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Eligibility Verification

A smarter + simpler way to verify eligibility

If you’re like most providers, your patient access staff probably spends a serious amount of time verifying accurate eligibility and benefit details. Despite all this effort, registration and pre-service errors continue to be the leading cause of denials.

Waystar’s Eligibility Verification solution automates much of this 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 technology at your fingertips, you can:

  • Prevent more rejections and denials
  • Strengthen front-end collections
  • Optimize staff productivity
  • Elevate the patient payment experience


Powerfully accurate eligibility verification

Waystar’s AI + RPA platform, Eligibility Verification combs through vast amounts of payer data to curate the most accurate and comprehensive benefit information — with richer coverage detail, staff become specialized in triaging eligibility issues. What’s more, our eligibility engine seamlessly integrates with all major EHRs.

Features + benefits

  • Superior eligibility results with RPA and expansive payer connectivity
  • Plan code matching to mitigate registration errors
  • Normalization of payer data for more efficient workflows
  • Intelligent alerts with actionable guidance for staff


Insurance eligibility verification
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Before Waystar, we were going to a variety of carrier websites and spending a lot of time on the phone to check eligibility. It was labor intensive. Now we have all our carrier information in one location in our system.

Manager of revenue cycle billing & coding, Optometric Medical Solutions

Read success story

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

  • Utilize RPA and EDI connections to surface complete response
  • Expansive payer connectivity for best data in the market
  • Enriched eligibility data when no EDI is available

Automated, intelligent workflow

  • Integrated workflow for seamless user experience
  • Intelligent warnings and Medicare Advantage plan alerts
  • Guided next best user actions

Unparalleled financial clearance operations

  • Auto-rechecks eligibility whenever account data is updated
  • Benefit information is normalized for ease of consumption
  • Self-pay validation for coverage verification

Get valuable insights into eligibility verification

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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.


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.