Availity vs Waystar
Two Claims & Clearinghouses vendors, side by side. Facts from public sources; judgments are ours.
At a glance
Derived from public facts · a rough scale, not a ranking
| Availity | Waystar | |
|---|---|---|
| Pricing model | Free to providers (funded by payers/pharma) · Essentials free; Plus from $25/month | Per-transaction / per-chart · per-claim fees plus subscription, quote based |
| Speed to go live | Self-serve portal registration | standard EHR/PM integration project |
| Automation model | Data / network utility · Multi-payer clearinghouse network | Software platform · AI-assisted RCM and clearinghouse suite |
| Built for | Small practices, Mid-size groups, Enterprise systems, Payers, Billing companies | Small practices, Mid-size groups, Enterprise systems, Billing companies |
| Security posture | HITRUST, HIPAA | HITRUST, SOC 2 Type II, PCI DSS |
| Company maturity | 25 yrs (est. 2001) | 9 yrs (est. 2017) |
| Financial backing | Payer-owned | Public (Nasdaq: WAY) |
| Named customers | 4 named | 5 named |
| Published results | Specific numbers public | Specific numbers public |
| Documented integrations | 3 listed | 5 listed |
| Third-party validation | None found | None found |
Bottom line
- Pick Availity if you want free eligibility, claims, and auth transactions through the portal most payers already sponsor, before paying anyone for point solutions.
- Pick Waystar if you want one proven clearinghouse and claims platform covering eligibility through payments across any practice size.
Availity
Payer-owned network for claims and eligibility
- Founded
- 2001
- HQ
- Jacksonville, FL
- Stage
- Payer-owned
- Raised
- n/a
What it does
- Multi-payer provider portal (Availity Essentials)
- EDI clearinghouse for claims, eligibility, and claim status
- Electronic prior authorization submission and status tracking
- Clinical data normalization via Fusion (Diameter Health)
- Business continuity clearinghouse switching (Lifeline, Rapid Recovery)
Where it's strong
- It is the mandatory front door to major payers (Elevance requires new submitters to use the Availity EDI Gateway), so connectivity is unmatched where those plans dominate.
- The core Essentials portal is free to providers, which keeps baseline cost near zero for eligibility, claims, and auth status checks.
- It proved operational resilience during the 2024 Change Healthcare outage, standing up Lifeline in 48 hours and processing 186 million stranded claims worth roughly $350 billion.
What buyers should weigh
- Ownership by Elevance, HCSC, and other Blues means the roadmap follows payer priorities, and provider workflow needs can come second.
- The free portal covers basics only; advanced clearinghouse features, analytics, and premium EDI services carry separate fees that are not published.
- Payer coverage is uneven outside Blues-heavy markets, so most provider organizations still need a second clearinghouse for full payer reach.
Named customers
Elevance Health · Humana · Florida Blue · Health Care Service Corporation
Integrations
Waystar
Public RCM platform spanning claims to patient payments
- Founded
- 2017
- HQ
- Lehi, UT
- Stage
- Public (Nasdaq: WAY)
- Raised
- $968M IPO (June 2024)
What it does
- Claims clearinghouse connected to 5,000+ payer endpoints
- Eligibility verification and prior authorization automation
- Denial prevention, appeals, and recovery workflows
- Patient estimates, billing, and payment collection
- Remit and payer payment management with analytics
- AI clinical documentation integrity via Iodine Software
Where it's strong
- True end-to-end RCM platform, so one vendor can replace several point solutions across the revenue cycle.
- Deep, certified EHR integrations (Epic, Cerner, MEDITECH) mean staff work claims inside existing workflows rather than a separate portal.
- Named client results are strong and public: Cincinnati Children's cut clearinghouse costs in half and BAYADA reduced denials 72%.
What buyers should weigh
- Pricing is modular and not published, and total cost climbs quickly as you add suites beyond the base clearinghouse.
- The $1.25B Iodine acquisition closed October 2025, so clinical intelligence products are still being integrated and roadmaps may shift.
- Enterprise contracts are multi-year, and switching clearinghouses later means re-doing payer enrollments, a real lock-in cost.
Named customers
Piedmont · Baptist Health (Kentucky) · Cincinnati Children's · Renown Health · BAYADA Home Health Care
Integrations
Compare against the rest of Claims & Clearinghouses
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