TriZetto vs Waystar

Last Updated:

Our analysts compared TriZetto vs Waystar based on data from our 400+ point analysis of Medical Billing Software, user reviews and our own crowdsourced data from our free software selection platform.

TriZetto Software Tool

Product Basics

TriZetto by Cognizant is a set of health systems designed to simplify workflows and help provide more exceptional care. Health organizations of various sizes and specialties rely on it to streamline daily operations, including increasing administrative productivity and efficiency.

It automates billing and payment processes in addition to managing insurance claims. Since health care professionals prefer spending more time focusing on the patient as opposed to time-consuming tasks like charting and documentation, it offers a comprehensive set of electronic modules to help them automate day-to-day clinical tasks.
read more...

Waystar (formerly Navicure or ZirMed) is a cloud-based solution for managing a health organization’s revenue cycle. Over 25,000 hospital organizations and health clinics use this system to track patients' revenue from their first visit until their final balance has been paid.

It’s ideal for health care organizations of all sizes. It helps providers get paid faster and more accurately by automating tedious billing tasks, improving claim accuracy and offering in-depth reporting tools that uncover areas for efficiency gains.

Popular features include eligibility checks, claims submission and tracking, denial management, and analytics dashboards. 

Users praise Waystar for its user-friendly design, ability to reduce billing errors, and seamless integration with other practice management systems.

While pricing varies based on factors like practice size and specific feature sets, the vendor offers a subscription model with fees based on metrics like claim volume.

read more...
$300 Monthly
Get a free price quote
Tailored to your specific needs
$100 Monthly
Free Trial is unavailable →
Get a free price quote
Tailored to your specific needs
Small
Medium
Large
Small
Medium
Large
Windows
Mac
Linux
Android
Chromebook
Windows
Mac
Linux
Android
Chromebook
Cloud
On-Premise
Mobile
Cloud
On-Premise
Mobile

Product Assistance

Documentation
In Person
Live Online
Videos
Webinars
Documentation
In Person
Live Online
Videos
Webinars
Email
Phone
Chat
FAQ
Forum
Knowledge Base
24/7 Live Support
Email
Phone
Chat
FAQ
Forum
Knowledge Base
24/7 Live Support

