Health Scholars

Waystar’s Eligibility Verification solution automates much of the eligibility process so you can say goodbye to the days of searching and interpreting patient coverage and focus on what really matters: your patients. With our powerful technology, you can:

• Prevent more rejections + denials
• Strengthen front-end collections
• Optimize staff productivity
• Elevate the patient payment experience

What makes Waystar the industry’s most accurate eligibility verification tool?

Getting insurance verification right the first time is crucial. Incorrect or incomplete eligibility has a ripple effect across the revenue cycle, from missed authorizations to reworking denied claims.  

Powered by Waystar’s AI + RPA, our Eligibility Verification tool combs through payer data to curate the most accurate and comprehensive benefit information. With richer coverage detail, staff can easily identify eligibility issues. Plus, our eligibility engine seamlessly integrates with all major EHRs.

Features + benefits

• Superior eligibility results with RPA + expansive payer connectivity
• Plan code matching to mitigate registration errors
• Normalization of payer data for more efficient workflows
• Intelligent alerts with actionable guidance for staff

Enriched benefit data

• Utilize RPA + EDI connections to surface complete response
• Expansive payer connectivity for best data in the market
• Enriched eligibility data when no EDI is available

Automated, intelligent workflow

• Integrated workflow for seamless user experience
• Intelligent warnings + Medicare Advantage plan alerts
• Guided next best user actions

Unparalleled financial clearance operations

• Auto-rechecks eligibility whenever account data is updated
• Benefit information is normalized for ease of consumption
• Self-pay validation for coverage verification

What our users have to say:

“ Before Waystar, we were going to a variety of carrier websites and spending a lot of time on the phone to check eligibility. It was labor intensive. Now we have all our carrier information in one location in our system. ”

- Manager of Revenue Cycle Billing & Coding

Boost helps healthcare organizations grow revenue by identfying missed billing opportunities. Boost uses data you provide to scan for missed coverage with your state's Medicaid and larger, commercial payors. It also moniitors Medicaid to identify when an encounter becomes eligible for retroactive reimbursement. Boost is extremely easy to implement as there is no integration required and no software to install. We eliminate risk to you by offering a contingency model and not requiring long-term contracts.

