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Prior Authorizations Platform

The smart + simple way to manage prior authorizations

Prior authorizations are a leading cause of denied claims year after year— a problem that costs healthcare providers millions. What’s more, a lack of prior authorization solutions keeps patients from getting the care they need when they need it.

Waystar’s Prior Authorization Platform uses artificial intelligence and RPA to automate the authorization process from verification to status retrieval. Our prior authorization solutions automate not only authorizations, but notifications of admission, full-service medical necessity checks, and referrals. Clients have seen reduction in denials, and more efficient use of staff. Find the way forward.

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Waystar’s Prior Authorization Solutions

Reduce denials + cut out manual work

Powered by intelligent automation, Waystar’s Prior Authorization solution:

  • Automatically verifies, initiates, statuses, and retrieves comprehensive authorization details
  • Initiates authorizations, saving time on manual processes
  • Automates patient referral status to cut manual work, stop revenue leakage, and improve the patient experience
  • Offers authorization submissions for unscheduled admissions
  • Auto-generates Advance Beneficiary Notices or Notice of Non-Coverage forms for Medical Necessity
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And, like all solutions that are part of our smart platform, Prior Authorization also:

  • Integrates directly with all major HIS and PM systems
  • Adapts to constantly shifting payer rules and requirements
  • Is maintained by the in-house team of experts who built it
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Prior auth by the numbers

auth transactions conducted per year
service lines covered
reduction in authorization process time
cost savings opportunity per manual auth transaction
*Source: Waystar data, 2023

How Prior Authorization works

4 squares reading as follows: Auth Verification: Reviews EHR orders in real time using AI to verify if an authorization is required. Auth initiation + submission: Accelerates the initiation and submission of required data and sends documentation directly to payers. Auth status + retrieval: Checks status until determination is complete and delivers details back into HIS or PM system. Auth intervention: Flags claims likely to be denied or needing intervention so your team can become specialized in your denials. Another box below these 4 reads: 39.7% of denials are caused by prior authorization

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A prior authorization solution for faster approvals + lower costs

Waystar’s breakthrough prior authorization technology integrates with all major EMRs and payer systems, constantly working behind the scenes to gain speed, reducing turnaround time, and increase accuracy with every exchange. Our smart platform uses millions of rules, created with data from the millions of authorization transactions we conduct each year. And our RPA connectivity automatically routes authorizations to payers based on patient type and managing entity.

Find the way forward — for you and your patients.

Products included

Includes Prior Authorizations (initiate + status)   |   Medical Necessity   |   Admission Notification/Submission   |   Referrals


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