Waystar Holding Corp.

Good day and thank you for standing by. Welcome to the Waystar first quarter 2026 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. To ask a question during the session, you will need to press star 11 on your telephone. You will then hear an automated message advising that your hand is raised. To withdraw your question, please press star 11 again. 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, Head of Investor Relations. Please go ahead.

Thank you, Operator. Good afternoon, everyone, and thank you for joining Waystar's first quarter 2026 earnings call. Joining me today are Matt Hawkins, Waystar's Chief Executive Officer, and Steve Oreskevich, Waystar's Chief Financial Officer. This afternoon, 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 four 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 include 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 filed 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 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 with 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, let me turn the call over to Matt.

Thank you, Edward, and good afternoon, everyone. Thank you for joining our Q1 2026 earnings call. Waystar delivered a solid start to the year, reflecting strong execution across the business and our innovation roadmap as we continue to position ourselves as the market leader in delivering an end-to-end healthcare revenue cycle platform. We drove strong performance across the core business, built on our innovation momentum, including our recent innovation showcase, and introduced a new AI-powered recruitment solution. What differentiates Waystar is the tangible value we deliver. Our platform is purpose-built, and integrates powerful LLMs into our core workflows to drive meaningful ROI for healthcare providers, improving accuracy, reducing friction, and lowering the total cost of operating the revenue cycle. As requirements expand across payers, policies, and workflows, providers increasingly choose embedded solutions they trust that deliver consistent financial outcomes. Importantly, the AI era is expanding Waystar's total addressable market opportunity meaningfully. Historically, revenue cycle technology addressed a roughly $20 billion software market. As we embed agentic AI directly into mission-critical workflows, we're building toward what we believe is the future of this industry, the autonomous revenue cycle platform. That shift unlocks a much larger opportunity. the approximately $100 billion in annual revenue cycle labor services performed across the industry today. We believe we're well positioned to automate a meaningful portion of this labor pool through new AI-powered capability launches like denials, prior authorization, and recoupment. In healthcare, where regulation and risk define success, this shift is critical. and Waystar is built to win. Our AI advantage is anchored in billions of proprietary longitudinal financial and clinical data points, deeply integrated workflows with significant switching and disruption risk, hard-won domain expertise that positions us as the trusted AI partner, and proven ability to operate at scale in an environment with little tolerance for hallucinations. Our first quarter results reinforce our conviction. Revenue of $314 million, representing 22% year-over-year growth. Strong retention supported that performance, with net revenue retention of approximately 111%, alongside continued adoption of our AI platform and approximately 99% first-pass acceptance rates across the platform. With that context, let me highlight a few key points from the quarter. First, our core growth drivers are durable. Continued expansion across the platform and solid core execution drove our results. We expanded within our installed base and demand signals are strong. Second, AI traction is accelerating. AI-powered capabilities drove roughly 40% of new bookings in Q1. and our clients leaned into the platform for prevention, automation, and visibility, rather than downstream rework. That shift reflects the value of embedded intelligence across the revenue cycle. Third, we maintained discipline through near-term headwinds. A few factors pressured patient payment volumes during the quarter, reflecting broader macro and weather-related dynamics. but we held financial discipline while continuing to invest in innovation. Steve will expand on these dynamics shortly. Let me discuss the quarter in more detail. We continued to expand our client base in Q1, adding 42 new clients with more than $100,000 in trailing 12-month revenue. Win rates exceeded our historical averages across segments, and we continue to see RFP activity shift toward platform evaluations over point solutions, favoring Waystar's unified mission-critical platform. We also delivered strong bookings ahead of internal expectations and building on a record Q4. Demand was broad-based, driven by both new logo wins and expansions within our installed base. We continue to build momentum with larger, complex provider organizations as they consolidate vendors and standardize on a single platform. Our implementation backlog is elevated across segments. We carry what we believe is the largest qualified sales pipeline in our history, reflecting deep multi-year platform commitments from providers and supporting visibility into 2027. Waystar delivered adjusted EBITDA of $135 million in Q1, representing an adjusted EBITDA margin of 43%. Revenue mix elevated the margin slightly above expectations, which Steve will discuss. We continue to balance profitability with targeted investment in innovation and AI. Turning to Iodine, Integration is running ahead of plan and continues to validate the strategic rationale of the acquisition. Iodine extends Waystar into the mid-cycle, where clinical intelligence plays a critical role in preventing denials and ensuring compliant reimbursement. The convergence of financial and clinical data represents one of the largest unmet needs in the revenue cycle. and new third-party research confirms it. A recent study of 50 mid-cycle leaders found that 86% of organizations have financial and clinical systems that are completely siloed or are reliant on manual data transfers, resulting in a lack of visibility into payer payment and denial outcomes. 