ZirMed

What ZirMed does

ZirMed, founded in 1999 and headquartered in Louisville, Kentucky, provides cloud-based revenue cycle management (RCM) software to the US healthcare industry and now operates as a brand/product line within Waystar Health. The platform connects providers to one of the largest payer networks in the United States — 5,202 professional claims payers, 4,650 institutional claims payers, 3,413 remittance payers, and 1,171 eligibility payers — covering an estimated 60% of the US patient population and used by over 1M providers. Core product modules span Financial Clearance (eligibility verification, prior authorization, propensity-to-pay, price transparency), Clinical Integrity + Revenue Capture (prebill anomaly detection, DRG anomaly detection, charge integrity), Claim Management, Payment Management, Denial Recovery, and Analytics + Reporting.

The technology stack rests on the AltitudeAI platform, which layers agentic AI (autonomous workflow execution), generative AI (content generation for productivity and communication), and predictive AI (denial prevention and payment forecasting) across the end-to-end RCM workflow. Differentiated infrastructure includes deep EHR/EMR and proprietary practice-management integrations (94% client-reported satisfaction) and compliance certifications covering HIPAA, HITRUST CSF, SOC 2 Type II, and PCI DSS. The product roadmap is delivered through annual events (True North Client Conference) and a newly formalised Innovation Lab cadence.

The business model combines subscription SaaS (quote-based annual contracts, pricing not publicly disclosed) with transaction-based clearinghouse revenue from claims, eligibility, remittance, and attachment volume. Go-to-market is enterprise-led via direct field sales to large health systems and hospitals, augmented by a mid-market self-serve channel, a billing-services partner program, and EHR-aligned distribution. Quantified outcomes cited on the customer side include $10M+ payment lifts, 300% back-office automation increases, 50% reductions in patient AR days, and 2x increases in patient payments, supporting a value-based selling motion into risk-averse healthcare provider procurement organizations.

Name

ZirMed

Legal name

Waystar Health

Website

https://zirmed.com

Company type

Private

Founded year

1999

Operating status

Operating

Headcount range

501–1,000 employees

Short description

ZirMed is a cloud-based healthcare revenue cycle management platform serving 1M+ US providers and connecting to 5,000+ payers, covering roughly 60% of the US patient population with AltitudeAI-powered agentic, generative, and predictive AI tools across claims, payments, denials, and analytics.

Ownership category

akta.pro rank

Product category

Healthcare Revenue Cycle Management Software

NAICS

Software Publishers (5132)

SIC

Services-Prepackaged Software (7372)

akta.pro primary industry

Claims Management, Scrubbing & Clearinghouse (HLACACAB)

akta.pro secondary industries

Price Transparency, Estimates & Patient Financial Clearance (HLACACAK), Patient Access, Registration & Intake (Front-End RCM) (HLACACAE), RCM Analytics, Benchmarking & Underpayment Detection (HLACACAL), Patient Billing, Statements & Payment Processing (HLACACAG)

Keywords

• Healthcare revenue cycle management
• Medical claims processing
• Healthcare SaaS platform
• Patient payment solutions
• Denial management software

Headquarters

HQ city

Louisville

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Software

Cost components

Technology or R&D, Personnel, Infrastructure, Marketing or Sales, Operations

Revenue model

1. Subscription SaaS Platform: Cloud-based RCM software delivered as subscription service with platform-wide AI capabilities. Pricing not publicly disclosed, quote-based for enterprise healthcare organizations.
2. Transaction-based Clearinghouse: Claims processing services for professional claims (5,202 active payers), institutional claims (4,650 payers), remits (3,413 payers), eligibility (1,171 payers), claims attachments (1,515 payers), estimation (1,171 payers), and claims monitoring (911 payers).
3. Healthcare IT Software: Part of the broader Medical Claims Processing Software market projected to grow from $12.12 billion in 2025 to $32.18 billion by 2033 at CAGR of 12.98%, with cloud-based solutions capturing over 60% market share.

Pricing tiers

Go-to-market motion3 records

Distribution channels4 records

Marketing channels10 records

Core offering

ZirMed provides a cloud-based healthcare revenue cycle management (RCM) SaaS platform that automates the end-to-end revenue cycle from financial clearance through denial recovery and analytics. The platform serves healthcare providers including health systems, hospitals, physician practices, ambulatory surgery centers, and billing services, processing claims, eligibility verification, payment management, and denial appeals powered by the AltitudeAI suite of agentic, generative, and predictive AI capabilities.

