Waystar With Epic: Where the Clearinghouse Meets Resolute

Through standard healthcare EDI transactions and Epic's interfaces for them, plus MyChart integration for the patient facing pieces. Eligibility runs as 270/271 in real time from Prelude at registration and in batch ahead of visits. Claims leave Resolute as 837 files, pass through Waystar's edits and payer connections, and return as 277 claim status and 835 remittances that post back to Epic. Prior authorization uses 278 transactions and, increasingly, payer portal automation where a payer does not support the electronic transaction. Denial data returns to Epic workqueues with Waystar's categorisation attached. Patient statements, estimates and payment options surface in MyChart.

Waystar does not publish the specific Epic interface list on its integration page, nor whether it is listed in Epic Showroom for particular modules. Both are things to ask for in writing. The standard questions in our integration questions guide apply, with the addition of postback rules: exactly which Waystar data lands in which Epic field or workqueue, because that is what your billing staff will see every day.

Where the AI comes in is above the transaction layer: predictive claim edits, denial propensity scoring, prior authorization determination and automated appeal drafting. Those features use the same interfaces; what changes is how much of the decision is made before a person sees the item.

For registration staff, eligibility and benefit detail at check in, and patient responsibility estimates. For billing staff, cleaner claims leaving Epic with fewer rejections, claim status and remits posted back without manual work, and denial workqueues sorted by Waystar's categories and recovery likelihood. For prior authorization staff, status tracking and, where enabled, automated submission. For patients, estimates, statements and payment plans in MyChart. Waystar cites more than 5,000 payer connections; that is a vendor figure and it is in the normal range for a national clearinghouse.

The value is in the denial and prior authorization layers, because that is where labour and revenue are lost. Our denial management use case and prior authorization automation use case set out what to measure, and the denial rate benchmark and days in AR benchmark give you a baseline to hold the vendor to. Any figure Waystar quotes for denial reduction should be compared against your own baseline, not a marketing average.

• Clearinghouse cutover planning if Waystar replaces an incumbent: payer enrolment, EDI testing per payer and parallel running, which is the longest item in most projects.
• Epic interface configuration for each transaction type, and postback rules into Resolute workqueues and Prelude.
• MyChart configuration for estimates, statements and payments, and the patient communication review that goes with it.
• Security review and the business associate agreement, covering claim and patient financial data retention, subprocessors and any use of your data to train shared models. The HIPAA and AI page lists what to insist on.
• Workqueue redesign and staff training, since denial categories and edit logic change what billers see.
• A test plan by payer and transaction, and a change control slot for cutover.

Revenue cycle projects fail in the enrolment and cutover phase rather than the interface phase. Ask Waystar for the payer enrolment plan and the parallel running period before agreeing a date. The CMS prior authorization rule also changes what payers must support electronically, which affects which Waystar features are worth paying for.

The first is overlap with Epic itself. Epic has been expanding its own payer platform and claims capabilities, and some organisations find they are paying Waystar for functions Epic now includes. Ask your Epic account team what your licence already covers before buying modules.

The second is pricing structure. Waystar prices against claim or transaction volume and publishes nothing, and module by module pricing can add up. Our Waystar pricing page sets out what buyers report and how to compare against Availity and others on a per transaction basis.

The third is that the AI features are the newest and least proven part of the offer. Predictive edits and denial scoring are sensible; automated appeal drafting and authorization determination need a compliance review, because a claim or appeal submitted with an error is your organisation's liability, not the vendor's. Our agent pilot metrics guide covers how to pilot those features with a control group.

• Which Epic interfaces and postback rules are used for each module we are buying, and is each module listed in Epic Showroom?
• What is the payer enrolment plan, how long is parallel running with our incumbent clearinghouse, and who does the per payer testing?
• Which of the AI features act automatically and which queue items for a person, and can we choose per feature?
• What are the measured denial reduction and clean claim rates at Epic customers of our size, against their own baseline rather than an average?
• What is the per transaction or per claim price at our volume, the module list, the minimum term and the exit terms, including data return?
• Where is our claim and patient data stored, for how long, and is any of it used to train shared models? Put it in the BAA.

Our vendor HIPAA question list covers the compliance side in more depth.

A Waystar decision on Epic is a multi-year, volume priced commitment that touches every claim you send, and the alternatives include your own EHR vendor. An independent review baselines your denial rate and days in AR, maps which Waystar modules your Epic licence already duplicates, prices the result per transaction against Availity and Epic's own platform, and sets up the pilot metrics for the AI features so you pay for what works. We take no vendor commissions.

Our vendor selection service runs that comparison; our deployment roadmap plans the cutover. Book a call with your claim volume, your current clearinghouse contract end date and your Epic release.