Silna Health vs Waystar (2026)

Silna works with more than 1,000 payers across 50 states, calling insurers for benefits and authorization status and submitting through their portals. On the provider side it connects to the EHR and practice management systems ABA providers already use, CentralReach and Catalyst among them, so insurance work runs alongside the clinic's existing setup. The list of practice systems is short and centered on ABA platforms, and whether authorization results flow back into them is unclear.

SourceSilna Health, silnahealth.com, /aba-therapy, engineering.silnahealth.com/posts/autonomous-browser-agents-enterprise and /posts/building-phone-agents-healthcareread 2026-10-09

Waystar integrates with Epic for eligibility, real time authorization, claim management and monitoring and MyChart payments, connects proprietary systems through an open API, and its agents fill in correction requests ahead of staff and match payer recoupments to the correct claims. Integration methods on its developer portal include REST APIs, web services, sFTP, HL7, batch, X12 EDI and bot connections.

SourceWaystar, waystar.com/epic-integration and developer.waystar.comread 2026-10-05

The prior authorization lifecycle runs from expiration tracking and weekly reminders through form generation, submission and continual payer follow up. It branches as requests for additional information or resubmission raise alerts, denials move to appeal and Medicaid plan switches are flagged so authorizations can be resubmitted to the new plan. For ABA the same lifecycle covers initial assessments, concurrent reviews and reauthorizations. Behind it, document validation rules combine with AND and OR logic into configurations, and a graph decides which rules apply to each document type.

SourceSilna Health, silnahealth.com/prior-authorization, /insurance-monitoring, /aba-therapy and engineering.silnahealth.com/posts/document-validationread 2026-10-09

AltitudeAI is an agentic network that runs end to end, continuously acts within workflows, executes defined tasks and learns from outcomes. Several agents work across the cycle (documentation opportunities before review, record analysis and correction requests, recoupment matching, prior authorization justification), and charges are held for clinical oversight before submission. Further agents recommend claim corrections and speed recovery through clinical appeals.

SourceWaystar, waystar.com agentic AI news releaseread 2026-10-05

Work starts without staff: weekly expiration reminders, recurring eligibility and benefit checks, real time monitoring of every active patient's coverage, automatic detection of new insurance and Medicaid plan switches, and phone agents that call payers to check whether a submitted authorization was approved. For ABA, authorized hours remaining and upcoming reauthorization deadlines are tracked continuously so renewals go out before therapy is interrupted.

SourceSilna Health, silnahealth.com/insurance-monitoring, /prior-authorization, /aba-therapy and engineering.silnahealth.com/posts/building-phone-agents-healthcareread 2026-10-09

Agents act continuously within the revenue cycle. They flag documentation opportunities before review begins, match payer take backs to claims as they arrive, and generate payment and discount offers live in the patient's self service session, with no staff member starting each one.

SourceWaystar, waystar.com spring showcase news releaseread 2026-10-05

Silna maintains an always current database of each payer's prior authorization requirements per specialty, kept by its Payor Intelligence team from payer bulletins and the thousands of authorizations it processes each week, and applies it to form generation and document validation so providers never track the rules themselves. Predictive Document Intelligence reads diagnosis reports, treatment plans and progress notes with multimodal models and checks them against those criteria before submission, ABA treatment plans and progress reports included, and Silna reports a 98 percent first pass acceptance rate for requests it validates.

SourceSilna Health, silnahealth.com/prior-authorization, /aba-therapy, /resources/best-prior-authorization-software and engineering.silnahealth.com/posts/document-validationread 2026-10-09

Agents analyze the full medical record against a data network that unifies clinical, financial and administrative intelligence from more than 7.5 billion annual transactions and one in three US hospital discharges. Rules for revenue capture are continually built and maintained by AI. Waystar maintains this dataset and joins it to the customer's records.

