Supergood | Waystar API

Automate eligibility checks, claim submission, claim status tracking, and remittance reconciliation in Waystar with a stable REST API. Supergood builds and operates production-grade, unofficial Waystar integrations so your team can streamline revenue cycle and patient payment workflows without heavy custom engineering.

Waystar is healthcare revenue cycle software used by health systems, provider groups, and billing companies to verify coverage, scrub and submit claims, manage denials, post remittances, and collect patient payments. With an unofficial API, you could run real-time eligibility before visits, submit and track professional/institutional claims with payer-specific edits, pull ERA remittances for posting, and keep billing queues synchronized—end to end.

If you’re a healthcare tech startup, RCM vendor, or practice management platform, integrating with Waystar unlocks concrete data flows and features:

• Pull: Eligibility responses (271), claim statuses (277), payer edits, ERA remittances (835), EFT details, denial codes (CARC/RARC), underpayment insights
• Push: Eligibility requests (270), professional (837P) and institutional (837I) claims, corrected claims, resubmissions with references, claim attachments metadata
• Build: Front-desk eligibility at scheduling/check-in, automated claim scrubbing and submission, real-time status dashboards, posting/reconciliation pipelines, denial worklists, patient financial experience features driven by estimates and payments

What is Waystar?

Waystar provides a unified revenue cycle and clearinghouse platform for healthcare providers. Its services span eligibility and coverage discovery, claim scrubbing and submission to thousands of payers, claim status tracking, electronic remittance posting, denial/underpayment analytics, prior authorization support, and patient payment and price estimate tools.

Core product areas include:

• Eligibility & Coverage Discovery (270/271)
• Claim Scrubbing, Submission & Status (837P/I, 276/277)
• Remittance & Posting (835 ERA, EFT/EOB)
• Denial & Underpayment Management (CARC/RARC analytics)
• Patient Payments & Price Estimates
• Prior Authorization & Referral Management (select modules)
• Revenue analytics and performance reporting

Common data entities:

• Patients and Guarantors
• Payers and Insurance Plans
• Providers (billing/rendering/facility) and NPIs/TINs
• Claims and Service Lines (837 professional/institutional)
• Eligibility Requests/Responses (270/271)
• Claim Status Notifications (276/277)
• Remittances (835 ERAs), Payments, Adjustments, Refunds
• Denials, Underpayments, and Workqueues
• Patient Estimates and Statements

The Waystar Integration Challenge

Teams rely on Waystar daily, but turning portal- and EDI-driven RCM workflows into automated pipelines is hard:

• Payer diversity and edit logic: Each payer has unique requirements, real-time edits, and rules that live in Waystar’s scrubber
• Enterprise security: SSO/MFA and strict network controls complicate headless automation
• EDI formats and batching: 837/835/270/271/276/277 files, batching windows, and delivery confirmations must be orchestrated
• Portal-first processes: Denial workqueues, attachments, and resubmissions often live behind web UIs
• Normalization: CARC/RARC codes, payer IDs, and service line adjustments need consistent schemas across carriers

How Supergood Creates Waystar APIs

Supergood reverse-engineers authenticated browser flows, batch interfaces, and network interactions to deliver a resilient API endpoint layer.

• Handles username/password, SSO/OAuth, and MFA (SMS, email, TOTP) securely
• Maintains session continuity with automated refresh and change detection
• Normalizes eligibility, claim, status, and remittance objects so you can integrate once across payers
• Aligns with customer entitlements and licensing constraints to ensure compliant access
• Bridges batch EDI where applicable with signed URL retrieval and delivery; exposes parsed JSON and raw X12 artifacts

Use Cases

PM/EHR-to-Clearinghouse Synchronization

• Submit professional and institutional claims from your PM/EHR
• Receive payer scrubber edits in real time and surface fix suggestions to billers
• Track claim IDs and references for corrected and resubmitted claims

Eligibility at Scheduling and Check-In

• Validate coverage and service-type benefits before visits
• Cache 271 results to your patient profile with effective/termination dates
• Reduce denials for eligibility-related reasons

Claims Status and Exception Automation

• Poll status (received, accepted, pending, denied, paid) with payer reason codes
• Route stalled or denied claims to targeted workqueues with next best action
• Attach documentation and resubmit where supported

Remittance Posting and Reconciliation

• Pull ERAs, payments, and adjustments to auto-post to your ledger
• Normalize CARC/RARC at the line level for accurate accounting
• Match EFTs to remittances and reconcile deposits

Patient Financial Experience

• Use payer benefits to generate accurate estimates
• Trigger digital statements and payment links, and reconcile self-pay collections
• Feed final balances and refunds back to your billing system

Available Endpoints

Authentication

POST /sessions: Establish a session using credentials. Supergood manages MFA (SMS, email, TOTP) and SSO/OAuth when enabled. Returns a short-lived auth token maintained by the platform.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/sessions \
  --header 'Authorization: Basic <Base64 encoded token>' \
  --header 'Content-Type: application/json' \
  --data '{
    "username": "[email protected]",
    "password": "<password>",
    "mfa": {"type": "totp", "code": "123456"}
  }'

Example response

{
  "authToken": "eyJhbGciOi...",
  "expiresIn": 3600,
  "user": {
    "id": "u_5f41a2",
    "name": "RCM Admin",
    "entitlements": ["eligibility", "claims", "remittances"]
  }
}

Eligibility

POST /eligibility/check: Submit a real-time eligibility (270) request and receive a normalized 271 response. Use this before scheduling or check-in.