Product Insights

  • Improve Quality Health Outcomes: Automate and integrate as many processes as possible to ensure health professionals can focus efforts on providing the best possible care for patients. Health analytics and insights assist clinicians in providing more accurate diagnosis and treatment. 
  • Increase Revenue: Increase health organizations’ daily traffic, which in turn leads to more revenue opportunities. Tools to help manage billing and claims can also help optimize return amounts. Physicians can treat more patients without sacrificing the quality of care provided, allowing for more money to be collected. 
  • Promote Accessibility: Access medical history, lab results, medication and more using online portals, any time and any place. View, edit and share records using any mobile device.
  • Enhance Patient Experiences: Provide patients with the ability to communicate with physicians online using the patient portal. Patients can exchange messages and video chat with healthcare professionals, access medical history, view lab results and more to take an active role in healthcare.
  • Interoperability: Address the changing industry landscape by achieving interoperability compliance for secure information exchange among physicians, patients and staff members. Data stored in the system is HIPAA compliant and only those with access can view it. 
read more...
  • Enhance Revenue Capture: Prevent lost revenue due to billing errors or missed opportunities with automated rules engines and advanced analytics. AnMed Health collected $931K in total rebilled and estimated additional revenue.
  • Boost Patients’ Financial Experiences: Use online payment portals to reduce payment friction. Renown Health reduced AR days by half while achieving a 3.8x increase in patient adoption of PatientWallet for payment management.
  • Streamline Claims Management Workflows: Achieve clean claims rate, reduce denials and automate claim submission processes with claim management capabilities. CPA Lab achieved 98% clean claim rate after using the solution.
  • Make Data-Driven Decisions: Access real-time dashboards and customize KPIs to improve financial and operational performance.
  • Optimize Revenue Cycle Management: Automate repetitive tasks like eligibility checks, claims scrubbing and payment posting to save time. Integrate with third party applications to consolidate financial data for efficient RCM processes.
  • Ensure Scalability and Adaptability: Adapt to industry changes and the growing needs of healthcare organizations.
read more...
  • Claims Processing: Automatically verify insurance and sweep claims, scrubbing them of any mistakes or coding errors, which often lead to denials or delayed reimbursement. This speeds up the process of submitting claims while helping improve first-time acceptance rates.  
  • Claims Reconciliation: Automate claims tracking throughout the reimbursement cycle. Monitor and convert EOB information into 835 remittance files to reduce errors and time spent reconciling claims. 
  • Rejection Prevention: Apply coding edits to insurance claims prior to submission. Receive error messages to identify rejections before they happen, reducing claims rejections. 
  • Eligibility Checks: Directly connect to insurance providers for real-time validation of patient eligibility. Integrate with practice management systems to seamlessly update patient insurance information. 
  • Patient Responsibility Estimation: Generate patient cost estimates in real time to improve client satisfaction and likelihood of payment. 
  • Prior Authorization: Automatically send prior authorization requests for treatment to patient insurance providers. Communicate with payers and track authorization requests within the provider portal. 
  • Patient Payments: Provide patients with a selection of payment options, including credit card processing, a payment portal and text-to-pay processing, to improve patient experiences. 
  • Denials Management: Receive claims denial notifications, along with causes and potential for appeal. Monitor error, edit and payer trends to reduce future denials. 
  • Contract Management: Audit payments against contractual agreements with payers. Automatically generate documents and track efforts to dispute underpaid obligations. 
  • RCM and Coding Services: Outsource revenue cycle management and coding processes, such as billing, patient statements, registration and insurance claims coding, to focus more on patient care and less on administrative tasks. 
  • Credentialing: Check and manage employee credentials against payer requirements to ensure maximum reimbursement. Store employee documentation to remain up-to-date on expired credentials. 
read more...
  • Financial Clearance: Verify patient insurance eligibility, secure necessary authorizations and present clear cost estimates.
    • Eligibility Verification: Instantly check patients’ insurance coverage and benefits, eliminating delays and potential errors. Automatically re-verify clients’ eligibility after data update. Apply payer-specific rules to interpret eligibility information accurately.
    • Coverage Detection: Access customizable dashboards and reports to gain visibility into potential billable coverage. Use advanced algorithms and a vast payer database to streamline coverage discovery, reducing manual effort.
    • Patient Estimation: Incorporate factors like contracted rates, insurance benefits, deductibles and out-of-pocket maximums to generate reliable estimates of a patient's financial responsibility. Share clear, easy-to-understand estimates with patients, building trust and minimizing billing surprises.
    • Authorizations: Secure necessary approvals from insurance payers before rendering specific services, treatments or medications. Monitor authorization requests statuses (pending, approved or denied) in real time. Generate and track referrals to specialists or other facilities, ensuring compliance with payer requirements.
    • Charity Screening: Analyze patient financial data (income, assets, etc.) against established charity care policies to quickly determine potential qualifications. Pull relevant financial information from multiple sources (credit reports, public records or patient self-attestation) for a comprehensive assessment.
  • Revenue Capture: Prevent billing errors, uncover missed charges, and eliminate undercoding and upcoding.
    • Charge Integrity: Use complex algorithms and rules engines to scan billing codes (CPT, HCPCS, etc.) against documentation to identify missing or potentially inaccurate charges. Identify instances where codes may not fully align with services rendered, minimizing compliance risks and potential audits.
    • DRG Anomaly Detection: Analyze patient data to compare the assigned DRG against what the documentation supports. Identify mismatches that could result in underpayment or overpayment. Flag DRG anomalies for review and correction before claims submissions.
    • DRG Transfer: Analyze historical claims data to uncover potentially under-coded or missed TDRGs. Automate claims recalculating processes and refile them with the correct TDRG code, recovering what was rightfully owed.
  • Claim Management: Streamline claim submission and tracking processes.
    • Claim Manager: Automatically scrub claims for errors, omissions and inconsistencies (missing modifiers or invalid codes) before submission. Help staff efficiently prioritize claims needing review or action (pre-edits, denials, etc.).
    • Monitoring: Pull and update claim status details directly from payer portals. Access dashboards to gain an up-to-the-minute view of where claims stand in the process (submitted, in progress, paid or denied) for individual claims or across the whole A/R.
    • Attachments: Securely transfer medical records, prior authorizations, EOBs, and other supporting files directly into the system. Process multiple attachments simultaneously, especially for high-volume situations.
  • Payment Management: Simplify patient and payer interactions with convenient digital payment options, clear estimates and automated payment posting tools.
    • Payer Reimbursement: Use intelligent algorithms to match payments from payers to the specific claims they were intended for, even with partial payments or complex scenarios. Quickly locate and download ERAs for review or reconciliation.
    • Patient Payments: Send digital bills and automated reminders, encouraging on-time payments. Enable patients to view balances and make payments using credit cards, debit cards or bank transfers.
    • Agency Manager: Access vendor scorecards for analyzing agency activity and results. Employ reconciliation tools to assign each overdue account to the appropriate collection agency.
  • Denial Resolution: Mandate pre-submission validation on all claims to reduce the volume of preventable rejections and denials. Identify trends and patterns of denied claims to make strategic changes to processes, documentation or workflows.
  • Analytics and Reporting: Focus on critical indicators like denial rates, A/R days and clean claim rates.
    • Medicare Analytics: Bypass manual processes and access Medicare's FISS system directly within the platform. Get clear claim status with easy-to-understand reason codes. Use worklists to prioritize denied, rejected, or RTP claims for rapid follow-up.
    • Compliance Reporting: Monitor and report on key quality measures like MIPS and HEDIS mandated by CMS (Centers for Medicare & Medicaid Services) and other payers. Automatically retrieve the latest CASPER reports directly from CMS.
read more...