SourceWaystar, waystar.com agentic AI news releaseread 2026-10-05

What persists sits on Silna's side: the payer requirements database and the growing record of reviewer corrections that shapes later submissions. The agents work from those shared stores and each authorization's own record, with no memory of a clinic or patient that has its own scope or lifetime.

SourceSilna Health, silnahealth.com and engineering.silnahealth.com/posts/beyond-the-agentread 2026-10-06

The agents have no memory that Waystar names, and it says nothing about what memory would hold or for how long. The network learns from outcomes through a learning loop that draws on denial insights and historical data.

SourceWaystar, waystar.com agentic AI news releaseread 2026-10-05

Staff stay in the loop where judgment matters. When document validation finds a gap against the payer's criteria, the provider reviews it and decides whether to update the documents or submit as they are, and requests for more information, resubmissions and appeals come back to the team as alerts. Behind the agents, Silna sends a set share of submissions to its own QA reviewers, who can override and correct the agent's work. Routine requests go out without staff touching each one, so there is no clinic sign off before a standard submission reaches the payer.

SourceSilna Health, silnahealth.com/prior-authorization, /resources/best-prior-authorization-software, engineering.silnahealth.com/posts/document-validation and /posts/beyond-the-agentread 2026-10-09

Charges require clinical oversight before submission, and correction requests are filled in ahead for staff. The network otherwise acts with minimal intervention, and Waystar names no review or approval step for other agent actions. Waystar says these agents cut manual correction work by up to 40%.

SourceWaystar, waystar.com agentic AI and spring showcase news releasesread 2026-10-05

Security starts with SOC 2 Type II certification through Vanta, operation under HIPAA and a pledge to treat patient confidentiality as a priority. On the agent side, each browser session is tied to a single provider through row level security, so one clinic's agent cannot reach another clinic's records. There is no single sign on or role management for a clinic's own staff.

SourceSilna Health, silnahealth.com and engineering.silnahealth.com/posts/autonomous-browser-agents-enterpriseread 2026-10-06

The platform carries HITRUST CSF, SOC 2, PCI DSS and HIPAA marks. Waystar names no SSO, roles or permissions the customer manages in public. Its developer portal covers SSO, HMAC security and a credential management API among its integration topics, but those pages sit behind a login.

SourceWaystar, waystar.com and developer.waystar.comread 2026-10-05

Clinics follow each authorization from submission to approval on a dashboard, with approvals passed along as they arrive. Inside Silna, every inference call and tool execution of a browser agent is saved as a pipeline step and each session gets a quality score from 0 to 100, a record that serves Silna's own engineers and reviewers. Clinics see status and outcomes rather than the agent's step by step trail.

SourceSilna Health, silnahealth.com/prior-authorization and engineering.silnahealth.com/posts/beyond-the-agentread 2026-10-06

Agents surface unjustified take backs and support validating patient assignments, documentation and coding accuracy, and claim monitoring reports status. Waystar names no record of each action the agents took. Reporting sits in Analytics and Reporting, a platform area of its own.

SourceWaystar, waystar.com and the spring showcase news releaseread 2026-10-05

The service is hosted. Its browser agents operate in sandboxed sessions on Silna's own self hosted Kasm Workspaces deployment, which isolates each session from the next and keeps agent activity off the clinic's own machines. There is no region choice, customer cloud or on premises option.

SourceSilna Health, silnahealth.com and engineering.silnahealth.com/posts/autonomous-browser-agents-enterpriseread 2026-10-06

The platform is delivered as cloud software. No hosting region, residency choice or option to run in a customer environment is published. Integrations run over REST APIs, web services, sFTP, HL7, batch files and X12 EDI.

SourceWaystar, waystar.com and developer.waystar.comread 2026-10-05

Silna sells one Care Readiness Platform built from prior authorizations, benefit checks, insurance monitoring and payor discovery, with prior authorizations priced at $35 each. These work as parts of one service rather than separate agents a clinic switches on, and there is no template or agent library. Customers include Behavior One Autism Solutions, Autism Learning Partners, ABS Kids, AnswersNow, HealthPro Heritage and Elite Alliance Physical Therapy.

