Best Claims Processing Software of 2024

BirchNotes, the most intuitive practice management and client-centric EHR system for mental health and substance abuse professionals, is designed to help you grow your practice and manage it with ease. An EHR was designed with a mental health therapist in view. Tools and features that are tailored to both mental and substance abuse professionals have been selected. All your EHR, billing and insurance, scheduling, telehealth, and other functions can be integrated into one system. There are no additional log-ins, systems or tools required. BirchNotes is flexible and scalable, regardless of the size or setting of your practice. Our workflows and insights are tailored to your practice. Our smart workflows, automation and customizable settings make it easy to manage your practice. This will allow you to spend more time on what is important to you. A better solution for better outcomes. You can have recurring appointments, group, telehealth, or recurring appointments. Plus, you can customize your calendar.

You can improve your claims management process and reduce denials with unmatched edits. Access to technology that allows for accurate claim submission and quick reimbursement is essential for health systems. Claims Director, SSI’s claims management software, streamlines billing processes and provides visibility by guiding users throughout the electronic claim submission process and reconciliation process. The system monitors changes in reimbursement criteria and incorporates them as they occur. The solution allows organizations to make the most of their reimbursement efforts by allowing them to edit at all levels: payer, industry, and provider.

Anagram Prosper gives money back to your patients -- at no cost for your practice. You can increase your margins and delight your patients. We partnered with top vendors to create wholesale price lists that better fit your needs and those of your patients. Rebate on products you already own. Incentivize your patients, increase conversions, and earn more revenue. Anagram Prosper allows you to save money for your patients without having to offer discounts or lower your margins. Our rebate program will help you increase sales and make your patients happy. Patients don't know what their out-of network benefits are. Anagram Access allows you to determine your patient's eligibility for vision plans in real time. This will maximize your savings. Anagram Access allows you to quickly calculate the amount your patient owes, and how much their vision plans reimburses.

Streamlining claims from beginning to end. Integrity, technology, and people are the foundations of this platform. A robust platform for interaction between insurance carriers, MGAs and captives. You can manage your files, deploy applications, and organize claims. Beagle understands the unique challenges that insurance service providers and adjusters face when it comes time to handle claims. Our core software functionality is designed for rapid response to claims, cost reduction, and to streamline the process. Our technology provides efficiency and expertise at every stage of the adjustment process. Express inspection and claim responses that reduce liability, and increase efficiency. New policy inspections and policy renewals. Beagle was designed to handle the daily processes. Claims handling is streamlined by leveraging the most recent technologies, allowing for a more efficient solution.

HealthRules®, Payor is a next generation core administrative processing system that offers transformational capabilities to all types of health plans. Health plans that use HealthRules Payor have been able, for more than ten year, to respond quickly to market opportunities and keep ahead of their competitors. HealthRules Payor is unique because it uses the patented HealthRules Language™, a vernacular similar to English that provides a revolutionary new approach for configuration, claims processing, and transparency of information. HealthRules Payor is a core system that transforms health plans, allowing them to innovate, grow and compete with other systems.

IMPACT is our core suite of Healthcare administration software. It supports all aspects of healthcare-related data transactions. Our customers use Impact to manage enrollment, provider contracts and re-pricing, benefit plans, authorizations/referrals, claims payment and the various complications that surround these functions. IMPACT is flexible and offers a wide range of industry-specific features.

KMR Claims Processing manager is a state of the art, fully integrated, customizable, claims processing solution for TPAs and Self-Insured. Our system allows for electronic claims, integrates seamlessly with Document Imaging systems, can process debit cards, and is fully HIPAA compliant.

ALYCE is designed for self-insureds and municipalities. It handles Workers' Compensation, Auto Liability and Auto Property claims. ALYCE's intuitive design features important data elements on the main claim pages, including the financial summary. All other details are available with a quick scroll, or a single click. Multi-tiered infrastructure to meet employer reporting requirements, based upon locations and departments. Recoveries, including salvage and subrogation as well as excess carrier payments. Automated repeating and scheduled payments with diary alerts. Automated diaries based upon events, financial transactions, and time lines. Automatic generation of form letters for claimants, lawyers, or other claim parties

Our software is built with industry knowledge and expert consulting. This knowledge is used to inform the business processes that are to be integrated into our platform. 360 provides end-to-end claims management transparency and integrity, which allows our clients to lower the total cost of their claims. Our clients get better results by using cost-effective technology that transforms the way they do business. Our software is customizable to meet the needs of our clients. It can also be integrated into existing systems to facilitate integration. This allows for in-house resources to support value-added activities that help businesses differentiate and grow.

Virtual Examiner®, PCG Software’s flagship product, monitors an organization's internal claims process to track provider data for fraudulent or abusive billing patterns and maximizes financial recovery. The Virtual Examiner®, a PCG Software product, allows healthcare organizations to improve their claims adjudication system by allowing for more than 31,000,000 edits per claim. The software monitors an organization's internal claim process to identify and reduce payments for incorrect or erroneous code to save premium dollars. Virtual Examiner®, is more than a claims management solution that focuses on code combinations. It is a cost containment solution that evaluates the claim not only for abusive billing patterns but also identifies those claims that may involve third-party liability/coordination of benefits, case management opportunities, physician billing education and many other cost recovery reports.

