Waystar Reviews & Pricing

Key Features

• Financial Clearance: Verify patient insurance eligibility, secure necessary authorizations and present clear cost estimates.
  • Eligibility Verification: Instantly check patients’ insurance coverage and benefits, eliminating delays and potential errors. Automatically re-verify clients’ eligibility after data update. Apply payer-specific rules to interpret eligibility information accurately.
  • Coverage Detection: Access customizable dashboards and reports to gain visibility into potential billable coverage. Use advanced algorithms and a vast payer database to streamline coverage discovery, reducing manual effort.
  • Patient Estimation: Incorporate factors like contracted rates, insurance benefits, deductibles and out-of-pocket maximums to generate reliable estimates of a patient's financial responsibility. Share clear, easy-to-understand estimates with patients, building trust and minimizing billing surprises.
  • Authorizations: Secure necessary approvals from insurance payers before rendering specific services, treatments or medications. Monitor authorization requests statuses (pending, approved or denied) in real time. Generate and track referrals to specialists or other facilities, ensuring compliance with payer requirements.
  • Charity Screening: Analyze patient financial data (income, assets, etc.) against established charity care policies to quickly determine potential qualifications. Pull relevant financial information from multiple sources (credit reports, public records or patient self-attestation) for a comprehensive assessment.
• Revenue Capture: Prevent billing errors, uncover missed charges, and eliminate undercoding and upcoding.
  • Charge Integrity: Use complex algorithms and rules engines to scan billing codes (CPT, HCPCS, etc.) against documentation to identify missing or potentially inaccurate charges. Identify instances where codes may not fully align with services rendered, minimizing compliance risks and potential audits.
  • DRG Anomaly Detection: Analyze patient data to compare the assigned DRG against what the documentation supports. Identify mismatches that could result in underpayment or overpayment. Flag DRG anomalies for review and correction before claims submissions.
  • DRG Transfer: Analyze historical claims data to uncover potentially under-coded or missed TDRGs. Automate claims recalculating processes and refile them with the correct TDRG code, recovering what was rightfully owed.
• Claim Management: Streamline claim submission and tracking processes.
  • Claim Manager: Automatically scrub claims for errors, omissions and inconsistencies (missing modifiers or invalid codes) before submission. Help staff efficiently prioritize claims needing review or action (pre-edits, denials, etc.).
  • Monitoring: Pull and update claim status details directly from payer portals. Access dashboards to gain an up-to-the-minute view of where claims stand in the process (submitted, in progress, paid or denied) for individual claims or across the whole A/R.
  • Attachments: Securely transfer medical records, prior authorizations, EOBs, and other supporting files directly into the system. Process multiple attachments simultaneously, especially for high-volume situations.
• Payment Management: Simplify patient and payer interactions with convenient digital payment options, clear estimates and automated payment posting tools.
  • Payer Reimbursement: Use intelligent algorithms to match payments from payers to the specific claims they were intended for, even with partial payments or complex scenarios. Quickly locate and download ERAs for review or reconciliation.
  • Patient Payments: Send digital bills and automated reminders, encouraging on-time payments. Enable patients to view balances and make payments using credit cards, debit cards or bank transfers.
  • Agency Manager: Access vendor scorecards for analyzing agency activity and results. Employ reconciliation tools to assign each overdue account to the appropriate collection agency.
• Denial Resolution: Mandate pre-submission validation on all claims to reduce the volume of preventable rejections and denials. Identify trends and patterns of denied claims to make strategic changes to processes, documentation or workflows.
• Analytics and Reporting: Focus on critical indicators like denial rates, A/R days and clean claim rates.
  • Medicare Analytics: Bypass manual processes and access Medicare's FISS system directly within the platform. Get clear claim status with easy-to-understand reason codes. Use worklists to prioritize denied, rejected, or RTP claims for rapid follow-up.
  • Compliance Reporting: Monitor and report on key quality measures like MIPS and HEDIS mandated by CMS (Centers for Medicare & Medicaid Services) and other payers. Automatically retrieve the latest CASPER reports directly from CMS.

Approach to Common Challenges

• Claim Denials: Built-in claim scrubbing helps check for errors or missing information before submission. The system may also offer automatic updates for regulatory and insurance-specific requirements to reduce compliance-related denials.
• Coding Errors: Integrated code lookup tools and coding suggestions based on medical documentation assist in assigning the right code to the right services. The application might also include audit trails to track changes and identify areas where coding mistakes are frequent.
• Slow Reimbursements: Many systems offer reporting features that can analyze the company’s reimbursement cycle, identifying payers that consistently cause delays or pinpointing bottlenecks in their own process.
• Delayed Patient Collections: The application assists practices in generating well-formatted patient statements with clear explanations of charges and outstanding balances. Secure online payment portals allow patients to pay via credit/debit cards or online wallets, speeding up collections.

Cost of Ownership

Limitations

• Difficulty submitting secondary claims.
• Difficulty viewing ACH checks.
• Occasional system crashes.

FAQs

• Denial Prediction: Analyzing data to predict potential claim denials, allowing for proactive corrections.
• Cash Flow Forecasting: Using historical data and trends to project future cash flow, aiding in financial planning.
• Payer Performance Analysis: Identifying payers with consistently slow reimbursement or high denial rates.

• Electronic Statements: Generates clear and easy-to-understand patient statements.
• Online Payments: Offers a secure portal for patients to view bills and make payments online.
• Reminders: Automates payment reminders via email, text or mail, reducing overdue balances.
• Payment Plans: May provide tools to help set up payment plans for patients who need financial flexibility.