# Medi vs Waystar

An RCM-platform comparison for billing companies evaluating Medi alongside Waystar.

URL: https://medibilling.app/compare/waystar
Last reviewed: 2026-07-27

# Medi vs Waystar

## Short answer

Waystar is an enterprise healthcare revenue cycle platform for health systems, hospitals, and large physician groups. It processes more than five billion payment transactions a year, serves over 30,000 provider organizations, went public on Nasdaq in June 2024 at a $3.5 billion valuation, and prices by custom quote with no public tiers. Medi is a billing-company-first revenue cycle platform priced per claim: it starts at $1.00 per claim and drops to $0.90 and $0.80 once monthly volume passes the published thresholds, with no monthly fee, no per-practice fee, no per-provider fee, and ERA posting included in the claim price.

They serve different buyers, so the comparison is rarely apples to apples. Choose Waystar if you are a hospital, health system, or large multi-specialty group that needs clinical documentation integrity, enterprise denial prevention, patient payment infrastructure, and autonomous AI workflows in one platform. Choose Medi if you are an independent billing company that runs claims, denials, appeals, ERAs, and collections across many client practices and wants cost that tracks claims billed, at a rate that steps down as the book grows. Size is the wrong tiebreaker. Ask which platform owns the daily work queue for the people doing the billing.

## How the two compare

| What a billing company evaluates | Waystar | Medi |
|---|---|---|
| Built for | Hospitals, health systems, large groups | Independent billing companies |
| Primary tenant | The provider organization | The billing company (practice is a scoped tenant) |
| Pricing model | Custom quote, commonly multi-year auto-renew | Published per claim, month to month |
| Scales with | Modules and organization size | Claims billed, not providers or practices |
| EHR / charting | No (connects to Epic, Oracle Health, others) | No |
| Clearinghouse | Self-operated (850+ payers); Navicure/ZirMed lineage | Stedi |
| Clinical documentation integrity | Yes (Iodine Software) | No |
| Patient payment portal | Yes (Patientco) | No |
| AI layer | AltitudeAI, 150+ models, autonomous agents | None |
| Cross-practice work queues | Not the design center | Core design |
| Practice-scoped staff permissions | Enterprise IAM | Built in (e.g. offshore poster sees 4 of 8 clients) |
| Data export / termination fee | Contract terms | Free export, no termination fee |
| Implementation | Months | Weeks |

## Choose Waystar if your organization is a health system

Waystar built its platform for large, complex healthcare organizations. Named clients include Piedmont, CHRISTUS Health, Cincinnati Children's, Mount Sinai, Renown Health, and University Hospitals, and the platform serves 18 of the 22 institutions on the U.S. News Best Hospitals Honor Roll. A [Black Book survey of 750-plus healthcare leaders](https://www.waystar.com/) rated Waystar 9.75 out of 10 across 18 KPIs, ahead of the next competitor at 8.27.

The platform spans six solution areas: financial clearance (eligibility, prior authorization, patient estimation, charity screening), clinical integrity and revenue capture (charge anomaly detection, DRG validation, CDI via the $1.25 billion [Iodine Software acquisition](https://www.waystar.com/news/waystar-to-acquire-iodine-software-accelerating-the-ai-powered-transformation-of-healthcare-payments/) completed in 2025), claim and payer payment management, denial recovery, patient financial care, and analytics. Its [AltitudeAI](https://www.waystar.com/news/waystar-accelerates-the-autonomous-revenue-cycle-with-ai-powered-innovations-featured-at-spring-showcase/) layer runs over 150 models and, as of the Spring 2026 showcase, has prevented $15.5 billion in denials while cutting appeal time by 90 percent. An agentic recoupment-matching tool announced in early 2026 matched $32 million in revenue risk for one early-adopter health system, work the company equated to roughly 13 full-time employees.

Waystar fits if:

- You are a hospital, health system, integrated delivery network, or large multi-specialty group.
- You need CDI and prebill revenue-leakage detection inside your RCM workflow.
- You want one vendor across patient access, authorization, submission, remittance, denials, patient payments, and analytics.
- Your claim volume is high enough that autonomous AI agents change the economics.
- You already run Epic or Oracle Health and need a clearinghouse and RCM layer that connects to it.
- Your budget supports six-figure annual contracts and a multi-month implementation.

