Eligibility Verification
The smart + simple way to verify eligibility
If you’re like most providers, your patient access team probably spends a serious amount of time verifying eligibility and benefit details for accuracy. Despite all this, 60% of providers cite frontend processes like eligibility as a top cause of denials that drain the bottom line.
Waystar’s Eligibility Verification leverages advanced automation to simplify the process, so you can say goodbye to the days of searching and interpreting patient coverage and focus on what really matters — your patients. With our powerful software at your fingertips, you can:
- Proactively prevent more rejections and denials with intelligent alerts
- Strengthen frontend collections by identifying coverage gaps, out-of-network risks, and missing patient data in real time
- Optimize staff productivity to focus on exceptions and resolve eligibility issues faster with enriched benefit data and actionable alerts
- Reduce billing surprises by capturing accurate coverage and eligibility details upfront
ELIGIBILITY BY THE NUMBERS
TRUSTED BY HEALTHCARE LEADERS NATIONWIDE
University Hospitals Health System
With Waystar, University Hospitals can confirm coverage up front, eliminating errors and reducing denials.
Brightspring Health Services
Community health organization utilizes eligibility software to improve frontend patient access processes.
Prisma Health
Health system partners with Waystar to make monumental revenue cycle changes in eligibility and beyond.
iCare Ambulance
Waystar makes it simple for an emergency ground transportation company to find vital eligibility details.
WHAT MAKES WAYSTAR DIFFERENT
Powerfully accurate eligibility verification
Eligibility Verification combs through vast amounts of payer data to curate the most accurate and comprehensive benefit information — with richer coverage detail and intelligent alerts, your staff can specialize in triaging eligibility issues and proactively prevent denials. What’s more, our eligibility engine seamlessly integrates with all major EHRs.
Features + benefits
- Better defined, more detailed eligibility results with expansive payer connectivity
- Plan code matching to mitigate registration errors
- Normalization of payer data for more actionable, efficient workflows
- Intelligent alerts to instantly flag plan exclusions and coverage gaps before claims are submitted
- Advanced, customizable alerts are tailored to your organization’s unique needs and workflows, proactively mitigating denials, surfacing critical eligibility information upfront, and improving financial transparency for staff and patients
- MBI Lookup to instantly retrieve missing MBIs in real time and enhance accuracy, reducing Medicare bad debt and write-offs
- Automatic searches to the correct payer if additional coverage is indicated
- Auto Coverage Detection automatically finds additional coverage, as soon as inactive coverage is indicated
Complete + enriched benefit info in seconds
Getting insurance verification right the first time is crucial. Incorrect or incomplete eligibility has a ripple effect across the revenue cycle, from missed authorizations to reworking denied claims. Here’s a closer look at how our automated solution works.
Enriched benefit data
- Leverage our expansive data network, which houses more than 50% of the U.S. patient population, to find coverage and verify eligibility
- Expansive payer connectivity is leveraged for fast, reliable, and complete benefit information
- Detailed responses provide nuanced benefits information to improve accuracy and make eligibility response more actionable for staff
Automated, intelligent workflow
- Auto Coverage Detection searches for hidden or unknown coverage in real-time, without manual intervention
- Integrated workflow for seamless user experience
- Actionable warnings and alerts for critical eligibility issues, including patient MBIs and managed Medicaid plans
- Guided next best user actions help you navigate for optimized results
Unparalleled financial clearance operations
- Benefit information is normalized for ease of consumption
- Payer connectivity monitoring provides visibility into payer health and automatically finds alternate routes in the event of payer outages that make direct connectivity unavailable
- Intuitive dashboards give a clear, visual snapshot of eligibility performance and usage trends
Get valuable insights into eligibility verification
Mastering eligibility: 3 essential strategies for a resilient revenue cycle
Waystar’s Eligibility Verification provides actionable, accurate data in real time
How verifying insurance eligibility can increase revenue + ease staff burden
How Prisma Health empowers their team and boosts productivity
Solutions that augment Eligibility Verification
Our solutions work together seamlessly to help bring even more value to your organization. Realize even greater benefits by exploring solutions especially complementary to Eligibility Verification below.
COMPLEMENTARY SOLUTIONS
Authorization Suite | Coverage Detection | Patient Estimation
Talk with a solution expert about Eligibility Verification
We want to hear from you about your organization’s challenges and needs. Fill out the form below to learn more or ask questions about Eligibility Verification — and how we can work together to help your team reduce denials and maximize collections.