With the growth of high-deductible health plans and the transition to value-based care, there’s a renewed emphasis on the patient financial experience. To meet patient expectations and help increase collections, you need timely, accurate information regarding eligibility, coverage, and copays. Many hospitals also offer self-service tools to engage patients who are shopping for services online as well as financial counseling at registration to facilitate upfront payments. Clearance Patient Access Suite automates the entire process. Features of our solution suite include: • Patient-facing cost-estimate tool • User-friendly dashboard • Eligibility verification and coverage discovery • Notification of admission • HIS integration • Registration data QA • Pre-authorization/medical necessity • Bill estimation • Point-of-service collections • Charity screening and enrollment The Clearance Patient Access Suite offers everything providers need to help financially clear patients and assist in collecting as early in the revenue cycle as possible. The solution helps you perform unlimited eligibility checks on every patient encounter, and assists you in getting the most complete and current eligibility information without time-consuming phone calls and manual searches. The eligibility verification capabilities of Clearance provide staff with consistent views so the most pertinent information, including key notifications, coverage dates, in/out of network views, specialized Medicare and Medicaid views, and eligibility history for an account is available at your fingertips. And by integrating with your HIS, it confirms eligibility throughout the revenue cycle for more accurate downstream billing. In addition to patient eligibility information, notification of admission details is also available. As part of an enhanced eligibility offering, Clearance Enhanced Eligibility uses advanced analytics to identify undisclosed insurance coverage. For patient accounts categorized as self-pay, its risk-suppression feature helps ensure anti-phishing compliance. Unique data sources are used to pinpoint likely funding sources in a targeted approach, presenting you with all valid commercial, government, and managed care insurance coverage. Efficiently Manage Your Workflow: The Connect Dashboard provides a base of operations to get a complete patient financial clearance profile providing at-a-glance information for action. In addition to eligibility details, patient registration data accuracy, pre-authorization, medical necessity, patient bill estimation, point-of-service collection capabilities, and more are all accessible within this same dashboard. Second, staff can utilize a browser-based floating toolbar from within the HIS to access key Clearance Patient Access Suite information without losing focus on registration system activities. Help Improve Registration Data Accuracy in Real Time: Revenue cycle success starts at registration and having accurate registration data can help result in reduced denials, fewer rejected claims, and fewer returned statements. Clearance QA helps identify errors at registration to provide accurate data for all your downstream processes, helping to enhance financial performance and keep your cash flow constant. Registration error warnings are viewable from the Connect Dashboard, helping to alert your registrars early to errors that need to be addressed. Staff can then correct the errors, helping to eliminate the need for additional FTEs to perform manual registration QA/audits. Manage Pre-Authorization and Medical Necessity Workflow: Clearance Authorization helps manage the cumbersome and time consuming pre-authorization and medical necessity processes. The solution determines if a pre-authorization is required and on file with the payer, monitors payers for pending pre-authorization decisions and updates the HIS/Practice Management system with payer results. It also provides a consistent workflow to manage both automatic and manual pre-authorization processes. Clearance Authorization also assists with the checking of medical necessity and automatic creation of necessary ABNs, helping to reduce denials, improve reimbursements, and ensure compliance with CMS. It also includes regularly updated National Coverage Decisions (NCDs) and Local Medical Review Policy (LMRP) content services to help confirm comprehensive Medicare compliance. Validate Patient Identity and Assess Propensity to Pay: Learning as much as you can about patients upfront is often a major challenge for patient access staff. Clearance Patient ID helps you verify that patient demographic data on file is correct and notifies users about patient data issues or red flag alerts that could be related to identity theft. The solution also helps you determine the guarantor’s ability and inclination to pay their bill. By screening patients and checking healthcare payment prediction scores, Clearance Propensity-to-Pay helps your staff assess the likelihood that a patient will pay, and if the payment will be timely. Offer Cost Estimates and Drive Collections: Cost transparency helps consumers make informed choices and plan for how they’ll pay for out-of-pocket expenses. It also helps providers as it enables you to engage consumers, facilitate appointments, build trust, and help increase collections. Clearance Estimator Patient Direct is a patient-facing tool housed on your website that enables patients to obtain reliable cost estimates for common procedures and services. It also helps you meet CMS price transparency requirements and includes appointment prompts to drive engagement. It is integrated with our provider-facing tool, Clearance Estimator, which uses the same charge master, contracts, and claims data to generate estimates. This solution enables you to provide cost estimates at the point of service and request payments based on the patient’s financial circumstances. Find Financial Assistance for Patients Who Can’t Pay Taking care of patients who are unable to pay is part of the mission for many hospitals. Clearance Advocate alerts users to patients who cannot pay and should be evaluated for charity, Medicaid, or other financial assistance. The solution provides an online charity screening interview and enrollment form available within the normal registration workflow. Leverage Patient-Access Analytics to Drive Change: When you want to make strategic improvements in Patient Access operations, analytics can provide the visibility and intelligence you need to make informed decisions and initiate data-driven discussions with stakeholders to drive process change. Acuity Revenue Cycle Analytics™ provides access to near real-time patient access data and trends within and across facilities, helping to provide insight into the effectiveness and financial impact of processes. Leveraging eligibility, estimation, medical necessity, and authorization data presented in an actionable format, Acuity Revenue Cycle Analytics can help you monitor, evaluate, and improve financial and operational performance.

