Case Study: Pagosa Springs Medical Center achieves 98% first-pass clean claim rate and cuts denials to 9% with Waystar

How Waystar enabled Pagosa Springs Medical Center to manage both commercial and government claims on a single, unified platform

Pagosa Springs Medical Center (PSMC) is a rural critical access hospital in Pagosa Springs, Colorado, serving a broad region with limited resources. Their biggest revenue-cycle challenge was high denial volume and inefficient manual rework: a first-pass clean-claim rate of just 70–75% and an approximately 30% denial rate under their incumbent clearinghouse. PSMC replaced its government-billing vendor with eSolutions (now part of Waystar) and evaluated options for commercial claims before selecting Waystar.

Waystar deployed a unified suite—including eligibility verification, claim manager/monitoring, EOB conversion, denial and appeal management, remits and lockbox solutions—which automated checks before submission and streamlined rework. About a year after going live with Waystar, PSMC’s first-pass clean-claim rate rose to 98% and denial rates dropped to an average of 9%, significantly reducing the cost and labor of working denials and delivering measurable ROI.

Pagosa Springs Medical Center

Debbie Campbell

Director of Revenue Cycle