Predictika · Revenue cycle platform quotes

An AI sales agent's revenue cycle platform quote, checked before it goes out

An AI sales agent prepares a revenue cycle platform subscription quote for a hospital, health system or physician group, with the modules, the EHR or practice management system, the claim volume, the go-live date, the term, the discount and the module count the quote states. Before it goes out, the agent sends it to Predictika, which checks it against a declarative model of the quoting rules and returns a verdict and every reason.

Scope: Waystar platform subscription quotes: 17 modules across Financial Clearance, Claim and Payer Payment Management, Denial Recovery, Clinical Integrity, Analytics and AltitudeAI, with customer type, facilities, claim volume, go-live timing, term, discount and the stated module count. See everything this validator covers

This validator models revenue cycle subscription quotes, not just the scenarios shown below.

  • Modules and dependencies — which modules need which others on the same quote, and which modules are offered only to hospitals and health systems.
  • Customer and timing — customer type, facility count and claim volume, and a go-live date that leaves enough weeks for the modules chosen.
  • Term, discount and statements — the subscription term, the discount against its limit and approval threshold, and the module count the quote states against the modules it lists.

Any platform quote that touches these rules is in scope — not only the scenarios pictured here. Not covered: prices, usage fees, taxes and other Waystar products. The module and solution-area names follow the public Waystar solutions pages; the dependencies between modules, the customer-type limits, the implementation timing and the discount thresholds are modeled from comparable revenue cycle software and are not published by Waystar. No prices are modeled.

The AI sales agentBuilds the platform subscription quote from the conversation and says it is ready.
Predictika validatorChecks every rule at once and returns the verdict, each finding, and the computed figures.

6 scenarios in 3 groups · each group runs from the agent’s first attempt to the outcome · click one to switch

What the agent proposes

The AI sales agent says

Illustrative agent statement. The validator receives the structured request below.

Proposing agent: AI sales agent (scripted)

Before sending, the agent must call Recorded run

Predictika validator


      

        
        
        
      

      
Waiting for the call.

      
    

  

  
  

    
Where rules-based CPQ gets it wrong
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Our assessment of what a typical rules-based CPQ (product rules, price rules and validation rules, as in Salesforce CPQ) does with the same cases. It is a judgment about effort and reliability, not a claim that nothing can be built.

    
What the validator caughtTypical rules-based CPQPredictika
Modules that need other modulesOnly with care
Estimation, Authorization, Attachments, Denial, Recoupment and AltitudeAI each depend on a different module, so a rule must test every pair against the same quote.		Every dependency is checked on every call, whatever order the modules were chosen in.
Modules limited to some customer typesOnly with care
Clinical Documentation Integrity, DRG Anomaly Detection and Medicare Management are offered only to hospitals and health systems, so a rule must read two fields chosen independently.		The module list and the customer type are compared on every call.
Facility count and claim volume by customer typeOnly with workarounds
A hospital, a health system and a physician group each have a different facility or volume range, so each needs its own rule.		Each limit is a separate finding, and all of them are returned together.
A go-live date that depends on the module countOnly with workarounds
The minimum number of weeks grows with every module added, so a separate rule must recompute it and compare it with the date on the quote.		The minimum is computed from the modules on the quote and compared with the go-live weeks on every call.
A stated module count and a discount with two thresholdsOnly with workarounds
The stated count must equal the modules listed, and the discount has an approval threshold and a hard limit, so the checks sit on top of the blocking rules.		The stated count is a field of the request and is compared with the computed count; the discount tiers are separate findings.

  

  

    
What this validator catches: findings from its test cases
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Every rule is checked on every call, in any order the choices arrive; one problem never hides another. Blocking findings stop the quote; approval findings need a person to sign off; everything else is computed.

