Coverage Detection + Eligibility Verification

Find more accurate,
up-to-date insurance

See how advanced automation + AI can slash denials, boost cash flow, and enhance efficiency — with less effort

Don't let errors or inaccurate eligibility information derail you from the start. If your software isn’t finding active coverage for up to 40% of patients who present as self-pay — or saving you 16 minutes per transaction — ask for more. Meet Waystar Coverage Detection and Eligibility Verification.

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COVERAGE DETECTION + ELIGIBILITY VERIFICATION

1.2K

payer
connections

50%

of U.S. patients in our
claims database

30-40%

of patients presenting as self-pay have active coverage found by Waystar

46%

reduction in eligibility-related denials

Stop errors, streamline workflows + strengthen your bottom line

Boost your organization’s revenue — and staff productivity — by finding hidden coverage and verifying eligibility with real-time automation.

Key Capabilities

Robust databases

contain millions of transactions and info from payers, hospitals, health systems, physicians + more

Seamless integration

with major EHR, HIS, and PM systems

Proprietary algorithms

search for historic claim matches and payers on file to find more billable coverage

Verify eligibility

at or before the time of service using robust data from payer portals and EDI 270/271

Real-time + batch functionality

work anywhere in your workflow

Automatic initiation

of real-time coverage detection if the eligibility response returns inactive coverage

AUTO ELIGIBILITY + AUTO COVERAGE DETECTION

30s

average Auto Coverage Detection response time

55%+

average Auto Coverage Detection hit rate

1/2

of U.S. patients in
Waystar’s database

Coverage Detection checklist

Make sure any solution you consider:

  • Automatically searches for active coverage — regardless of a patient’s point of entry, or if they are presumed to be a self-pay patient
  • Maximizes efficiency with real-time responses
  • Provides actionable results for active and inactive coverage to prevent more eligibility denials and rejections
  • Works across the revenue cycle, not just at one touchpoint
  • Offers customizable dashboards and reports for billable transparency
CoverageDetection_Checklist.png

Stop denials + speed payments — automatically

Waystar’s Auto Eligibility + Auto Coverage Detection automatically kick in to find the most accurate, updated coverage when a problem with insurance information is flagged. They work at every point of your end-to-end workflow, increasing efficiency, reducing denials, and improving cash flow.

Front end

Back end

1

Pre-service and point-of-service registration

If the initial eligibility search returns inactive or subscriber not found, Coverage Detection activates in real time with no intervention from your team, increasing efficiency.

2

Before claim submission

If eligibility is rejected during claim processing, Coverage Detection initiates a search for updated coverage automatically, reducing eligibility-related denials.

3

Claim status and follow-up

When a payer response indicates an eligibility error during claim statusing, Coverage Detection kicks in to find the correct coverage, streamline resubmissions in advance of a denial.

4

Denial
response

If an eligibility denial is received, Coverage Detection searches for active, billable coverage, helping your team overturn denials and recover revenue faster.

Back end

COVERAGE DETECTION CALCULATOR

How successful is your team at finding insurance + preventing denials?

Use our simple calculator to find out.

Calculate now
CoverageDetection_Calculator.png

All metrics on this page are proprietary Waystar data or case studies.

“Before, we used a complex spreadsheet to verify eligibility — and just getting through that was a job in itself. Now, using Waystar Eligibility Verification before a claim goes out is much more efficient and helps improve our clean claim rate and lower rejections.”

Sue Siebenthaler, Assistant Director of Operations, Medicount

“Finding eligibility is a breeze. I like that I can pull the history of the claim — finding out what claims get rejected the most and why — which has been really beneficial. Waystar gives us additional information which I wasn't expecting. So, if there's another policy on there, I can follow the trail and not bother patients who are in recovery, or their family.”

Cori Wagner, Billing Specialist, iCare Ambulance

“We are using Waystar pretty much front to back. For batch eligibility, we run eligibility out of our EMR and send those batches to Waystar. From a frontend perspective, being able to identify when a patient is eligible and utilizing that eligibility pathway with Waystar feeds into our revenue.”

Linda Rosser, Senior Director of Front Revenue Cycle,
BrightSpring Health Services

TRUSTED BY HEALTHCARE LEADERS NATIONWIDE

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BrightSpring + iCare Ambulance find coverage for presumed self-pay patients

See how providers reduce uncompensated care and increase profit margin by finding hidden, billable coverage.
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Centerstone optimizes RCM by slashing eligibility denials

Non-profit health system leverages analytics to uncover denial trends and the reason for rejections.
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Health systems find hidden, billable coverage for patients faster

Advocate Health, Permian RMC + Frederick Health reduce uncompensated care and deliver a better patient financial experience by finding hidden coverage upfront.
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