Wayspring delivers a cloud‑based platform that automates prior authorization and benefits verification for specialty medications by connecting directly to EHR systems (Epic, Cerner, etc.) via HL7/FHIR and to payer APIs for real‑time eligibility checks. The solution auto‑populates required forms, routes requests, tracks status, and provides analytics and patient‑portal notifications to shorten approval cycles and support medication adherence.
Funding
$45M raised to dateRaised to date based on public sources. This may differ from the amount the company actually raised and is based only on what is publicly available on the internet.
CHFounders
Product
Problem
Healthcare providers prescribing specialty medications must navigate labor-intensive prior authorization and benefits verification workflows, which often involve manual data entry, multiple payer portals, and lengthy turnaround times. These complexities delay medication access and contribute to suboptimal patient adherence, especially for high-cost therapies.
Solution
Wayspring offers a cloud‑based platform that automates the prior authorization and benefits verification processes for specialty drugs. The system connects directly to electronic health record (EHR) systems and payer APIs using HL7/FHIR standards, enabling real‑time eligibility checks and auto‑population of required forms. Workflow rules route requests to the appropriate payer, track status, and trigger electronic signatures where needed. Providers receive instant notifications of approval, denial, or additional information requests, reducing cycle times from days to hours. Integrated analytics surface bottlenecks and compliance metrics, allowing health systems to optimize staffing and improve overall medication fulfillment rates. The platform also supports patient‑facing portals that deliver status updates and next‑step instructions, helping maintain adherence.
Target Audience
The primary customers are specialty pharmacies, health systems, and physician practices that prescribe high‑cost specialty therapies and need to streamline prior‑authorization workflows. Secondary users include payer networks seeking integrated, automated claim verification solutions.
Features
- Bidirectional EHR integration (Epic, Cerner, etc.) via HL7/FHIR for seamless order capture and result return
- Direct payer connectivity through secure APIs for real‑time eligibility and benefits verification
- Automated prior‑auth generation with dynamic form population and electronic signature capture
- Rules‑engine driven routing and escalation to appropriate payer contacts or clinical reviewers
- Centralized document repository with audit‑ready storage and role‑based access controls (HIPAA compliant)
- Real‑time status dashboards and KPI reporting on turnaround times, denial rates, and cost metrics
- Patient portal notifications (SMS/email) delivering approval status and medication pickup instructions
- AI‑assisted recommendation engine suggesting formulary alternatives or supplemental assistance programs