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Waystar vs TriZetto Provider Solutions

Compared by PracticeAll's healthcare IT team · Updated · How we review

The short answer

Waystar and TriZetto Provider Solutions are both clearinghouses with eligibility, claim editing and denial tools, but they differ in scope. Waystar is a software platform covering financial clearance through patient payments and analytics, with AltitudeAI automation, and it serves practices through large health systems. TriZetto, part of Cognizant, is often embedded in practice management systems and adds outsourced billing, coding and credentialing services. TriZetto's 2024 to 2025 portal breach is a point to raise in security review.

Choose Waystar if you keep billing in-house and want eligibility, authorizations, claims, denials and patient payments on one software platform.

Choose TriZetto Provider Solutions if your PM system already uses it and you may want to outsource billing, coding or credentialing to the same vendor.

Waystar vs TriZetto Provider Solutions at a glance

WaystarTriZetto Provider Solutions
Best forPractices and health systems with in-house billing that want one RCM software platformPractices and billing companies wanting a clearinghouse plus optional outsourced services
Practice sizePhysician practices to large health systems; 30,000+ clientsPhysician practices, billing services, hospitals and health centers
Starting priceNot publishedNot published
Pricing modelQuote-based; rates not publishedQuote-based; can also be arranged through a partner PM or EHR vendor
Core approachSoftware-only platform from eligibility to remittance, denials and analyticsClearinghouse with RCM tools, plus billing, coding and credentialing services
EHR integrations500+ EHR and PM systems, including Epic, eClinicalWorks, NextGen, AdvancedMD and Kareo650+ direct EMR and PM integrations
HIPAA / BAAHITRUST CSF certification announced 2021; request BAAStates SOC 2, EHNAC and HITRUST; reported a breach in 2025; request BAA
PlatformsCloud web interface or inside your PM systemCloud clearinghouse portal; also embedded in partner PM systems
Notable strengthBreadth: prior auth, estimates, patient payments, denials and AI in one suiteEmbedded in many PM systems, with outsourced services available
Main drawbackBroad suite may be more than a small practice needs; no public pricing2025 portal breach affecting more than 3.6 million people, per state filings

Key differences

Scope of the platform

Waystar's platform covers financial clearance (eligibility, estimates, coverage detection and authorization), claim management and attachments, remittance and patient payments, denial and appeal management, and analytics. It says it processes more than 7.5 billion payment transactions a year. TriZetto Provider Solutions covers similar ground on the claims side, with eligibility, patient estimates, prior authorization, claim editing, ERAs and denial recovery, plus contract management to spot underpayments. The difference is that TriZetto also sells people: billing, coding, revenue recovery and credentialing services. Waystar is software your staff or billing company run.

Claim editing and AI

Waystar applies AltitudeAI, which it describes as predictive, generative and agentic AI, across its workflows, and cites a 98.5% average first-pass clean claims rate. TriZetto's Advanced Claim Editing adds machine learning denial prediction and more than 30,000 coding-specific edits inside its clearinghouse portal, and TriZetto says, citing Cognizant denial data, that it can help reduce avoidable denials by 50%. TriZetto cites a 98% average payer acceptance rate. All of these are vendor figures; ask for results from practices of your size and specialty.

Connectivity and PM integration

Waystar lists 5,000+ payer connections and 500+ EHR and PM integrations, and publishes a supported systems list that includes Epic, eClinicalWorks, NextGen, AdvancedMD and Kareo. Staff can work in Waystar's interface or inside their PM system. TriZetto cites 650+ direct EMR and PM integrations and publishes a payer list; its pages give 8,000+ or 11,000+ payer connections depending on the page. Many practices use TriZetto because their PM vendor has built it in, which can simplify setup.

Security record

Waystar announced HITRUST CSF certification in April 2021. TriZetto says its clearinghouse is HITRUST, SOC 2 and EHNAC accredited. HIPAA Journal reports that TriZetto detected suspicious activity in its web portal on October 2, 2025, that unauthorized access began in November 2024, and that state filings indicate more than 3.6 million people were affected. The exposed eligibility transaction records included names, Social Security numbers and health insurance details. Ask TriZetto what changed after the incident, and ask both vendors for current audit reports.

Which should you choose?

For claims and eligibility alone, both can do the job. Choose based on how much of the revenue cycle you want in one system, and whether you want services as well as software.

Choose Waystar if:

  • Your billing team wants one platform for authorizations, estimates, claims, denials and patient payments
  • You are a larger group, ASC or health system needing analytics and AI tools
  • Your PM system is on Waystar's supported list

Choose TriZetto Provider Solutions if:

  • Your PM or EHR vendor already embeds TriZetto as its clearinghouse
  • You want the option to outsource billing, coding or credentialing
  • You want contract management to check payments against payer contracts

Consider Inovalon if Medicare DDE access matters, or Office Ally for a clearinghouse paired with a $0 practice management system.

Read the full reviews

Waystar logoWaystar reviewPractices wanting clearinghouse, eligibility and denial tools in one platformContact for pricingTriZetto Provider Solutions logoTriZetto Provider Solutions reviewPractices and billing services that want a large clearinghouse plus optional RCM servicesContact for pricing

Sources

  1. Waystar: About us
  2. Waystar: Physician and specialty practices
  3. Waystar: Supported systems
  4. Waystar achieves HITRUST CSF certification (April 2021)
  5. TriZetto Provider Solutions homepage
  6. TriZetto claims management
  7. TriZetto Advanced Claim Editing
  8. TriZetto payer list
  9. HIPAA Journal: TriZetto Provider Solutions data breach

Waystar vs TriZetto Provider Solutions: FAQ

Is Waystar or TriZetto better for a small practice?

TriZetto is often the simpler choice for a small practice whose PM system already uses it, since setup runs through the PM vendor and outsourced billing is available later. Waystar suits small practices that bill in-house and want eligibility, claim tracking, denial and patient payment tools in one place, though much of its suite goes beyond what a small practice needs. Compare quotes for your claim volume.

What is the price difference between Waystar and TriZetto?

Neither vendor publishes pricing, so both require a quote. TriZetto pricing can depend on whether you buy directly or through your PM or EHR vendor, and outsourced billing is priced separately. Ask both for per-claim or per-provider fees, add-on module costs, implementation fees and contract length in writing.

Do Waystar and TriZetto work with eClinicalWorks?

Waystar lists eClinicalWorks on its published supported systems list, along with Epic, NextGen, AdvancedMD and Kareo. TriZetto says it has more than 650 direct EMR and practice management integrations but does not name them on its homepage. Confirm with your PM or EHR vendor which clearinghouses it supports and whether switching changes your fees.

Are Waystar and TriZetto HIPAA compliant, and do they sign a BAA?

Both handle claims data as HIPAA business associates and should sign a BAA. Waystar announced HITRUST CSF certification in 2021. TriZetto states HITRUST, SOC 2 and EHNAC credentials, but reported a web portal breach, detected in October 2025, that state filings put at more than 3.6 million people. Ask each vendor for its current HITRUST letter or SOC 2 report.

Can you switch from TriZetto to Waystar, or use both?

Yes. Switching clearinghouses usually means new payer enrollment for ERAs and electronic funds, testing with your PM system and a period of running both while old claims settle. Some organizations keep one clearinghouse for submission and add another vendor's tools for specific tasks. Check your contract's notice period before starting.