Waystar Holding Corp.

Good day and thank you for standing by. Welcome to the Waystar fourth quarter and fiscal year 2025 earnings conference call. At this time, all participants are in a listen-only mode. After the speaker's presentation, there will be a question and answer session. Please be advised that today's conference is being recorded. I would now like to hand the conference over to your first speaker today, Edward Parker, Investor Relations. Please go ahead.

Thank you, Operator. Good morning, everyone, and thank you for joining Waystar's fourth quarter and fiscal year 2025 earnings call. Joining me today are Matt Hawkins, Waystar's Chief Executive Officer, and Steve Oreskevich, Waystar's Chief Financial Officer. This morning, we issued a press release announcing our financial results and published an accompanying presentation deck. You can find these materials at investors.waystar.com. Before we begin, I would like to remind you that this call contains forward-looking statements, which are predictions or beliefs about future events or performance. Examples of these statements include expectations of future financial results, growth, and margins. These statements involve a number of risks and uncertainties that may cause actual results to differ materially from those expressed in these statements. For a full discussion of the risks and other factors that may impact these forward-looking statements, please refer to this afternoon's press release and the reports we follow with the SEC, all of which are available on the Investor Relations page of our website. Any forward-looking statements made on this call are only as of today and will not be updated unless required by law. We will also discuss certain non-GAAP financial measures. These measures are intended to provide additional insight into our performance and should not be considered in isolation or as a substitute for financial information prepared in accordance of GAAP. We have provided reconciliations of the non-GAAP financial measures included in our remarks to the most directly comparable GAAP measures together with explanations of these measures in the appendix of the presentation slide deck and our earnings release. With that, I would like to turn the call over to Matt.