## Choose Medi if billing is the business you sell

Medi is built for independent billing companies that run revenue cycle work as their product across many client practices. The cost starts at $1.00 per claim and moves to $0.90 and then $0.80 at the volume marks published on the pricing page. There is no monthly fee, no per-practice fee, and no per-provider fee. Medi has no EHR, scheduling, charting, CDI, or patient payment portal, because the buyer is the billing company, not the health system.

Medi fits if:

- Billing is the business you sell, not a department inside a hospital.
- Your team is organized by function (posters, denial leads, follow-up specialists) and needs cross-practice queues so a specialist can work every client's denials without switching contexts.
- You want cost that tracks claims billed at published tiers, does not scale with provider count or practice count, and needs no sales call to understand.
- Your clients already have an EHR and want a billing-only relationship.
- You need practice-scoped permissions so an offshore poster can reach four of your eight clients but not the other four, inside one workspace.
- You want EDI billed as it is consumed, not wrapped into a seat fee you cannot audit.

## Pricing reality

Waystar does not publish pricing; its process is demo-first and custom-quote only. Third-party analyses [estimate the range at roughly $0.20 to $0.35 per claim](https://www.verifytx.com/waystar-pricing/) for clearinghouse usage, with annual platform contracts that reviewer aggregators put from roughly $11,000 per year for smaller groups up to $200,000 to $1,000,000 or more for enterprise health system agreements. Reviewers also cite layered implementation and integration fees on top. Treat all of these as estimates and confirm with Waystar.

Medi's fee structure is published and fixed:

| Fee | Amount |
|---|---|
| Platform fee | None; no per-practice fee, no per-provider fee |
| Providers inside a practice | Unlimited, no additional fee |
| Claim submission (837P) | Starts at $1.00 per claim, with $0.90 and $0.80 rates for the volume above each published tier mark (ERA/835 posting included) |
| ERA posting (835) | Included in the per-claim fee; no separate charge |
| Eligibility check (270/271) | $0.25 per inquiry |
| Claim status (276/277) | $0.20 per inquiry |
| COB inquiry, discovery, attachments | $1.50 per transaction; in controlled rollout, turned on during onboarding rather than by default |
| 277CA acknowledgments, claim PDFs | Included |
| Migration (month to month) | $100 per practice, capped at $3,000 (one-time) |
| Migration (12-month commitment) | Free |
| Data export | Always free |
| Early-termination fee | None |
| Contract | Month to month available; no auto-renewal lock-in |

Model your own book with the [pricing calculator](/tools/pricing-calculator).

The pricing gap is not a verdict on quality. It is a structural difference in who each product is for: Waystar prices a platform spanning CDI, autonomous agents, and patient payment infrastructure; Medi prices a billing-company work surface.

## Scale and acquisition history

Waystar reported roughly $835 million in 2024 revenue with adjusted EBITDA margins above 40 percent, and went public on Nasdaq in [June 2024](https://www.waystar.com/news/waystar-announces-pricing-of-initial-public-offering/) at a $3.5 billion valuation, raising $968 million. It was formed in 2017 from the merger of Navicure and ZirMed, two of the original electronic claims clearinghouses, and the current platform consolidates eight-plus products: Recondo (patient estimation and prior authorization, 2019), Patientco (patient payments, 2021), eSolutions (Medicare RCM analytics), Ovation (claims monitoring), and Iodine Software (CDI, 2025).

That history matters for a billing company. The breadth is a real advantage for a health system that wants one vendor. For an independent billing company running fifteen to two hundred providers, it raises a different question: which modules of an enterprise suite will your team actually use, and how does daily operation feel at that scale rather than at fifteen hundred providers?

Medi is built at the billing-company level by design: one workspace, multiple client practices, practice-scoped permissions, cross-practice reporting, and queue routing that matches how billing teams are organized. There is no CDI, patient portal, prior-authorization workflow, or hospital-trained AI, because the buyer does not need them.