Body parameters

• patient: demographics and identifiers
• subscriber: when patient is dependent
• payerId: Waystar/clearinghouse payer identifier
• serviceDate: ISO 8601 date
• serviceTypeCodes: array of ANSI X12 service type codes (e.g., "30" for general coverage)
• provider: billing/rendering provider identifiers

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/eligibility/check \
  --header 'Authorization: Bearer <authToken>' \
  --header 'Content-Type: application/json' \
  --data '{
    "payerId": "payer_bcbs_tx",
    "serviceDate": "2026-01-24",
    "serviceTypeCodes": ["30", "98"],
    "provider": {"npi": "1234567890", "tin": "12-3456789"},
    "patient": {
      "firstName": "Jordan",
      "lastName": "Patel",
      "dob": "1988-04-12",
      "gender": "U",
      "memberId": "JXP1234567"
    }
  }'

Example response

{
  "eligibilityRequestId": "elg_72d9b1",
  "status": "eligible",
  "payer": {"id": "payer_bcbs_tx", "name": "BCBS Texas"},
  "coverage": {
    "planType": "PPO",
    "planName": "BlueChoice PPO",
    "memberId": "JXP1234567",
    "groupNumber": "G12345",
    "effectiveDate": "2025-01-01",
    "terminationDate": null
  },
  "benefits": {
    "copay": {"primaryCare": 25.0, "specialist": 45.0},
    "deductible": {"individual": 1500.0, "family": 3000.0, "remaining": 900.0},
    "outOfPocketMax": {"individual": 5000.0, "remaining": 3200.0}
  },
  "serviceTypes": [
    {"code": "30", "description": "Health Benefit Plan Coverage", "covered": true},
    {"code": "98", "description": "Professional (Physician) Visit - Office", "covered": true}
  ],
  "artifacts": {"x12": {"format": "271", "size": 20480}}
}

Claims

POST /claims: Submit a professional (837P) or institutional (837I) claim. Supergood normalizes service lines and returns scrubber edits and submission status.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/claims \
  --header 'Authorization: Bearer <authToken>' \
  --header 'Content-Type: application/json' \
  --data '{
    "claimType": "837P",
    "payerId": "payer_united",
    "billingProvider": {
      "npi": "1992749815",
      "tin": "98-7654321",
      "name": "Downtown Medical Group",
      "billingAddress": {
        "line1": "100 Health Way",
        "city": "Austin",
        "region": "TX",
        "postalCode": "78701"
      }
    },
    "patient": {
      "accountNumber": "PT-100233",
      "firstName": "Ava",
      "lastName": "Nguyen",
      "dob": "1992-07-03",
      "gender": "F",
      "subscriberRelationship": "self",
      "memberId": "UHC7788991"
    },
    "diagnosisCodes": [
      {"code": "J01.90", "qualifier": "ICD10"}
    ],
    "serviceLines": [
      {
        "sequence": 1,
        "cpt": "99213",
        "modifiers": ["25"],
        "units": 1,
        "chargeAmount": 135.00,
        "placeOfService": "11",
        "from": "2026-01-23",
        "to": "2026-01-23",
        "diagnosisPointers": [1]
      }
    ],
    "submit": true,
    "referenceId": "ehr-claim-20491"
  }'

Example response

{
  "claimId": "clm_9a3f21",
  "status": "accepted_pending_payer",
  "edits": [
    {"code": "WYS-0001", "severity": "warning", "message": "No referring provider supplied; not required for POS 11."}
  ],
  "payerId": "payer_united",
  "artifacts": {"x12": {"format": "837P", "size": 45123}},
  "createdAt": "2026-01-24T16:10:11Z",
  "referenceId": "ehr-claim-20491"
}

GET /claims: Retrieve claims by date range, status, or payer for monitoring and workqueue routing.

