specification: FinOps Framework
specificationVersion: '1.0'
schema: https://www.finops.org/framework/
provider: Waystar
providerId: waystar
created: '2026-07-04'
modified: '2026-07-04'
reconciled: false
tags:
- Healthcare
- Revenue Cycle Management
- Clearinghouse
- X12 EDI
- FinOps
- Cost Management
- FOCUS
description: >-
  FinOps view of Waystar spend. Waystar is an enterprise healthcare RCM and
  clearinghouse platform billed through negotiated contracts rather than
  public, usage-metered API pricing. Cost typically combines a platform
  subscription with per-transaction clearinghouse fees on volume - eligibility
  checks (270/271), claims submitted (837), claim status (276/277),
  remittances/ERAs (835), and authorizations (278). Because pricing is
  quote-based, the meters below are modeled to help a customer allocate and
  forecast RCM spend, not derived from a published rate card.
notes: >-
  Per-unit rates are not public; reconcile against your Waystar contract and
  invoices. Effective cost per transaction depends on negotiated volume tiers,
  which modules are licensed, and payer mix.
sources:
- https://www.waystar.com/
- https://www.waystar.com/clients-partners/
- https://developer.waystar.com/
- https://focus.finops.org/focus-specification/v1-3/
alignedWith:
  framework: FinOps Foundation Framework
  frameworkUrl: https://www.finops.org/framework/
  dataSpec: FOCUS
  dataSpecVersion: '1.3'
  dataSpecUrl: https://focus.finops.org/focus-specification/v1-3/
publisherName: Waystar
serviceCategory: Healthcare Revenue Cycle Management
billingModel:
  pricingCategory: Contract / Per-Transaction
  billingFrequency: Monthly
  billingCurrency: USD
  chargeCategories:
  - Purchase
  - Usage
  - Adjustment
focusColumns:
  ServiceName: Waystar Platform
  ServiceCategory: Healthcare Revenue Cycle Management
  ProviderName: Waystar
  PublisherName: Waystar
  InvoiceIssuerName: Waystar
  BillingCurrency: USD
  ChargeCategory: Usage
  PricingCategory: Contract / Per-Transaction
meters:
- name: eligibility_transactions
  description: Eligibility/benefit inquiries (X12 270/271) processed through the clearinghouse.
  unit: transactions
  aggregation: sum
  dimensions:
  - account
  - payer
  - provider
- name: claim_transactions
  description: Claims submitted (X12 837P/I/D) through the clearinghouse.
  unit: claims
  aggregation: sum
  dimensions:
  - account
  - payer
  - claim_type
- name: claim_status_transactions
  description: Claim status inquiries (X12 276/277).
  unit: transactions
  aggregation: sum
  dimensions:
  - account
  - payer
- name: remittance_transactions
  description: Remittance advice / ERA (X12 835) retrieved and posted.
  unit: transactions
  aggregation: sum
  dimensions:
  - account
  - payer
- name: authorization_transactions
  description: Prior authorization / referral reviews (X12 278) plus RPA-assisted authorizations.
  unit: transactions
  aggregation: sum
  dimensions:
  - account
  - payer
- name: platform_subscription
  description: Recurring platform/module subscription independent of transaction volume.
  unit: months
  aggregation: sum
  dimensions:
  - account
  - module
principles:
- name: Visibility
  description: Track transaction counts by type (eligibility, claims, status, remits, auth) and by payer to see where clearinghouse fees accrue.
- name: Allocation
  description: Map transactions to provider/practice/team so RCM spend maps to internal cost centers and lines of business.
- name: Optimization
  description: Reduce avoidable transactions - cut denials and rework, batch where real-time is not required, and consolidate eligibility checks - to lower per-transaction spend.
- name: Accountability
  description: Assign owners per module and review monthly transaction volume and fees against the contracted tiers.
maintainers:
- FN: Kin Lane
  email: kin@apievangelist.com