    
1Patient Estimation needs Eligibility Verification on the quote.
2Authorization needs Eligibility Verification on the quote.
3Price Transparency needs Patient Estimation on the quote.
4Claim Attachments needs Claim Manager on the quote.
5Claim Monitoring needs Claim Manager on the quote.
6Denial + Appeal Management needs Claim Manager on the quote.
7Recoupment Manager needs Remit + Deposit Management on the quote.
8Medicare Analytics needs both Analytics and Medicare Management on the quote.
9DRG Anomaly Detection needs Clinical Documentation Integrity on the quote.
10AltitudeAI needs Claim Manager on the quote.
11Clinical Documentation Integrity, DRG Anomaly Detection and Medicare Management are quoted only for hospitals and health systems.
12A physician group is quoted up to 2,000 thousand claims a year; the quote has 2001 thousand.
13A single-hospital quote covers up to 3 facilities; the quote has 4. Use Health System.
14A health-system quote needs at least 2 facilities; the quote has 1.
15Go-live in 15 weeks is too soon; 5 modules need at least 16 weeks.
16The quote states 6 modules; the quote lists 5.
17A discount of 15 percent needs sales leadership approval.
18A discount of 26 percent is over the 25 percent limit.
19The subscription term must be 1 to 5 years; the quote has 0.
20The subscription term must be 1 to 5 years; the quote has 6.
21The EHR or practice management system is not one of the named systems; a person should confirm the integration.
22The quote has no modules.
23A term under 3 years with 8 or more modules needs approval.
24Over 20,000 thousand claims a year needs a capacity review.
25A discount of 30 percent is over the 25 percent limit.
26The subscription term must be 1 to 5 years; the quote has 7.

  

  

    
Scenarios and results
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The recorded result of the validator for each scenario on this page: the request the AI agent sent, the verdict, and every finding, in the order they appear above.

    
1. Modules, facilities, timing and discount: A hospital with five facilities and eight modules, a short go-live and a 30 percent discount

    
The agent's request. Please quote a Waystar platform subscription for a hospital with 5 facilities on Epic, with Patient Estimation, Price Transparency, Authorization, Claim Attachments, Remit + Deposit Management, Denial + Appeal Management, Recoupment Manager and DRG Anomaly Detection. The quote lists 7 modules, a 3-year term, go-live in 20 weeks and a discount of 30 percent. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Patient Estimation needs Eligibility. Patient Estimation needs Eligibility Verification on the quote.
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  • Authorization needs Eligibility. Authorization needs Eligibility Verification on the quote.
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  • Claim Attachments needs Claim Manager. Claim Attachments needs Claim Manager on the quote.
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  • Denial + Appeal Management needs Claim Manager. Denial + Appeal Management needs Claim Manager on the quote.
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  • DRG Anomaly Detection needs CDI. DRG Anomaly Detection needs Clinical Documentation Integrity on the quote.
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  • Hospital facility count. A single-hospital quote covers up to 3 facilities; the quote has 5. Use Health System.
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  • Go-live too soon. Go-live in 20 weeks is too soon; 8 modules need at least 22 weeks.
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  • Stated module count does not match. The quote states 7 modules; the quote lists 8.
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  • Discount over limit. A discount of 30 percent is over the 25 percent limit.
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2. Modules, facilities, timing and discount: The agent resubmits after fixing the errors

    
The agent's request. Please quote a Waystar platform subscription for a health system with 5 facilities on Epic, with Eligibility Verification, Patient Estimation, Price Transparency, Authorization, Claim Manager, Claim Attachments, Remit + Deposit Management, Denial + Appeal Management, Recoupment Manager, Clinical Documentation Integrity and DRG Anomaly Detection. The quote lists 11 modules, a 3-year term, go-live in 30 weeks and a discount of 10 percent. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Quote summary. 11 module(s); minimum go-live 28 weeks.
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3. Medicare Analytics, term and discount: A hospital with Medicare Analytics, a six-year term and a 27 percent discount