Differentiator

Problem solved

Functional benefit

Products and services

• Financial Clearance Front-end revenue cycle suite delivering insurance benefits verification, price transparency, prior authorization automation, eligibility verification, patient estimation, coverage detection, charity screening, registration QA, advanced propensity to pay, and price transparency for healthcare providers.
• Clinical Integrity + Revenue Capture Mid-cycle revenue capture suite providing utilization management, clinical documentation integrity, prebill anomaly detection, charge integrity, DRG anomaly detection, and Transfer DRG (TDRG) for capturing missing charges and revenue in healthcare organizations.
• Claim Management End-to-end claim management suite providing claim manager, claim attachments, claim monitoring, and Medicare management with automated claim monitoring and streamlined attachments processing for healthcare providers.
• Payment Management Payment processing suite delivering payer reimbursement, remit and deposit management, EOB conversion and payer lockbox, patient reimbursement, patient payments, and agency manager capabilities for healthcare revenue cycle operations.
• Denial Recovery Denial and appeal management suite with recoupment manager for tracking, appealing, and recovering denied claims, helping healthcare providers get paid faster and more fully.
• Analytics + Reporting Analytics and reporting suite providing actionable intelligence from data with analytics, Medicare analytics, and quality and compliance reporting capabilities for healthcare revenue cycle management.
• AltitudeAI Platform Waystar's AI platform powering the entire revenue cycle management suite, providing agentic AI, generative AI, and predictive AI capabilities that automate work, prioritize tasks, and eliminate errors across the end-to-end platform.

Quantifiable outcome

• $10M+ generated in payment lift for Piedmont health system
• +5 more outcomes

Named customers16 records

Segments10 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

AI capability8 records

Feature9 records

Partnerships

Five partnerships are on record, tiered core and strategic.

• EHR/EMR System VendorscoreTechnology or IntegrationIntegration partnerships with Electronic Health Record and Electronic Medical Record systems enabling seamless RCM workflows within existing healthcare IT infrastructure. 94% of clients are satisfied with EHR integrations per Third Party Provider Satisfaction Survey.
• Healthcare Payers (Insurance Companies)coreTechnology or IntegrationExtensive network of 5,202 professional claims payers, 4,650 institutional claims payers, 3,413 remits, 1,171 eligibility payers covering BC/BS, Medicare, Commercial, Medicaid, DMERC, and Tricare. Active payer connections require enrollment for some payers.
• Practice Management System VendorscoreTechnology or IntegrationProprietary System Integration partnerships for physician and specialty practices enabling RCM integration with practice management systems.
• Billing Services PartnerscoreChannel Partner/ Reseller/ DistributorPartner program for billing services providers who manage RCM for healthcare clients. Partner login portal available at login.zirmed.com/ui/partners with dedicated partner resources.
• Waystar Early Adopter Program MembersstrategicStrategic or Co-development PartnerEarly adopter program providing exclusive access to innovation for selected healthcare organizations to co-develop and test new AI-powered RCM features before general release.

Scale indicators9 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• Availity: Availity operates a major healthcare clearinghouse and provider-payer collaboration platform. Directly comparable to ZirMed/Waystar in the payer-provider data exchange and eligibility/claims clearinghouse business with similar transaction-fee economics.
• FinThrive: FinThrive is a healthcare revenue cycle management platform formed from the merger of nThrive and Experian's healthcare arm. Competes head-to-head with ZirMed/Waystar across the full RCM stack for hospitals and health systems.
• R1 RCM: R1 RCM is a leading end-to-end healthcare revenue cycle management company serving large health systems and hospitals. Directly comparable to ZirMed/Waystar in target market (enterprise health systems), product breadth (full-stack RCM), and AI-driven automation focus.
• NextGen Healthcare: NextGen Healthcare offers an integrated EHR and RCM platform targeted at ambulatory practices and specialty groups. Directly comparable to ZirMed/Waystar in physician and specialty practice RCM with similar subscription plus transaction-fee economics.
• Athenahealth: Athenahealth provides cloud-based EHR plus integrated practice management and RCM (athenaCollector) primarily to ambulatory providers. Closely comparable to ZirMed/Waystar's ambulatory segment with overlapping claims management, patient billing, and denial workflows.
• Experian Health: Experian Health provides patient access, claims management, and RCM solutions to hospitals and physician practices. Directly comparable to ZirMed/Waystar in patient financial clearance, eligibility verification, and identity management offerings.

Broad incumbents

• Oracle Health (Cerner): Oracle Health (formerly Cerner) provides enterprise EHR with integrated RCM capabilities to large hospital systems globally. Functions as a broad incumbent competitor, particularly for inpatient RCM where Cerner's installed base creates bundled competition.
• Epic Systems: Epic is the dominant EHR vendor for large health systems and increasingly bundles RCM capabilities (Resolute) into its platform. Competes with Waystar as a broad incumbent that health systems may consolidate onto instead of using third-party RCM.
• Optum (Change Healthcare): Optum acquired Change Healthcare to form a clearinghouse and RCM powerhouse within UnitedHealth Group. Competes directly with Waystar in claims clearinghouse, payment integrity, and patient access — with the advantage of payer vertical integration.

Emerging players

• AKASA: AKASA is an AI-native RCM platform focused on automating revenue cycle workflows for health systems using generative and agentic AI. Comparable to ZirMed/Waystar as an emerging AI-driven competitor targeting the same automation pain points, though with narrower product breadth.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/zirmed
• YouTubeyoutube.com/channel/UClK8V4mKfF1_paNzPIUJlHQ
• Facebookfacebook.com/zirmedinc
• LinkedInlinkedin.com/company/61643
• Instagraminstagram.com/waystarsoftware

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles3 records

Funding overview

Funding rounds6 records

Investors2 records

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A2 records

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about ZirMed