Waystar Holding Corp. (Waystar) provides healthcare organizations with mission-critical cloud software that simplifies healthcare payments.
The company’s enterprise-grade platform streamlines the complex and disparate processes its healthcare provider clients must manage to be reimbursed correctly, while improving the payments experience for providers, patients, and payers. The company leverages internally developed AI, as well as proprietary, advanced algorithms to automate payment-related wor...
Waystar Holding Corp. (Waystar) provides healthcare organizations with mission-critical cloud software that simplifies healthcare payments.
The company’s enterprise-grade platform streamlines the complex and disparate processes its healthcare provider clients must manage to be reimbursed correctly, while improving the payments experience for providers, patients, and payers. The company leverages internally developed AI, as well as proprietary, advanced algorithms to automate payment-related workflow tasks and drive continuous improvement, which enhances claim and billing accuracy, enriches data integrity, and reduces labor costs for providers.
The company’s clients utilize its software to manage pre-encounter workflows, such as eligibility checks and prior authorization approvals, as well as mid- and post-encounter workflows, such as co-pay collection, claims submission and monitoring, and payer remittances. The company’s software helps to avoid or reduce billing errors throughout the healthcare payment workflow, from pre-encounter eligibility verification to determine patient insurance eligibility and benefits prior to rendering service, to mid- and post-encounter solutions, such as its revenue capture suite, which identifies and resolves missing charges and errors in claims submissions by providers, the company’s claims management suite, which helps ensure submissions in accordance with payer contracts, and its denial avoidance solution, which offers a root cause reporting tool for denied claims to help reduce preventable denials in the future.
The company’s software is used daily by providers of all types and sizes across the continuum of care, including physician practices, clinics, surgical centers, and laboratories, as well as large hospitals and health systems. The company serves over 30,000 clients of various sizes, representing over one million distinct providers practicing across a variety of care sites, including 16 of the top 20 U.S. News Best Hospitals. The company’s client base is highly diversified, and for the year ended December 31, 2024, its top 10 clients accounted for only 11.2% of its total revenue for such period. The company’s business model is designed such that as its clients grow to serve more patients, their claims and transactional volumes increase, resulting in corresponding growth in its business. In addition, the company’s clients frequently adopt a greater number of its solutions over time and introduce its solutions across new sites of care. In 2024, the company facilitated over six billion healthcare payments transactions.
The company’s platform benefits from powerful network effects. The company’s cloud-based software is driven by a sophisticated, automated, and curated rules engine, employing AI to generate and incorporate real-time feedback from millions of network transactions processed through its platform each day. Every transaction the company processes provides additional data insights across providers, patients, and payers, which are embedded in updates that are deployed efficiently across its client base. This results in cumulative benefits to the company over time - as it captures more data from each transaction it processes, the company leverages that data to continue to improve the Waystar platform through embedded machine learning, advanced algorithms, and other in-house AI technologies to deliver added value to its clients. In turn, the more value the company creates for its clients, the more likely it is that they will continue to use its products, allowing the company to continue to capture more data that results in tangible improvements to its platform. As a result, the company’s clients benefit from faster and more efficient performance from software that is evolving to meet ever-changing regulatory and payer requirements, enabling accurate and timely reimbursement.
The Waystar Platform
The company’s innovative cloud-based software platform is purpose-built to simplify its clients’ payment-related challenges. The key components of the company’s platform include:
Modern, Differentiated Software: The company provides modern, scalable healthcare payments software solutions. The company’s platform is in alignment with best-in-class offerings in other industry verticals that include multi-tenancy, micro-services architecture, and robust data security. The company’s technology is cloud- native, allowing it to deploy it across any type and size of provider, from single-physician practices to the most sophisticated multi-site health systems. This single-instance, multi-tenant infrastructure is underpinned by an event-driven microservices architecture, all of which the company has built in-house.
A Comprehensive Solution Set: The company’s software addresses the entire healthcare payments workflow, from pre-service patient onboarding and prior authorization through post-service payment collection. Rather than attacking individual pain points for a client user, the company’s solutions can meet the full demands of an entire organization, eliminating the need for point solutions, boosting productivity through a seamless end-user experience, and reducing the risk of loss of data or information.