100% expressed interest in a single AI-powered platform to bridge the gap from mid-cycle to the final claim. We'll publish the full study in the coming weeks, but these findings reinforce why we acquired Iodine and the demand signal we're seeing in the market. Iodine's AI talent is now fully integrated into Waystar, accelerating AI initiatives across the combined platform. We're generating early cross-sell traction in both directions and go-to-market demand is exceeding our expectations. Last quarter, we outlined the four interconnected pillars that position Waystar to lead in the AI-powered revenue cycle. Now, I'll focus on how those pillars translate into outcomes for providers. First, Waystar is the mission-critical infrastructure providers depend on to get paid. operating at scale in one of the most highly regulated payment environments, directly inside live revenue cycle workflows, eligibility, authorization, claims, denials, appeals, and payments. This results in very sticky long-term customer relationships. Second is our proprietary data at scale. We process over 7.5 billion transactions each year And with iodine, our models now learn from clinical data on approximately one-third of U.S. hospital discharges annually, giving us visibility into the financial and clinical dimensions of reimbursement. Not just what happened, but why. Our models learn across hospitals, physician practices, and ambulatory settings. Every claim, denial, and payment improves performance. clients benefit from patterns across tens of thousands of similar organizations. Third, Waystar operates a deeply deployed, multi-sided network and proprietary data rails between payers and providers. We connect over 1 million providers to every major payer through 100,000 plus live integrations across electronic health records, practice management systems, clearinghouses, and clinical platforms. We touch roughly 60% of the U.S. patient population each year, yet we only penetrate a small portion of the total transactions those patients generate. As volume increases, our platform delivers better outcomes. Fourth, Waystar combines scale distribution with deep domain expertise. We serve providers across all care settings with low client concentration, creating both resilience and broad reach. Our forward deployed teams, product, clinical, revenue integrity, and client success work directly inside real workflows. We develop and refine many of our AI capabilities in close partnership with clients, ensuring what we deliver works in production. With that foundation in place, let me turn briefly to how AI is operating and evolving across the platform today. At Waystar, AI is embedded directly inside workflows where decisions are made and dollars move. The platform identifies issues upstream, resolves them inside live workflows, and learns continuously from outcomes. This quarter, we accelerated the shift from task-level automation toward agentic workflows, each step moves us closer to the autonomous revenue cycle where the platform absorbs the administrative burden so teams can focus on exceptions, strategy, and patient care. Today, approximately 50% of our solutions leverage AI, and nearly 40% of revenue is generated by AI-embedded workflows. At last week's Spring Innovation Showcase, we introduced several net new capabilities that expand AI-embedded workflows across the revenue cycle, including deeper convergence of financial and clinical intelligence to prevent issues before billing and expanded agentic intelligence that assesses documentation, prioritizes opportunities, and guides next steps directly within live workflows. Early deployments are delivering strong outcomes. Our new pre-bill anomaly detection solution delivers an estimated $3 million in net revenue per 10,000 patient discharges and a 5X return in recovered revenue over three years. New Waystar Altitude AI-powered capabilities within our patient financial experience are expected to drive a 50% increase in collections, meaningful in a market where patients account for more than $556 billion in out-of-pocket spending. Some of the most damaging revenue loss in healthcare happens after providers have already been paid through payer recoupments. Payers regularly take back funds from previously paid claims, often months or years later, by offsetting them against future payments with little transparency into which claims are involved, why the funds were recouped, or whether the action is even valid. Based on our industry remittance data analysis, we estimate payers take back over $40 billion from providers each year through these offsets. And recoupments are growing at more than two times the rate of overall claim volume, creating significant accelerating cash flow volatility. Waystar's new recruitment solution built on Altitude AI brings transparency to this process. Providers can now detect previously hidden recoupments, understand their root causes, and take action efficiently all using remittance data at scale. Early results are compelling. Providers are reducing recruitment reconciliation time by over 80%, and one early adopter health system matched $32 million in revenue risk, work equivalent to approximately 13 full-time employees. This new SKU integrates quickly for existing clients and demonstrates how we convert administrative complexity into financial outcomes through AI. Looking ahead, our priorities are clear. Execute against our product roadmap with AI embedded deeper into every workflow. Drive cross-sell and platform adoption across our installed base. And maintain operational discipline while investing in the capabilities that widen our competitive advantage. Q1 reinforces that our role in the healthcare ecosystem is deepening. We're operating at the intersection of complexity, scale, and outcomes, and our platform is engineered for exactly this environment. Before I turn the call over to Steve, I'm pleased to share that we'll be hosting our first Analyst Day on Tuesday, August 25th. alongside our annual Waystar True North Client Conference. You'll hear directly from our customers, partners, and leadership team. We hope that many of you can join us. With that, let me turn it over to Steve.