Prior Authorization | AI Systems | Revenue Cycle Management - Waystar

Supported Systems | Payer List

FASTER, SMARTER PRIOR AUTHS ARE FINALLY HERE

Get faster approvals at a lower cost with automated prior authorizations from Waystar. Our breakthrough technology integrates with all major EMRs and payer systems, constantly working behind the scenes and gaining speed and accuracy with every exchange. Find out what greater productivity and fewer denials can mean for your team—and for your patients.

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GET THE SIMPLE SOLUTION TO ONE OF YOUR BIGGEST CHALLENGES

Prior authorizations are a leading cause of denied claims—a problem that costs providers billions in lost revenue and keeps patients from getting the care they need when they need it. The challenge is only growing as the volume of prior auths increases. Plus, many services don’t require a prior auth, but many billing teams waste valuable time looking into whether or not one is needed.

Artificial Intelligence and RPA technology can help automate the authorization process and free up your staff. What’s more, we can get up and running quickly, with no new personnel required.

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UNLOCK YOUR PRIOR AUTH POTENTIAL WITH AI AND RPA

There’s a wealth of powerful data within your EHR—you just need real-time insights and seamless integration to make it actionable. Our Prior Authorization solution, powered by Waystar’s Hubble:

UNLOCK YOUR PRIOR AUTH POTENTIAL WITH AI

There’s a wealth of powerful data within your EHR—you just need real time insights and seamless integration to make it make it actionable. Our Prior Authorization solution, powered by AI:

• Integrates directly with all major HIS and PM

systems

• Checks whether an authorization is needed

• Anticipates payer behavior, so you can

predict likelihood of authorization and

accurate approval timetables

• Adapts to constantly shifting payer rules and

requirements

• Works at scale and across specialties
• Built and maintained by our in-house team of

experts

Automatically verifies, initiates, statuses and retrieves comprehensive authorization details
Enables efficient, intelligent automation by initiating authorizations at twice the speed of manual processes
Integrates directly with all major HIS and PM systems

Provides end-to-end authorization platform, including authorizations submissions for unscheduled admissions, as well as auto-generating ABNs or Notice of Non-coverage forms for Medical Necessity
Adapts to constantly shifting payer rules and requirements
Was built and is maintained by our in-house team of experts

HOW IT WORKS

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Waystar_LoginScreen.v3.png

GET THE SIMPLE SOLUTION TO ONE OF YOUR BIGGEST CHALLENGES

Prior authorizations are a leading cause of denied claims—a problem that costs providers billions in lost revenue and keeps patients from getting the care they need when they need it. The challenge is only growing as the volume of prior auths increases.

Artificial Intelligence and RPA technology can help automate the authorization process and free up your staff. What’s more, we can get up and running quickly, with no new personnel required.

THE BURDEN OF PRIOR AUTHS:

$14

amount healthcare industry spends on manual prior authorizations per transaction²

21 min

average staff time to secure manual prior authorization²

92%

of physicians say that prior authorization programs have a negative impact on patient clinical outcomes³

$30B

estimated annual cost of prior authorizations for healthcare providers

12.4%

of denials are caused by incomplete or missing authorizations

$11.18

average cost per manual prior

84%

of physicians believe prior authorizations place a high or extremely high burden on them and their staff

FIND OUT HOW MUCH EASIER PRIOR AUTHS CAN BE

$454M

estimated amount providers could save annually by transitioning to electronic prior auth transactions²

300+

direct payer
connections

50%

reduction in auth
processing time

75%

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75%

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75%

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75%

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GET EXTRA INSIGHTS

Looking for more information on how our Prior Authorization solution can transform your workflows and your bottom line? Check out our resources to learn more.

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How AI can save you from drowning in prior auth problems
> Read now

Prior Authorization data sheet
> Read now

How to know the score when choosing an AI vendor
> Download

GET EXTRA INSIGHTS

Looking for more information on how our Prior Authorization solution can transform your workflows and your bottom line? Check out our resources to learn more.

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> Download

How AI can save you from drowning in prior auth problems
> Read now

Prior Authorization data sheet
> Download

How to know the score when choosing an AI vendor
> Download

Leveraging AI for Prior Auths: a Frost & Sullivan white paper
> Download

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> Download

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> Download

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> Download

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Feature

Waystar

Other

Details

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Waytstar

Category
Average

Overall Score

95.7

87.3

% Clients Satisfied

73

N/A

Best Vendor Relationship

95.2

84.3

Product

94.2

86

Value

96.9

86.6

Operations

95.5

88.9

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90%

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90%

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CLAIM MANAGEMENT

Most popular

Starter

Simplify Denials Management

Core

Reach Workflow Excellence

Performance

Get visibility into the claim lifecycle

Premium

Achieve Revenue Cycle Automation

	Expanded claim lifecycle visibility through date tracking and proof of timely filing reports
Automated front-end claim editing and scrubbing		●	●	●	●
View and edit claims in customizable workgroups for prioritization and staff assignment		●	●	●	●
Payer response clarified and simplified with Simple Response™ technology		●	●	●	●
Hundreds of crowdsourced rules and edits		●	●	●	●
Claim process lifecycle visibility with date tracking and proof of timely filing reporting		●	●	●	●
Dashboards and reports for key rev cycle performance and user productivity metrics		●	●	●	●
Real-time claim status inquiries with approximately 5-7 second payer responses		●	●	●	●