Uncompensated care continues to have an enormous impact on providers’ bottom lines, with $41.3B in charity care and bad debt recorded for 20182. As millions of consumers have recently lost their employer-based healthcare coverage due to unemployment, and millions of others struggle with high out-of-pocket deductibles, it falls to you to help alleviate patients’ financial stress and simultaneously support the bottom line. We can help via our proven strategy that drives patient satisfaction, loyalty, and revenue. Engage our Expertise: Helping patients to secure financial assistance requires a combination of innovative technology and expert staff: • Our Eligibility & Enrollment Services leverage AI and other innovative tools to improve process efficiency and screen all patients. Bedside tablets are part of our proprietary workflow and can be used to capture patient documentation and signatures in a timely, efficient manner. • Our staff has local, state, and federal-specific expertise and in-depth experience in sourcing potential coverage for each patient. We leave no stone unturned as we assess patients’ eligibility for Medicare/Medicaid, Disability/SSI, Third-party Liability, commercial insurance, state and county programs, social programs, and charity. We then help patients to enroll in the appropriate program(s) and process claims for payment. Customizable Services: Our team is tightly integrated to serve as an extension of your organization. We understand that patient experience is enhanced with our ability to express empathy and kindness as we assist patients in understanding their financial responsibility while helping them to find and enroll in programs. We offer onsite services where our team is embedded to deliver high-touch assistance early in the patient journey, driving faster enrollment to accelerate payment. We also offer remote services as needed.

MedData is more than just a vendor that improves A/R metrics. We are a trusted partner providing end-to-end revenue cycle management solutions for hospitals and physicians across all payer types. Because of our range of capabilities, we are able to handle any account regardless of origin – high/low dollar, re-billing, secondary/coordination of benefits, government payers, out-of-state Medicaid, accident accounts, Workers’ Comp, denials, etc. – and under any circumstances – small balance insurance follow-up, project-specific/work down of aged A/R, legacy receivable conversions, or as an extended business office. We triage accounts to identify problems and then share that knowledge with the hospital, which helps improve internal processes by fixing issues that contribute to avoidable denials. Our trending reports are based on specific KPIs established together with the hospital and delivered at the hospital’s preferred frequency. We track payer, denial type, service, and other trends to help drive improvements in a hospital’s processes that will lead to long-lasting gains in A/R performance. MedData has the capability to send out electronic 270/271 eligibility inquiry and to receive the response. We leverage the 270/271 response feature for many different scenarios such as: • Pure self-pay: to discover another payer source • Resolve issues with payer information that is on record in your system • Verify payer filing order We can process electronic claim submissions performing edits in any system and scrubbing where appropriate as well as working from any claim editing software. Our platform manages all elements of the project, giving the hospital full transparency into account activity and status. And it is administratively simple: We can work directly with any hospital-based billing system (Epic, Cerner, Artiva, Soarian, Meditech, Paragon, Star, Allscripts, and Invision). MedData has been performing revenue cycle management services for 40 years, and 100% of our business is in the healthcare industry. Our experienced and tenured team has been performing A/R recovery services for a variety of client types and sizes for more than 10 years. We have advocates, specialists, and leadership with expert knowledge of denials management, billing, guidelines, procedures, and compliance who are ready to respond to a hospital’s needs and meet its A/R goals.

MedData’s Eligibility & Enrollment Services help hospitals and uninsured patients quickly find and enroll in available coverage programs to help pay for care. We’ve been able to find assistance for millions of patients through our work with Medicaid, Social Security Disability, County Indigent, Crime Victims Compensation, Charity, HIPP, COBRA, Long-Term Care, and many other programs. Our proprietary screening tool screens and coordinates more than 2000 different programs, at federal, state, county and all levels. We have solutions for primary placement, or safety net behind your internal teams and will seamlessly integrate into any existing process. MedData’s Eligibility Services have significantly improved the financial performance for every hospital client within the first 12 months of implementing our services – and sometimes in as few as six months. Our innovative screening process begins at the patient’s bedside with a comprehensive in-house screening and eligibility analysis. If a remote option is needed, we have developed innovative contactless tools to safely and effectively screen all patients. And our patient advocates are equally committed to your outpatient population, applying the screening process to ensure any and all programs the patient is eligible for are identified. MedData’s Eligibility & Enrollment Services have maintained HFMA Peer Review status for more than 11 years.

Allows advocates to file and track program applications, verifications and deadlines to manage populations more completely and effectively (over 6,000 verification combinations). Provides on-demand status updates of any account in process and operates as a customer relationship management tool. Allows MedData to target and certify client accounts in ways that hospitals and most unsophisticated competitors never could. No denial for lack of documentation.