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

Waystar delivers innovative technology that simplifies and unifies healthcare payments. The company’s cloud-based platform helps healthcare providers across all care settings streamline workflows, improve financial performance and bring more transparency to the patient financial experience. Waystar solutions have been named Best in KLAS or Category Leader by KLAS Research 16 times (across multiple product categories) and earned multiple #1 rankings from Black Book. The Waystar platform is used by more than half a million providers, 1,000 health systems and hospitals, and 5,000 payers and health plans—and integrates with all major hospital information and practice management systems. On an annual basis, Waystar’s AI-powered solutions process $5B in patient payments, generate $4B in out-of-pocket estimates and process claims representing approximately 40% of the U.S. patient population. For more information, visit www.waystar.com.

• Check eligibility in real time using Stedi APIs or portal.
• Send up to 1,000 checks at once using async batch. Submit using the API or a bulk CSV.
• Run MBI lookups and CMS checks with an SSN.
• Get accurate coverage with COB and Insurance Discovery checks.
• 1,200+ supported eligibility payers

Stedi is the only clearinghouse built on modern APIs, while supporting both real-time and batch EDI processes.

Stedi enables health techs and incumbents to exchange mission-critical transactions - from eligibility to claims and remits. With a security-first cloud infrastructure, built-in payer redundancy via 3,500+ route connections, and market-leading sub-10-minute support response times, Stedi provides reliability and responsiveness to avoid billing outages and reduce denials.

N/A

• Connects to 1,000+ eligibility payers – the broadest coverage of any clearinghouse.
• Modern, JSON-based APIs.
• Responses in 1-3 seconds.
• Support for insurance discovery, MBI lookup, and COB checks.