## Stack role

What Waystar covers depends on the modules an organization licenses. At full deployment it spans the pre-claim and post-claim cycle: identity verification, financial clearance, prior authorization, charge-capture integrity, scrubbing, submission, remittance, denial prevention, appeal generation, patient billing and self-service payments, and analytics. The [AltitudeAI](https://www.waystar.com/news/waystar-introduces-agentic-ai-advance-toward-autonomous-revenue-cycle/) agentic layer, announced in January 2026, is meant to identify a denial reason, pull the clinical record, pre-populate a correction, and submit an appeal without a staff member doing those steps. Waystar also runs as a standalone clearinghouse (837, 835, 270/271, 276/277) without the broader suite; that piece reflects its Navicure and ZirMed roots.

Medi covers the billing-company operating layer. Generally available: professional claim building, scrubbing, and submission via Stedi; ERA review with CARC and RARC translation, per-line posting, and PLB handling, with auto-posting available as an opt-in once a billing company turns it on; denial queues by practice and payer; appeals and tracking; payer enrollment; patient statements; fee schedule management; practice and provider setup; cross-practice A/R aging; permission tiers for billing-company staff; and audit logging retained seven years, beyond HIPAA's six-year documentation retention minimum (45 CFR 164.316(b)(2)(i)). A BAA is signed before any PHI workflow goes live.

In controlled rollout, turned on during onboarding rather than by default: underpayment detection, the recovery workspace, COB inquiry, insurance discovery, and claim attachments. They are built, not vapor, but they are not switched on for everyone, so treat them as a conversation during onboarding rather than something running on day one.

Medi has no EHR, scheduling, patient payment portal, prior authorization, CDI, or hospital-trained AI, and it generates professional claims only, with no institutional 837I path. If you need those from your billing software, Medi is the wrong product.

## What should a billing company verify before choosing?

The deciding factor is the daily work surface your staff uses after implementation, not either product's marketing. Pressure-test these in a side-by-side walkthrough:

- Where does cross-practice denial routing live, and can a specialist work every assigned client's open denials from one screen without switching practice contexts?
- How does the system handle a payer ERA with PLB segments, recoupment lines, and line-level adjustments spanning multiple client practices at once?
- What does a manager see for A/R aging across the full book versus one client, and can they drill from the aggregate to a single claim?
- How do practice-level rules layer on top of payer-level rules without conflicts a biller has to resolve by hand?
- What is the permission model for offshore staff who should reach some but not all client practices?
- How is payer enrollment (trading-partner agreements, NPI registration, ERA enrollment) tracked across many client practices?
- What is the all-in first-year cost, including implementation, integration, training, and any module or usage fees outside the base contract?
- What exports cleanly before a migration decision, and what operational state (open appeals, in-flight authorizations, unposted ERAs, follow-up notes) does not?

For a billing company looking at Waystar, the question worth answering honestly is whether the enterprise platform fits the operational need, or whether your largest client is a health system already on Waystar and you are being pulled into the same procurement.

## Is Medi always a better fit than Waystar?

No. It depends on who is evaluating.

Waystar is the right answer for hospital systems and enterprise RCM operations. Its scale, AI infrastructure, CDI, payer-network breadth, and patient payment tools are built for organizations that process hundreds of thousands of claims a year and want one vendor across the full revenue cycle. Hospitals on Waystar are buying the right product for their context.

Medi is the right answer for independent billing companies whose clients do not need CDI, patient financial tools, or enterprise AI agents, and who want a billing-company work surface with published per-claim pricing that steps down as the book grows. A shop managing claims, denials, appeals, ERAs, and collections across small to mid-sized practices is a different buyer than a hospital CFO signing an enterprise contract.

The comparison genuinely comes up in two cases: an independent billing company that has grown large enough to attract Waystar, or a Waystar-using hospital wondering whether its in-house billing office should sit on the same platform as its clinical departments. Both are legitimate, and the answer turns on which workflows drive the daily work and who owns them.

