Waystar Rated #1 Overall in Black Book's Q1 2026 Agentic and Generative AI Revenue Cycle Management Benchmark

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New study of 774 hospital and medical group revenue cycle leaders finds payer-change responsiveness, auditability, and support performance are now the defining differentiators

NEW YORK CITY, NEW YORK / ACCESS Newswire / February 20, 2026 / Black Book Market Research LLC today announced the availability of its 2026 report, "Revenue Cycle Management Agentic & Generative AI Benchmark: Qualitative KPI Performance, Governance, and Outcomes," an independent benchmarking study measuring client-reported performance of agentic AI-enabled revenue cycle management (RCM) solutions used by hospitals and medical groups.

Fielded in two waves spanning Q4 2025 and Q1 2026, the study captures feedback from 774 verified revenue cycle leaders and power users with a minimum of six months of hands-on experience using the solution they rated. In total, 49 vendors with reported RCM AI products and/or services were included in the survey set; 20 vendors met the threshold for inclusion in the comparative performance ranking.

Waystar rated #1 overall

In the comparative set of qualifying vendors, Waystar ranked #1 overall, leading the benchmark across key client experience measures and the report's qualitative KPI framework designed to reflect day-to-day operational reality in revenue cycle operations. Because RCM is operationally unforgiving, where downtime, unresolved issues, and slow escalations quickly become cash-flow risk, the Q1 2026 benchmark places special weight on operational support and production trust. In the study, Waystar achieved the highest client-reported performance for:

• Support responsiveness and issue resolution, including escalation quality and speed of closure

• Reliability and operational trust in production environments

• Implementation execution and time-to-value outcomes

• Security, compliance confidence, and governance readiness for AI-enabled workflows

Respondents emphasized the practical difference between "AI features" and "operationally governed automation," citing the importance of fast support ownership, clear communication during escalation, and permanent fixes rather than temporary workarounds, especially during payer policy volatility and audit-sensitive workflows.

What the benchmark found: governance and auditability are now procurement requirements

Across provider segments, respondents increasingly differentiated between "AI as features" and "AI as an operating model," with buying confidence shifting toward solutions that demonstrate governed action execution, auditable decisioning, and rapid adaptation to payer volatility. The report highlights the most differentiating selection drivers as:

• Responsiveness to payer rule and policy changes

• Workflow automation quality and signal-to-noise (rework avoidance)

• Explainability, traceability, and audit defensibility

• Governance controls, human-in-the-loop design, and enterprise security posture

"Revenue cycle leaders are no longer rewarding AI claims in isolation, they're rewarding controlled automation that holds up under payer change, audit scrutiny, and operational stress," said Doug Brown of Black Book Research. "This benchmark is designed to isolate what's attributable to the vendor in real workflows: operational fit, trust, time-to-value, and support performance when issues become cash problems."

Report contents and availability

The Q1 2026 benchmark includes a comparative ranking of 20 qualifying vendors, an 18-KPI qualitative RCM AI specific performance framework, and three indices (Agentic Readiness Index, Payer Friction & Volatility Index, and Revenue Protection Score), plus market analysis on agentic AI operationalization and governance requirements.

The report is available now through Black Book Market Research. For access, licensing, or media/analyst inquiries, contact [email protected]. Industry stakeholders can register for gratis download of the full report at ZZZZZ Other vendors included in the comparative ranking (alphabetically) are: Adonis; AGS Health; Akira AI; AgenticPractice (apurv.ai); Automation Anywhere; AutomationEdge; AutoSapien; Cedar; CitiusTech; Ensemble Health Partners; FinThrive; Firstsource; ImagineSoftware; Infinx; Moveo; R1 RCM (R37); Thoughtful AI; UiPath; Ventra Health.

About Black Book Market Research

Black Book Market Research is an independent healthcare market research and public opinion firm focused on measuring client experience, operational performance, and technology adoption across provider and payer ecosystems. Black Book's research model is vendor-agnostic and structured to protect against pay-to-win dynamics by separating research operations from commercial relationships, with results produced from respondent data and predefined scoring rules. Download the report in full at https://www.blackbookmarketresearch.com or contact [email protected]

SOURCE: Black Book Research