Waystar Holding Corp. Q4 FY2025 earnings call

2025 was a defining year with over $1 billion in revenue. Completed acquisition of Iodine Software. Extended AI leadership with Waystar Altitude AI preventing over $15,000,000,000 in denials. Q4 added 85 clients with trailing twelve months spend above $100,000. Win rates improved. Cross-sell and upsell momentum. Iodine adds over 1,000 hospitals and health systems with 35% customer overlap. Integration ahead of plan. Platform has four pillars: mission-critical infrastructure, unmatched proprietary data, deeply deployed network, deep domain expertise.

Fourth quarter revenue reached $304,000,000, growing 24% year over year and 12% organically. Adjusted EBITDA reached $129,000,000, up 29% year over year, with an adjusted EBITDA margin of 42.5%. For the full year, revenue increased 17% year over year to $1,100,000,000. Adjusted EBITDA was $462,000,000 at a 42% margin. Iodine contributed $31,000,000 in the fourth quarter. Organic revenue grew 13% for the full year. Net revenue retention rate was 112% with 97% gross revenue retention and a net promoter score above 70.

2026 revenue expected $1,274,000,000 to $1,294,000,000, up 17% year over year. Adjusted EBITDA $530,000,000 to $540,000,000, up 16% year over year. Margin ~42%. Iodine growth similar to Waystar's 10% normalized organic growth. Sequential growth 1%-3% throughout year, third quarter at low end due to seasonality.

Forward-looking statements involve risks and uncertainties, including those in SEC filings about factors impacting results, regulatory, market competition, technology implementation risks.

Q: Congrats on the quarter. Matt, maybe I want to start off on AI, and I appreciate all the color you gave, the advantages you have in an AI world. But I wanted to understand, when you talk to your customers and say, looking at RCM specifically, what is their appetite to use LLMs and build on their own versus buy from somebody like Waystar Holding Corp.?

A: The vast majority of clients would rather integrate AI capability into their systems of record or action that run the backbone of their business. Most provider organizations do not have the abundance of engineering talent to test and deploy AI, so Waystar is well positioned to deliver AI as done so far.

Q: You have mentioned several new AI agents launching this year. How do you think about that launching? Are those individually incremental revenue opportunities for Waystar Holding Corp. or combined with Iodine too? Or is that something that you see as helping to increase the moat of your current AI offering, or maybe some of both?

A: It is a bit of both. Some will be new SKUs with new price to value. Other AI capability will add on to existing software modules, helping both incremental revenue and increase moat.