. Declare & triage: Name an incident lead, open a shared log, confirm the scope (eligibility / submissions+attachments / remits), and tag affected claims “OUTAGE.”

2. Stabilize the flow: Pause failing auto-retries. Move in-flight claims to a time-stamped outbox. Freeze payer-rule edits until services recover.

3. Keep moving safely: If allowed, switch to a secondary rail. If not, export payer-ready batches using the payer’s permitted temporary method. For high-value claims, park policy-mapped narratives locally so evidence travels on reopen.

4. Protect deadlines & cash: Work the outbox in this order: filing deadline → dollar value → age. Use the payer’s approved manual route for near-deadline claims.

5. Prevent duplicates: Before release, dedupe by patient, DOS, CPT/HCPCS/CDT, charge. Hold any flags for manual review.

6. Reconcile fast: When 835s resume, post daily, tie remits to OUTAGE tags, and chase any missing remits after 5 business days.

7. Communicate clearly: Send a daily internal update (status by rail, backlog size, risks, next actions). If you’re a vendor, send one concise client update with impact + recovery order.

Need help building your own backup strategy? Just reply with “outage” and we’ll help you develop one.

Next week, I’ll cover whichever topic below gets the most votes.

See you next Tuesday,
Dino Gane-Palmer