Product Ranking

#34

among all
Medical Billing Software

#43

among all
Medical Billing Software

Find out who the leaders are

User Sentiment Summary

Great User Sentiment 21 reviews
Excellent User Sentiment 315 reviews
83%
of users recommend this product

TriZetto has a 'great' User Satisfaction Rating of 83% when considering 21 user reviews from 3 recognized software review sites.

91%
of users recommend this product

Waystar has a 'excellent' User Satisfaction Rating of 91% when considering 315 user reviews from 2 recognized software review sites.

4.3 (13)
4.6 (116)
n/a
4.5 (199)
2.9 (4)
n/a
5.0 (4)
n/a

Awards

No awards.

Waystar stands above the rest by achieving an ‘Excellent’ rating as a User Favorite.

User Favorite Award

Synopsis of User Ratings and Reviews

Cost Savings: Electronic documentation decreases paperwork, enhances employee efficiency, and leads to reduced office supply and operational costs in the long term.
Patient Engagement: Patient portals empower individuals to access their health information, schedule appointments and communicate with healthcare providers.
Patient Safety: Features like medication alerts and allergy notifications help prevent errors and improve patient safety.
Show more
Robust Integration Capabilities: Integrate with EHRs, medical billing solutions and practice management systems to eliminate duplicate data entry.
Easy-to-Use Dashboard: Gain a centralized view of key metrics for quick insights on claim statuses, denial rates and reasons, and A/R aging.
Comprehensive Revenue Cycle Management Suite: Eligibility verification, coding, payment posting, and analytics and reporting tools help practices streamline revenue management processes.
Show more
Learning Curve: Staff may require time and training to adapt to new technology, potentially affecting productivity during the transition phase.
Data Security Concerns: EHRs are vulnerable to data breaches and cybersecurity threats, requiring robust security measures and ongoing vigilance.
Show more
Steep Learning Curve: Training can be time-consuming and disruptive to practice’s workflow initially.
High Cost: Initial expenses (setup and software licenses) can be significant.
Complex Secondary Claims Submission: May require manual workarounds, resulting in reimbursement delays.
Show more

TriZetto garners praise for its comprehensive suite of features that streamline medical billing processes, from patient registration and insurance verification to claim submission and payment processing. Users appreciate its ability to automate tasks, reducing manual effort and the potential for errors. The software's scalability makes it suitable for healthcare organizations of all sizes, accommodating the needs of both small practices and large enterprises. Additionally, TriZetto's analytics and insights empower healthcare professionals to make data-driven decisions, improving patient care and optimizing revenue cycles. However, some users note that TriZetto's robust functionality comes at a cost, as it can be more expensive than some competing solutions. The software's complexity may also present a learning curve for new users, requiring additional training and support. Despite these drawbacks, TriZetto remains a popular choice for healthcare organizations seeking a comprehensive and scalable medical billing solution. Its ability to automate tasks, improve efficiency, and provide valuable insights makes it particularly well-suited for large organizations with complex billing needs.

Show more

Waystar's core strength lies in its ability to automate repetitive, error-prone tasks within RCM. This can free up significant staff time for higher-value work, and reduce costly mistakes that lead to denials or missed revenue. Additionally, analytics tools appear robust, providing insights that can drive better decision-making around process improvement and resource allocation.However, smaller practices may find the cost and complexity prohibitive. Additionally, like any cloud-based system, maximizing Waystar's value will require ongoing training and attention to updates.

Show more

Screenshots

Top Alternatives in Medical Billing Software


AdvancedMD

athenaOne

CareCloud Central

CollaborateMD

CureMD

DrChrono

DuxWare

eClinicalWorks

EZClaim

Intergy

NextGen Enterprise

Oracle Ambulatory EHR

RXNT

Tebra Managed Billing

WebPT

Related Categories

WE DISTILL IT INTO REAL REQUIREMENTS, COMPARISON REPORTS, PRICE GUIDES and more...

Compare products
Comparison Report
Just drag this link to the bookmark bar.
?
Table settings