Seamless Integrations: The company’s solutions are integrated with a broad range of systems provided by over 200 channel partners, including ERP applications, as well as PM and EHR systems. This deep connectivity is an important point of differentiation and makes the company’s solutions faster to implement, easier to use, and harder to replace.
An Expansive Network: The company’s extensive network of clients and counterparties underpins its platform. Over more than two decades, the company has built direct connectivity with healthcare payers-from large health insurers to small third-party administrators-to the benefit of its clients and partners. This network has allowed the company to build a large database of information to generate insights and drive continuous improvements.
Advanced AI Capabilities Driven by Proprietary Data Asset: The company builds predictive scoring capabilities using extensive training data sets and advanced machine learning which it applies to data that passes through its platform. Using these machine-learning models, the company is able to predict an outcome for a variety of reimbursement workflows, which it incorporates into its solutions to drive improved results for payers, providers, and patients. The company’s data asset is consisted of the billions of transactions it facilitates each year, as well as the numerous variables that factor into each of those payments. This allows the company to leverage the compounding value of this data asset to advance its AI and automation capabilities, which continuously learn and improve its platform. The company’s data include elements, such as demographics, geography, diagnosis and prognosis, and care provider, as well as a variety of counterparty details. For example, the company leverages AI in denials prevention and recovery platform, where it helps the company predicts denied claim appeals success based on a variety of factors, including patient benefits, procedure performed, applicable payer involved, and codes used. This enables providers to prioritize their workflow efforts and drive maximum recovery value on denied claims. In addition, the company uses AI to discover missing charges and capture otherwise lost revenue, to align claim status and escalation efforts with claim-specific expected remit timeframe, to drive work queue prioritization by expected value, to predict the likelihood of charity qualification driving pre-service financial intervention, and for behavior modeling to align patient collection costs.
Growth Strategy
The company’s growth strategies include expanding its relationships with existing clients; growing its client base; deepening and expanding its relationships with strategic channel partners; and innovating and developing adjacent solutions, as well as selectively pursuing strategic acquisitions.
Solutions
The company’s comprehensive solution set streamlines the complex and disparate processes relating to payments received by healthcare providers and addresses related pain points for providers, patients, and payers. The company’s solutions include:
Financial Clearance: The company’s platform automates insurance verification processes and validates that patients are eligible for care through the prior authorization process, helping eliminate downstream rejections and denials that leads to revenue delays and leakage. Based on a survey, 81% of patients would more actively pursue care if they knew the cost upfront. The company’s financial clearance solutions provide patients with price transparency tools and cost estimation data points that offer them better clarity around their expected costs.
Patient Financial Care: The company’s platform enables digital interactions between the patient and provider, including delivery of electronic statements and processing of patient payments through its patient portal. The company offers an omni-channel payment experience, with multiple ways for patients to pay, as well as flexible payment arrangements. These solutions deliver a better financial experience for patients, as well as faster collection times and higher collection rates for providers.
Claims and Payer Payment Management: The company’s platform streamlines the cumbersome reimbursement process that providers follow to submit claims and receive remittance information. The company’s solutions ensure submission of appropriate documentation and claim submission in accordance with payer contracts and automate workstreams that help its clients avoid denials and rejections, monitor in- process claims, and process payer remittances. In addition, the company offers claim scrubbing capabilities to check for errors and verify accuracy to limit billing mistakes.
Denials Prevention and Recovery: The company’s platform leverages predictive analytics to identify claims that are likely to be denied and to prioritize denied claims based on the likelihood of claims appeal success. The company reduces manual workflows, as well as denial appeal processing time. The company also conducts root cause analysis to help providers reduce the chance of denials in future claims.
Revenue Capture: The company’s platform leverages AI and machine learning to identify and resolve missing charges and errors in claims submissions, reducing manual auditing and increasing reimbursement accuracy and cash flow for its clients.