HM Health Solutions offers a complete solution for health plans. The Enterprise Health Solution is a comprehensive platform that manages health plans. It provides the support you need and the business outcomes you desire. Platform applications and tools manage functions such as enrollment, billing, claims, provider management, customer service, and billing. The Enterprise Health Solution (EHS), which can seamlessly move your member from enrollment to claims payment, is the only end-to-end proven solution. Others claim to offer a fully integrated solution. They don't mention that you might need to order all modules in order to achieve this integration. The Enterprise Health Solution has always been focused on health plan administration. Our expertise in the area of health plan payers is unmatched by any other company.

ResolvMD is a full-service, experienced medical billing company that processes all types of health service claims (AHCIP, etc.). ResolvMD is a full-service medical billing company that processes all health service claims (AHCIP etc.) on behalf of doctors. Our goal is to make doctors as competent and confident in their billing as they are in the practice. We do this by surfacing data-derived insights, democratized knowledge, and other data-derived insights. We offer the most secure, cost-effective and modern platform for processing claims. Our target audience is physicians (mainly specialists such emergency physicians, urgent care plastic surgeons, anesthesiologists and paediatricians, as well as general surgeons). To process their claims for health services, they need a billing agent. They value efficiency, time, trust and cost. Today, we are targeting Alberta physicians (primarily in Calgary, Edmonton and Medicine Hat, Lethbridge. Okotoks, and any other centre with more than 25,000 people).

We provide solutions-first products that solve critical resource problems and improve outcomes for the entire claims ecosystem.

The transaction costs of vouchers are reduced by efficient checks, integrated expertise, and high levels of automation. Sumex Core is the foundation for automated electronic invoice verification. It includes the business components and workflows that can be assembled and parameterized in modular fashion. Effective invoice verification is possible only if the reference data and tariff are current and accurate. Sumex reference data are compiled from publicly accessible sources, processed in a timely fashion, and made available on Sumex tariff server. The data can also be accessed by experts within the context of current billing. DRG Expert supports the control of billing for services in acute healthcare, as per SwissDRG regulations. DRG Expert provides case data within the context of regulations, includes statistical key figures, and offers what-if analyses.

Jopari ProPay, a cloud-based solution for healthcare payers, is a payment processing system. It offers a complete suite of payment methods including EFT/ERA payments, virtual card payments and paper checks. Jopari ProPay helps healthcare payors eliminate paper and reduce operating expenses by streamlining payment and remittance processes. It allows payers to outsource payment processing so they can focus on other core tasks. Jopari ProPay gives providers a choice of multiple payment delivery methods, so that they can select the one that best suits their needs. The self-service portal allows providers to view their EOBs/Rs, and track their payments. Over 50,000 ERISA plans and fully insured groups trust Jopari ProPay as a secure, compliant and compliant payment processor.

Context4 Health Plans Suite is a modular, cloud-based technology platform that protects the integrity of your health plans and allows you to accurately price them. Our team of certified clinical, dental, and healthcare professionals provides immediate, defensible Fraud, Waste, and Abuse detection. A combination of accurate data and cutting-edge cloud technology creates a defensible and proven medicare reference-based pricing solution (RBP). Professional support is available to ensure compliance and efficiency with more than 100 healthcare data sets. Advanced medical coding software that expedites claim submission and minimizes denials.

Curacel's AI-powered platform allows insurers to track fraud and automatically process claims. You can easily collect your claims from your Providers and auto-vet them. Curacel Detection can help you identify and curb fraud, waste, and abuse in the Claims Process. Collect claims from providers to prevent fraud, waste, and abuse in the claims process. To understand where Insurers are losing the most value, we studied the Health Insurance industry. This was the Claims Process. The Claims Process is mostly manual and is prone to fraud, waste, and abuse. Our AI-driven solution helps reduce wastage and makes the Insurer more efficient, unlocking hidden value. Ravel insurance is unique in that it is built upon on-demand policies that only cover a short time. Both the policy holder and the insured want a fast and accurate claim settlement.

The most widely used patient safety platform. Comprehensive patient safety software that can drive long-lasting change and performance improvements in your organization. Global community of patient safety experts. RLDatix is a global community of patient safety experts. RLDatix customers, industry leaders and thought leaders can share their best practices and inspire you with their ideas. RL Suite Comprehensive solutions for patient safety to support your safety and healthcare quality efforts. Your data can be turned into actionable intelligence that will help you reduce and mitigate risk. By identifying and reducing infection rates and clinical risks, you can intervene quickly and keep patients safe. Engage patients in real time to ensure that they have the best experience possible. To ensure compliance and institutional learning, centralize policies and procedures.