## Other comparisons billing companies look at

Waystar competes at enterprise scale with athenahealth, Epic Resolute, and other large RCM platforms. For independent billing companies, the more relevant comparisons are mid-market PM and billing-company-first platforms.

- [Medi vs Tebra](/compare/medi-vs-tebra) — the most common comparison for independent billing companies; very different scale than Waystar.
- [Medi vs AdvancedMD](/compare/advancedmd) — per-provider PM that moved its clearinghouse to Waystar in 2025.
- [Medi vs CollaborateMD](/compare/collaboratemd) — direct billing-company-first PM at independent scale.
- [Medi vs PracticeSuite](/compare/practicesuite) — multi-tenant billing-service PM with EHR bundling.
- [Medi vs Claim.MD](/compare/claim-md) — clearinghouse-focused at the opposite end of the scale from Waystar.
- [Medi vs Office Ally](/compare/office-ally) — free-tier clearinghouse with Practice Mate PM.
- [Medi vs Availity](/compare/availity) — payer-network layer that competes with Waystar at the enterprise clearinghouse tier.
- [Best Waystar alternatives for billing companies](/best/waystar-alternatives) — the full field of options beyond the head-to-head pages.

The [billing-company software evaluation guide](/docs/billing-company-software-evaluation-guide) covers when enterprise RCM is the right answer versus a billing-company-first operating layer.

## Frequently asked questions

### Is Waystar a clearinghouse or a full RCM platform?

Both, depending on the license. Waystar began as the combination of Navicure and ZirMed, two established claims clearinghouses, and has since built a full RCM platform on top, adding prior authorization, CDI, patient payments, denial management, and AI workflow automation. You can license it as a clearinghouse layer or as end-to-end RCM. The clearinghouse roots are why Waystar carries over 850 payer connections and why EHR vendors like NextGen Healthcare publish integrations with it for EDI.

### Is Waystar a good Medi alternative for an independent billing company?

Rarely. Waystar is engineered at health-system scale and economics: enterprise contracts, custom pricing, multi-month implementations, and a surface that includes CDI, patient portals, and agentic AI. For a billing company running fifteen to two hundred providers across many client practices, that breadth is overhead for workflows you do not own. Your daily work — claim building, denial routing, ERA posting, follow-up queues, payer enrollment — is a subset of what Waystar covers, and a billing-company-first platform tends to fit that subset more directly.

### What does Waystar actually cost?

Waystar does not publish pricing; all quotes require a sales engagement. Third-party aggregators cite a range from roughly $11,000 per year for smaller organizations to $200,000 to $1,000,000 or more per year for enterprise health system agreements, with implementation, EHR-integration, and training fees layered on top and also custom-quoted. The structure assumes formal procurement, multi-year budgets, and an IT team to manage integration. These figures are estimates, not published rates.

### Does Medi connect to the same payers as Waystar?

Medi uses [Stedi](https://www.stedi.com/) for 837 professional claim submission, 835 ERA, 270/271 eligibility, 276/277 claim status, and 277CA acknowledgments. There is no 278 prior-authorization transaction on the Medi side. Stedi's network covers the major commercial payers, Medicare, and Medicaid programs most billing companies work with. Waystar documents connections to over 850 payers. For specialty payers or state Medicaid programs with non-standard EDI, verify connectivity directly with either vendor.

### Can a billing company use both Waystar and Medi?

In theory, yes, though it is unusual. Some billing companies serving large health systems run Waystar at the health-system level for enterprise RCM and CDI while using a billing-company-first platform like Medi for independent practice clients. Running two platforms — enrollment, queues, reporting, permissioning — is real overhead, and most pick one operating layer. More often, a billing company evaluating Waystar is doing so because a large health system client uses it and wants the company to connect in, not replace its own platform.

### How current is this comparison?

Last reviewed 2026-07-27. Waystar is publicly traded (Nasdaq: WAY), and its product, pricing, and acquisitions change. Primary sources for current positioning are [waystar.com](https://www.waystar.com/) and [investors.waystar.com](https://investors.waystar.com/). Pricing estimates here come from third-party aggregators and market analyses available at review time; they are estimates, not published rates. Verify current pricing and packaging with Waystar before any procurement decision.