Analytics and Reporting: The company’s platform collects and collates vast amounts of healthcare data, and the company organizes and presents these data in dashboards that can be customized to meet the needs of individual clients. The company provides data visualization and business intelligence analytics to enable providers to manage payment and denial trends across their business. The company drives increased workflow efficiency by eliminating manual spreadsheets for evaluation of business trends and enable performance optimization through real-time evaluation of key performance indicators.
Go-to-Market Strategy
The company has built a go-to-market engine focused on acquiring new clients, driving expanded use of its platform for existing clients, and strengthening and growing its relationships with channel partners.
The company sells its platform through its sales team consisted of over 100 representatives. The company’s sales teams are dedicated to either ambulatory providers or hospital and health system clients given the specific needs, call points, and sales cycles of those client types. The company’s sales approach to ambulatory provider clients consists of high velocity direct enterprise go-to market strategy, with a shorter sales cycle, whereas its direct enterprise go-to-market strategy for hospital and health systems clients typically has a longer sales cycle.
The company leverages data and analytics to manage the effectiveness of its sales force, as well as identify areas for potential improvement. The company’s client-centric sales model is fueled by frequent engagement with its clients. The company has assigned dedicated client success managers to clients that have generated almost half its revenue since the beginning of 2021.
In addition to the company’s direct sales force, it has a team focusing on strengthening and expanding its channel partner and alliance relationships. The company has established strong partnerships with the nation’s leading EHR and PM providers for integration and joint go-to-market efforts to providers. In addition, the company’s strategic partners extend its sales presence and accelerate direct sales of its solutions by actively referring and promoting the company to their client bases, enabling incremental touchpoints for its sales team who is ultimately responsible for marketing and selling to the client. The company also partners with and sells to outsourced revenue cycle or billing service providers, who leverage its technology to help providers manage their administrative processes and payments.
The company’s go-to-market representatives are supported by a commercial operations team that is focused on developing strategic plans and driving team member development to enhance its effectiveness. The company’s go-to- market team also works with its product subject-matter experts, who help identify prospective client pain points and business challenges and help configure optimal solutions. Additionally, the company has built a high- performance marketing function that has significantly elevated Waystar’s voice in the industry, expanding awareness of its brand over time.
Clients
The company’s clients represent healthcare providers across all types of care settings, including physician practices, clinics, surgical centers, and laboratories, as well as large hospitals and health systems. Generally, 30% of the company’s revenue comes from hospitals and health systems, while 70% comes from ambulatory and alternate sites of care. The over 30,000 clients the company serves also varies significantly in size and represent over one million distinct providers in total, including 16 of the top 20 U.S. News Best Hospitals. As a result of the company’s broadly applicable model, its client base is highly diversified, and for the year ended December 31, 2024, the company’s top 10 clients accounted for only 11.2% of its total revenue. The number of clients has grown to 1,203 in the year ended December 31, 2024, driven by large, new client wins and successful cross-selling and up-selling efforts.
Research and Development
For the year ended December 31, 2024, the company’s research and development expense was $48.8 million.
Intellectual Property
In the United States, the company has 19 trademark registrations, 15 issued patents, and 26 copyright registrations. In addition, the company has registered the www.waystar.com domain name, which it uses in connection with its platform.
Regulation
The company is contractually required to structure and provide its solutions in a way that supports its clients’ HIPAA (Health Insurance Portability and Accountability Act) compliance obligations to use prescribed electronic formats. The company must also comply with HIPAA’s breach notification rule and equivalent state breach notification laws.
The company is also subject to numerous additional laws, regulations, and industry standards. For example, the California Consumer Privacy Act of 2018 (CCPA), which was subsequently amended by the California Privacy Rights and Enforcement Act of 2020 (CPRA), originally took effect in 2020, and provides California residents expanded privacy rights and protections, and provides for civil penalties for certain violations. Further, the company is also subject to industry standards, such as PCI-DSS as a result of the credit card payments initiated by patients and provider staff members.
History
Waystar Holding Corp. was founded in 2017. The company was incorporated in 2019.