SourceSilna Health, silnahealth.com and /resources/best-prior-authorization-softwareread 2026-10-09

Separately named platform solutions each do their own job, among them eligibility verification, real time authorization, authorization and referral status, claim management and monitoring, and patient payments, with AltitudeAI agents shipped inside them for documentation, correction requests, recoupment matching and payment offers. The platform groups them as Financial Clearance, Clinical Integrity and Revenue Capture, Claim and Payer Payment Management, Payment Management, Denial Recovery, and Analytics and Reporting.

SourceWaystar, waystar.com and /epic-integrationread 2026-10-05

Models are picked for each payer portal after testing cost, context window, intelligence and speed, and production traffic can be split between models that perform equally, for example half to Haiku 4.5 and half to GPT 5.4. The phone agents use Deepgram for speech recognition and ElevenLabs for speech, and the customer has no choice of model.

SourceSilna Health, engineering.silnahealth.com/posts/beyond-the-agent and /posts/building-phone-agents-healthcareread 2026-10-06

Google Cloud is an agentic AI collaboration partner, but Waystar names no model provider, routing or customer choice of model. AltitudeAI combines agentic, generative and predictive AI.

SourceWaystar, waystar.com and the spring showcase news releaseread 2026-10-05

Authorizations can be followed from submission to approval through an API as well as Silna's dashboard, which gives a clinic's other systems a way to track them. There is no public API reference, SDK or MCP server, and the agents themselves work through payer portals, payer phone lines and Silna's own app.

SourceSilna Health, silnahealth.com/resources/best-prior-authorization-softwareread 2026-10-09

Proprietary systems integrate through Waystar's open API, and Waystar runs a partner portal. Its developer portal at developer.waystar.com offers a suite of revenue cycle APIs, from insurance verification and prior authorization to claims, remittance and patient payments, with test sandbox accounts and HMAC security. The documentation sits behind a login, so no API reference, endpoints or developer documentation are public.

SourceWaystar, developer.waystar.com and waystar.comread 2026-10-05

An in house Experiments platform sets what share of prior authorizations each portal agent submits with no human touch and routes a share of agent submissions to human QA, comparing human and AI results, and specialist reviewers flag minor or major errors to build a dataset of where the agent was wrong. Models are tested per portal in a sandbox on production infrastructure for duration, token use and accuracy, and every session gets a score from 0 to 100 for execution quality, apart from its final outcome.

SourceSilna Health, engineering.silnahealth.com/posts/beyond-the-agentread 2026-10-06

By Waystar's account, the agentic network learns from outcomes with minimal intervention, drawing on denial insights and historical data. Waystar does not explain how the loop runs, what it tunes or how a change is measured. It says AltitudeAI has prevented $15.5 billion in denials and cut time on appeals and recovery by 90%.

SourceWaystar, waystar.com agentic AI and spring showcase news releasesread 2026-10-05

Browser agents work payer portals on their own, logging in with 2FA, navigating complex legacy interfaces, entering clinical data and recording approvals, across Blue Cross, Aetna, United and dozens of other portals, inside sandboxed browser sessions. They now handle nearly half of all prior authorizations and are trained to stop and ask for help rather than guess when stuck. Phone agents navigate payer phone menus to retrieve plan details.

SourceSilna Health, engineering.silnahealth.com/posts/autonomous-browser-agents-enterprise, /posts/beyond-the-agent and /posts/building-phone-agents-healthcareread 2026-10-06

Work moves through EHR integrations, payer connectivity and the open API, and Waystar names no browser, desktop or portal operation by its agents. The developer portal lists RPA bots among its integration methods but names no agent that operates screens.

SourceWaystar, waystar.com and developer.waystar.comread 2026-10-05