Thank you, Edward, and good morning, everyone. Thank you for joining our Q4 2025 earnings call. Today, we're pleased to share Waystar's strong Q4 and full-year 2025 results, reflecting the durability of our business model, the execution of our team, and the trust providers place in our platform. 2025 was a defining year for Waystar. We crossed a billion dollars in revenue, exceeded both our revenue and EBITDA guidance, and achieved strategic milestones that strengthened our competitive position. We completed the acquisition of iodine software, adding more than 1,000 hospitals and health systems, deep clinical intelligence, and significantly expanding our addressable market. This combination positions Waystar as the only platform with both clinical and counter visibility and financial outcome intelligence at scale. We also extended our AI leadership. In 2025, Waystar Altitude AI prevented more than 15 billion in denials for our clients, reduced appeal time by 90%, and drove double-digit increases in denial overturn rates. We launched new agentic capabilities that cut documentation analysis by 40%, powered by data from one in three US hospital discharges and more than 7 billion annual transactions. These results demonstrate accelerating demand for mission-critical AI-powered revenue cycle software and validate Waystar's ability to deliver meaningful ROI for providers. I'm proud of what our team accomplished in 2025. We enter 2026 with strong momentum, a clear leadership position, and a platform we built to sustain durable, profitable growth while delivering exceptional value to our clients. Let me walk through our fourth quarter performance. Q4 revenue reached $304 million, growing 24% year over year and 12% organically. Both subscription and volume-based revenue contributed to this strength. These results underscore the mission-critical nature of our platform, elevated patient utilization, and the successful onboarding of new clients. Waystar added 85 clients with trailing 12-month spend above $100,000, up from 30 a year ago and more than double last quarter. Win rates improved beyond our historical average of more than 80%, reflecting sustained competitive momentum and clear provider preference for Waystar's cybersecurity unified platform. We delivered 112% net revenue retention with 97% gross revenue retention and a net promoter score above 70. Cross-sell and upsell momentum in our large installed base drove this performance and reinforces how deeply Waystar is embedded in our clients' daily operations, serving as essential infrastructure for getting paid. Waystar delivered a record bookings quarter in Q4, and we closed several sizable deals to cap off a strong 2025. We enter 2026 with a robust sales pipeline and the largest implementation backlog in our history. This demand signals strong customer confidence in our platform and reinforces our conviction in the durability of our low double-digit long-term growth outlook. Adjusted EBITDA reached $129 million, up 29% year-over-year, with an adjusted EBITDA margin of 42.5%. exceeding our long-term target of 40%. Waystar continues to operate as a rule of 50 business, pairing strong revenue growth with increasingly efficient operations. Our core business delivers durable, organic growth. Idine extends that strength through disciplined platform expansion, moving Waystar into the mid cycle, a critical stage where payers deny roughly 60 million claims each year. Together, We deliver full revenue cycle visibility through our unified financial and clinical platform. Iodine adds more than 1,000 hospitals and health systems with only 35% customer overlap, expanding our addressable market and cross-sell opportunity. Integration is ahead of plan, and we now expect to realize over 90% of committed cost synergies in fiscal 2026. We fully integrated our commercial teams and they're already producing results. In Q4, we generated cross-sell traction in both directions and built a robust new business pipeline. Market demand for the Waystar platform is strong. Unified financial and clinical data unlocks unique value and accelerates our innovation roadmap. Our next generation pre-bill anomaly detection solution demonstrates this opportunity. We expect a mid-sized health system to recover $7 million annually in previously missed reimbursement, a 5X return over three years. This is the first of many innovations only our integrated platform can deliver, advancing us toward a fully autonomous revenue cycle, including using clinical data to prove medical necessity for prior authorization and overturned denials requiring clinical documentation, all without human intervention. Now, let me take a broader view on AI because it is core to who we are and where we're headed. While many new AI entrants add lightweight tools that sit on top of fragmented revenue cycle workflows, Waystar takes a fundamentally different approach. Our end-to-end platform gives us full visibility across the revenue cycle, including authorizations, claims, denials, and payments, and deep into the layers where complexity resides. peer policy, adjudication logic, diagnosis-related grouping, and denial reasoning. This breadth and depth makes Waystar the system of action, identifying issues upstream, resolving them inside the workflow, and closing the loop on payment with minimal human intervention. For more than a decade, Waystar has deployed AI, including machine learning and advanced decisioning engines, across revenue cycle workflows at scale grounded in proprietary data and embedded processes few in the industry can match. We're extending those capabilities with LLMs, generative and agentic AI, while maintaining control of the data, decisioning logic, and outcomes that matter most to providers. Today, approximately 50% of our solutions leverage AI, and nearly 40% of our revenue is driven by AI embedded in mission critical reimbursement workflows. In 2025, roughly 30% of new bookings came from AI-powered capabilities. This signal is clear. Clients trust Waystar to deliver AI that goes beyond assistance to enable agentic, outcome-driven revenue cycle automation. We believe Waystar is well positioned to lead the next era of healthcare revenue cycle automation. The foundations of software moats are shifting in the age of AI. From workflow stickiness and switching costs to a new set of structural advantages, our strength comes from four interconnected pillars. Mission-critical infrastructure, unmatched proprietary data, an extensively deployed network, and scale distribution paired with deep domain expertise. First, our platform is the mission-critical infrastructure providers need to get paid. Waystar is embedded directly in the flow of dollars, decisions, and denials, and our 97% gross revenue retention proves it. Once clients implement Waystar, they stay. We reduce administrative burden, prevent billions in avoidable denials, accelerate cash flow, and ensure reimbursement accuracy at scale. Our commercial model is aligned with consumption, which is a function of providers seeing patients As agentic AI streamlines workflows and reduces manual work, the durability of our model strengthens. Pricing is tied to claims, payments, or prescribing providers, directly matching how value is created in the revenue cycle. Our multi-year partnership with Google Cloud's Gemini LLM accelerates innovation, and we retain control of the data, decisioning, and outcomes providers care most about. As RCM moves toward agentic AI and autonomous workflows, our role deepens. Our agents act on behalf of providers, resolving issues, correcting errors, and closing the loop on payment. Second, Waystar has an unmatched proprietary data advantage. AI strength ultimately comes down to data, its scale, richness, structure, and proximity to action. We operate one of the largest healthcare payment data sets in the United States, processing more than 7 billion transactions annually. With Iodine, we pair that financial depth with unmatched clinical data, and our models now learn from approximately one-third of U.S. hospital discharges each year. We deploy AI across the full revenue cycle continuum from authorization and eligibility to denials and appeals, Our data advantage is self-reinforcing. Every claim, denial, and payment improves our models. When a provider uses Waystar, they benefit from the learnings of tens of thousands of organizations like theirs. Similar size, similar payer mix, similar challenges. And because our data spans the full care continuum, hospitals, physician practices, outpatient surgery centers, Our models see patterns no single organization or new entrant can match. General purpose model vendors lack this real time closed loop proprietary data. Third, Waystar's platform is a deeply deployed multi-sided network creating scale and connectivity that others cannot replicate. We sit at the center of the payer provider patient ecosystem. connecting over 1 million providers to every major payer, powered by more than 100,000 live integrations across EHRs, practice management systems, clearinghouses, and clinical platforms. We touch approximately 60% of the US patient population each year and process billions of dollars in patient payments across our network annually. We built this network over more than a decade. It represents scale. trust, and connectivity that cannot be bought or quickly engineered. Every transaction flowing through Waystar increases network intelligence, sharpens model accuracy, and expands our distribution advantage. The result? A platform that strengthens continuously with every client we serve and every workflow we power. Fourth, Waystar combines scale distribution with deep domain expertise. We serve providers across all care settings with low concentration. Our top 10 clients represent approximately 11% of revenue, driving resilience, reach, and durable bookings growth. Our go-to-market organization consistently delivers strong win rates, rapid time to value, and compelling client ROI. Forward deployed teams, product management, revenue integrity, clinical documentation, and client success experts work directly alongside real workflows. Dozens of clients co-develop and pilot new AI capabilities with us, validating outcomes before broad release. We've already seen our AI-enabled engineering tools reduce manual work, in some cases by more than 75%, and we expect further improvement as we scale these capabilities in 2026. These pillars enable our AI to deliver outcomes at scale. In less than a year, Waystar Altitude AI has prevented 15 billion in denials and accelerated appeal package generation by 90%, turning work that once took days into minutes. Our network consistently achieves approximately 99% clean claim and first pass acceptance rates, driving faster, more accurate reimbursement. These outcomes expand our footprint, build trust and help providers improve margins while freeing staff for higher value work. Last month, we shared our vision for Waystar's autonomous revenue cycle, a dynamic end-to-end agentic network that acts continuously within workflows, learns from outcomes and delivers meaningful financial results with minimal intervention. Providers don't want point solutions They need trusted cybersecurity platforms that unify financial, clinical, and operational outcomes. Our product roadmap is robust, and we expect to launch several new AI agents this year on Waystar's platform. We have the data, the deployment, the distribution, and the discipline to lead this next era of healthcare revenue cycle automation. We're moving with the urgency and the mindset of a disruptor, Because this moment demands nothing less. With that, I'll turn the call over to Steve.