    
The agent's request. Please quote a Waystar platform subscription for a hospital with 3 facilities on Epic, with Eligibility Verification, Patient Estimation, Claim Manager, Claim Monitoring, Remit + Deposit Management, Patient Payments, Analytics and Medicare Analytics. The quote lists 8 modules, a 6-year term, go-live in 30 weeks and a discount of 27 percent. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Medicare Analytics needs Analytics and Medicare Management. Medicare Analytics needs both Analytics and Medicare Management on the quote.
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  • Discount over limit. A discount of 27 percent is over the 25 percent limit.
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  • Term out of range. The subscription term must be 1 to 5 years; the quote has 6.
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4. Medicare Analytics, term and discount: The agent resubmits after fixing the errors

    
The agent's request. Please quote a Waystar platform subscription for a hospital with 3 facilities on Epic, with Eligibility Verification, Patient Estimation, Claim Manager, Claim Monitoring, Remit + Deposit Management, Patient Payments, Analytics, Medicare Management and Medicare Analytics. The quote lists 9 modules, a 5-year term, go-live in 30 weeks and a discount of 10 percent. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Quote summary. 9 module(s); minimum go-live 24 weeks.
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5. Physician group modules and term: A physician group with an inpatient module, Recoupment Manager and a two-year term

    
The agent's request. Please quote a Waystar platform subscription for a physician group with 1,800 thousand claims a year on Epic, with Eligibility Verification, Patient Estimation, Price Transparency, Claim Manager, Denial + Appeal Management, Recoupment Manager, Clinical Documentation Integrity and AltitudeAI. The quote lists 8 modules, a 2-year term, go-live in 30 weeks and a discount of 5 percent. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Recoupment Manager needs Remit + Deposit. Recoupment Manager needs Remit + Deposit Management on the quote.
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  • Inpatient modules not for physician groups. Clinical Documentation Integrity, DRG Anomaly Detection and Medicare Management are quoted only for hospitals and health systems.
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  • Short term with many modules. A term under 3 years with 8 or more modules needs approval.
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6. Physician group modules and term: The agent resubmits after fixing the errors

    
The agent's request. Please quote a Waystar platform subscription for a physician group with 1,800 thousand claims a year on Epic, with Eligibility Verification, Patient Estimation, Price Transparency, Claim Manager, Remit + Deposit Management, Denial + Appeal Management, Recoupment Manager and AltitudeAI. The quote lists 8 modules, a 3-year term, go-live in 30 weeks and a discount of 5 percent. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Quote summary. 8 module(s); minimum go-live 22 weeks.
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Narration transcript
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The text of the narrated walkthrough, step by step.

    
    
      
  1. Welcome to a demo of Predictika's Validator. An AI sales agent prepares a revenue cycle platform subscription quote for a hospital, health system or physician group, with the modules. Before it goes out, the agent sends it to Predictika, which checks it against a declarative model of the quoting rules and returns a verdict and every reason.
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  2. I will start with the first request by the agent.
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  3. The agent says. Please quote a Waystar platform subscription for a hospital with 5 facilities on Epic, with Patient Estimation, Price Transparency, Authorization. The quote lists 7 modules, a 3-year term, go-live in 20 weeks and a discount of 30 percent. The rest of the request is on screen.
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  4. Before it goes out, the agent calls the validator.
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  5. Blocked, with nine findings, all in one answer. Patient Estimation needs Eligibility Verification on the quote. Authorization needs Eligibility Verification on the quote. Claim Attachments needs Claim Manager on the quote. The other six are on screen.
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  6. The validator returned nine blocking findings in one answer. A check that reads one field at a time would pass most of this; it shows only when the choices in the quote are checked against each other.
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  7. What this shows: for a stated module count and a discount with two thresholds, a rules-based CPQ can do this only with workarounds.
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  8. Now the agent resubmits.
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  9. The corrected request. It changes the customer type to Health System, the Eligibility Verification to yes, the Claim Manager to yes, the Clinical Documentation Integrity to yes and the module count stated on the quote to 11. Two more changes are on screen.
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  10. It calls the validator again.
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  11. This time the validator clears it.
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  12. All nine earlier findings are cleared.
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  13. Nine problems caught in one call, fixed in one pass, and a clean quote. That is the value of Predictika's validator: catching mistakes before they reach the customer. Now you can try the other scenarios yourself.
    14.