Query parameters

• since: ISO 8601 datetime
• until: ISO 8601 datetime
• status: one of queued|rejected_scrubber|accepted_pending_payer|paid|denied
• payerId: string

Example response

{
  "items": [
    {
      "claimId": "clm_9a3f21",
      "status": "accepted_pending_payer",
      "payerId": "payer_united",
      "patient": {"accountNumber": "PT-100233", "name": "Ava Nguyen"},
      "billedAmount": 135.0,
      "submittedAt": "2026-01-24T16:10:11Z"
    },
    {
      "claimId": "clm_7bc922",
      "status": "rejected_scrubber",
      "payerId": "payer_aetna",
      "patient": {"accountNumber": "PT-100198", "name": "Jordan Patel"},
      "billedAmount": 280.0,
      "submittedAt": "2026-01-24T15:00:09Z",
      "edits": [
        {"code": "WYS-1023", "severity": "error", "message": "Subscriber ID missing or invalid."}
      ]
    }
  ],
  "page": 1,
  "pageSize": 50,
  "total": 2
}

Remittances

GET /remittances: Retrieve ERA remittances (835) for posting and reconciliation. Returns claim- and line-level adjustments with CARC/RARC.

Query parameters

• from: ISO 8601 date
• to: ISO 8601 date
• payerId: string
• eftTraceNumber: string (optional)

curl --request GET \
  --url 'https://api.supergood.ai/integrations/<integration_id>/remittances?from=2026-01-01&to=2026-01-24&payerId=payer_united' \
  --header 'Authorization: Bearer <authToken>'

Example response

{
  "items": [
    {
      "remittanceId": "era_51dd20",
      "payerId": "payer_united",
      "paymentDate": "2026-01-23",
      "paymentMethod": "EFT",
      "eftTraceNumber": "20260123-UNH-88421",
      "totalPaid": 10235.74,
      "claimPayments": [
        {
          "claimId": "clm_9a3f21",
          "patientAccount": "PT-100233",
          "billedAmount": 135.0,
          "allowedAmount": 120.0,
          "paidAmount": 96.0,
          "patientResponsibility": 24.0,
          "adjustments": [
            {"group": "CO", "carc": "45", "remarkCodes": ["N538"], "amount": 15.0},
            {"group": "PR", "carc": "2", "remarkCodes": [], "amount": 24.0}
          ],
          "linePayments": [
            {
              "sequence": 1,
              "cpt": "99213",
              "billedAmount": 135.0,
              "allowedAmount": 120.0,
              "paidAmount": 96.0,
              "adjustments": [
                {"group": "CO", "carc": "45", "amount": 15.0},
                {"group": "PR", "carc": "2", "amount": 24.0}
              ]
            }
          ]
        }
      ],
      "artifacts": {"x12": {"format": "835", "size": 68742}}
    }
  ],
  "page": 1,
  "pageSize": 50,
  "total": 1
}

Get full API Specs →

Technical Specifications

• Authentication: Username/password with MFA (SMS, email, TOTP) and SSO/OAuth where enabled; supports service accounts or customer-managed credentials
• Response format: JSON with consistent resource schemas and pagination; raw X12 artifacts retrievable for audit
• Rate limits: Tuned for enterprise throughput while honoring licensing and usage controls
• Session management: Automatic reauth and cookie/session rotation with health checks
• Data freshness: Near real-time retrieval of eligibility, claim status, and remittance artifacts
• Security: Encrypted transport, scoped tokens, and audit logging; respects Waystar entitlements and compliance requirements
• Webhooks: Optional asynchronous delivery for claim status changes, scrubber edits, and remittance arrivals

Performance Characteristics

• Latency: Sub-second responses for list/detail queries under normal load
• Throughput: Designed for high-volume eligibility checks and batch claims/remittances
• Reliability: Retry logic, backoff, and idempotency keys minimize duplicate actions
• Adaptation: Continuous monitoring for UI/EDI changes with rapid adapter updates

Getting Started

1. Schedule Integration Assessment

Book a 30-minute session to confirm your Waystar product mix, licensing, and authentication model.

2. Supergood Builds and Validates Your API

We deliver a hardened Waystar adapter tailored to your workflows and entitlements.

3. Deploy with Monitoring

Go live with continuous monitoring and automatic adjustments as Waystar evolves.

Schedule Integration Call →

Frequently Asked Questions

Q: Which Waystar products can this integration cover?

Supergood supports workflows across commonly used Waystar eligibility, claim management, status, remittance, and patient financial tools, subject to your licensing and entitlements. We scope coverage (e.g., eligibility, claim scrubber/submit, 276/277 status, 835 retrieval) during integration assessment.

Q: How are MFA, SSO, and EDI/batch interfaces handled for automation?

We support username/password + MFA (SMS, email, TOTP) and can operate behind SSO/OAuth when enabled. For batch flows, we manage EDI timing windows, generate 837 files, and retrieve signed URLs or delivery confirmations programmatically.

Q: Can I post payments and reconcile directly from ERAs?

Yes. You can pull parsed 835s with line-level CARC/RARC and EFT details, then post to your PM/GL. We provide both normalized JSON and access to raw X12 for audit and dispute workflows.

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