Setting Up Waystar for Prior Authorization Automation

Before setup, it helps to understand what the tool actually automates:

What it automates:

• Identifies when a case on your OR schedule requires prior authorization (based on payer rules)
• Pre-fills authorization request forms with clinical data from your EHR
• Submits requests electronically to payers who accept electronic submissions
• Tracks authorization status across all open requests in a single dashboard
• Alerts you when authorizations are approved, pending, or denied
• Handles some payers' auto-approval workflows without human intervention

What it doesn't automate:

• Clinical documentation that doesn't exist in your EHR yet (you still need notes from the physician)
• Peer-to-peer reviews (still requires a physician phone call)
• Fax-based payers who don't accept electronic submissions (though Waystar can handle some fax workflows)

Contact your Waystar account representative or go to waystar.com to request a demo of Auth Accelerate.

During the demo and setup, you'll be asked to provide:

• Your most common insurance companies and plan types
• Your most common CPT code combinations
• Your EHR system name and version

What you should see: A demo showing the authorization workflow from case scheduling to approval tracking.

This step requires IT support or your EHR vendor's help. The integration sends case scheduling data from your EHR (SIS, HST Pathways, etc.) to Waystar automatically when a case is added to the OR schedule.

Work with your Waystar implementation specialist (they provide this) and your EHR vendor to:

1. Enable the Waystar integration module in your EHR
2. Map the relevant data fields (patient demographics, procedure codes, diagnosis codes, scheduled date)
3. Test with 3–5 sample cases to verify data flows correctly

What you should see: When a case is added to your OR schedule, it appears in Waystar within minutes with the patient and procedure information pre-filled.

Waystar maintains a database of payer authorization requirements. You'll review and customize these for your specific payer contracts:

1. Log into your Waystar account
2. Go to Settings → Authorization Rules
3. Review the default rules for each of your major payers
4. Add any center-specific rules: "Blue Shield requires prior auth for all orthopedic procedures over $1,000"

What you should see: A list of payer rules that tells Waystar when to automatically flag a case for prior authorization.

In Waystar, go to the Authorization module. You'll see a dashboard showing:

• Cases that need authorization submitted
• Cases with authorizations pending
• Cases approved (with auth numbers populated back to your EHR)
• Cases denied (requiring follow-up or appeal)

Configure your notification preferences: set up email alerts for approvals, denials, and cases approaching their surgery date without an authorization.

What you should see: A centralized view of all open authorizations, color-coded by status.

Find a case in the dashboard that needs prior authorization. Click on it. You'll see the pre-filled authorization request with patient demographics and procedure codes already populated.

Review the pre-filled information. Add any additional clinical notes or documentation required for this payer. Click Submit. Waystar sends the request electronically to the payer.

What you should see: The case status changes to "Submitted" with a timestamp. Most electronic submissions receive a payer acknowledgment within minutes.