Pega Smart Claims Management for Healthcare vs Waystar

Pega Smart Claims Management for Healthcare9.1Visit Waystar8.7Visit

Higher score Pega Smart Claims Management for Healthcare #2 in Healthcare Claims Processing And Management Software 9.1/10 Pricing on request ✓ 4 of 6 features Contact Pega

vs

Waystar #4 in Healthcare Claims Processing And Management Software 8.7/10 Pricing on request ✓ 2 of 6 features Visit Waystar

• Pega Smart Claims Management for Healthcare fits best

  Enterprise health plans with configurable claims workflows

• Waystar fits best

  Providers seeking broad revenue-cycle claims automation

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Side by side

Feature	Pega Smart Claims Management for Healthcare 9.1/10 Visit ↗	Waystar 8.7/10 Visit ↗
At a glance
Editor score	9.1	8.7
Ranking	#2 in Healthcare Claims Processing And Management Software	#4 in Healthcare Claims Processing And Management Software
Best for	Enterprise health plans with configurable claims workflows	Providers seeking broad revenue-cycle claims automation
Pricing model	Paid	Paid
Starting price	Pricing on request	—
Free plan	—	Not checked yet
Free trial	—	—
Deployment	Cloud, Self-hosted	Cloud
Platforms	Web	Web
Compliance	HIPAA	SOC 2, HIPAA, PCI DSS
Built for	Enterprise	Small business, Mid-market, Enterprise
Features Pega Smart Claims Management for Healthcare 4/6 · Waystar 2/6
Claim submission	✓ (best)	Not checked yet
Claim status tracking	✓ (best)	Not checked yet
Claims adjudication	✓ (best)	Not checked yet
Denial management	Not checked yet	✓ (best)
EDI transactions	✓ (best)	Not checked yet
Eligibility verification	Not checked yet	✓ (best)
Our review
Pros	Accepts claims through XML, EDI, API, or manual entry Supports automated adjudication and examiner review Includes inventory routing, audit trails, reporting, and regression testing	Automates eligibility, claim scrubbing, status follow-up, and denial workflows Supports remittance matching, payment posting, reconciliation, and patient payments Connects with EHR and practice-management systems, with 530 integrations
Cons	Pricing requires contacting sales Workflow configuration may be more than smaller teams need Claims testing relies on reusable test claims, scenarios, and regression sets	Pricing requires a request to sales Broad workflow coverage may exceed the needs of teams seeking a narrow tool Published positioning emphasizes revenue-cycle workflows over adjudication
Our verdict	Pega Smart Claims Management for Healthcare supports health plans processing claims through configurable workflows and business rules. It covers intake, pre- and post-adjudication edits, adjudication, work routing, and finalization or… Read the review →	Waystar provides cloud-based revenue cycle software for physician practices, billing services, hospitals, and health systems. Its coverage follows claims through financial clearance, editing and submission, status follow-up, denials and… Read the review →

Strengths and trade-offs

• Pega Smart Claims Management for Healthcare — where it wins

  • Accepts claims through XML, EDI, API, or manual entry
  • Supports automated adjudication and examiner review
  • Includes inventory routing, audit trails, reporting, and regression testing

  Where it doesn't

  • Pricing requires contacting sales
  • Workflow configuration may be more than smaller teams need
  • Claims testing relies on reusable test claims, scenarios, and regression sets

• Waystar — where it wins

  • Automates eligibility, claim scrubbing, status follow-up, and denial workflows
  • Supports remittance matching, payment posting, reconciliation, and patient payments
  • Connects with EHR and practice-management systems, with 530 integrations

  Where it doesn't

  • Pricing requires a request to sales
  • Broad workflow coverage may exceed the needs of teams seeking a narrow tool
  • Published positioning emphasizes revenue-cycle workflows over adjudication

• Pega Smart Claims Management for Healthcare9.1/10 · Pricing on request

  An enterprise claims workflow system spanning intake, adjudication, routing, and testing.

  Contact PegaFull verdict →
• Waystar8.7/10 · Pricing on request

  Broad claims-to-payment automation for healthcare providers, with pricing by request.

  Visit WaystarFull verdict →