	Make eligibility and benefit coverage inquiries
Leverage 1,200 payer connections		●	●	●	●
Verify eligibility and co-payments		●	●	●	●
Quickly and easily enter patient info		●	●	●	●
Expedite check-in by accessing real-time plan information in seconds		●	●	●	●
Automated provider enrollment		●	●	●	●
Denial prevention with automated pre-claim eligibility verification		●	●	●	●

	Streamline denial management
Flexible workgroups and automation to close non-workable denials		●	●	●	●
Eligibility integration to check patient coverage within denial workflow		●	●	●	●
Root cause reporting to reduce preventable denials		●	●	●	●
Robust outcome reporting and dashboards for user-friendly resubmissions and payer follow-up		●	●	●	●

	Simplify appeal processes
Appeals wizard that allows you to create three-step, 100% paperless appeals packages		●	●	●	●
More than 600 payer appeal templates available and pre-populated with remit and provider data, including proof of timely filling		●	●	●	●
Custom and dynamic attachments and saved responses streamline submission		●	●	●	●
Ability to batch 100 similar appeals to same payer		●	●	●	●

	Automate claim status checks
Custom schedules to accommodate follow-up workflow			●	●	●
Proactive claim status checks based on predictive analytics that determine optimal timing			●	●	●
Automatic claim status checks without the need for batch files			●	●	●
Early notification of pended claims			●	●	●
Payer response clarified and simplified with Simple Response™ technology			●	●	●
Ability to work by exception with focused workgroups			●	●	●

	Visualize your performance and deliver actionable insights
Custom dashboards and reports				●	●
Alerts to drive corrective action when KPIs deviate from target range				●	●
All-in-one, standardized rev cycle analytics for financial performance clarity				●	●
Intuitive drill-down capabilities to identify key details in the health of the rev cycle				●	●

	Automate bank reconciliation processes
Automated identification of missing or inaccurate deposits and ERAs					●
Streamlined payment posting workflows to avoid posting delays that increase AR days					●
Aggregated reporting for payment information —even if you use more than one bank					●

	Convert paper EOBs to electronic files
Indexing of checks and documents for historical tracking					●
Automated payment posting and reconciliation					●

FEATURES

ANALYTICS PRO

ANALYTICS PEAK

Expanded claim lifecycle visibility through date tracking and proof of timely filing reports PRO + PEAK +	+	+
Dynamic, interactive, easy-to-use data visualization tools that allow for a deeper understanding of your rev cycle PRO + PEAK +	+	+
Your data unified on an end-to-end RCM platform PRO + PEAK +	+	+
Unlimited custom dashboards + reports with simple, yet robust BI tools to see and explore the data your way PRO PEAK +		+
Tailored insights with custom defined calculations, definitions and KPIs unique to your organization PRO PEAK +		+
Ad-hoc data analysis tools for deeper insights into every facet of your revenue cycle PRO PEAK +		+

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Number of claims you follow up on monthly

< >

Number of FTEs dedicated to payer follow-up

< >

Fully loaded annual salary of medical biller

< >

Total savings per year

$204,327

These numbers are for demonstration only and account for some assumptions. Contact us for a more comprehensive and customized savings estimate.

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Monthly claim volume

< >

Current denial rate

< >

Average claim value

< >

Average number of appeal packages submitted per month

< >

Total additional revenue recovered per year

$204,327

Total staff hours saved

These numbers are for demonstration only and account for some assumptions. Contact us for a more comprehensive and customized savings estimate.

Gross patient revenue

Net patient revenue

Patient mix (% Inpatient)

< >

Payer Mix (% Commercial)

< >

Payer mix (% Government)

< >

Payer mix (% Other/self pay)

< >

Note: The above values need add up to 100%

100%

$1.8M

$2.2M

$3.3M

$7.9M

OUTER RANGE: Likely cash impact range for a system of your size

INNER RANGE: Most probable range given your specific information

Benefit range accounts for benefit to be attained through missing charges, CPT coding errors and DRG assignment errors. This calculator is designed to be educational in nature based upon limited information. It is therefore not a guarantee of performance. 1 HFMA blog, 2016

CONTACT US

Looking for more information on how our Prior Authorization solution can transform your workflows and your bottom line? Check out our resources to learn more.

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¹CAQH index, 2018² CAQH index, 2019
³ AMA survey, 2018

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