Best Claims Processing Software - Page 3
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Compare the Top Claims Processing Software as of December 2025 - Page 3
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1
PlanXpand
Acero Health Technologies
PlanXpand™ is Acero’s proprietary transaction processing engine, one that powers each of our products for health benefits administrators. Leveraging this engine, clients may choose to implement Acero’s products concurrently or incrementally. In addition to selecting one of our standard products, administrators also may choose to utilize PlanXpand™ to develop a custom solution to extend existing system capabilities. Acero’s unique, integrated solutions feature Service-Oriented Architecture, allowing health benefits administrators and insurers to add features and functions to existing adjudication platforms. At the same time, our sophisticated design and engineering enables real-time adjudication of every type of claim, all in direct interaction with the core claims system, resulting in more accurate processing, more satisfied customers and less need for claims adjustments. -
2
ClaimBook
Attune Technologies
ClaimBook enables faster settlement of insurance claims, improved accountability and fewer rejections. It is well equipped with the features to address every part of the claims and evidence submission. ClaimBook supports international patient treatment with dedicated workflows, therefore enabling medical tourism. A built-in Rules Engine that disallows incomplete submissions, and knows what information and documents need to be submitted. This results in error-free submissions that are complete and guarantees that it is pre-authorized. ClaimBook's Smart Data Extraction can read documents uploaded to extract relevant data from the Hospital's Information System (if integrated with ClaimBook) to prevent the need for manual entries. ClaimBook also features Integrated Emailing by creating a virtual inbox in your dashboard. Withing the dashboard, emails can be composed, the design feature is similar to Microsoft Outlook. -
3
omni:us
omni:us
Seamless integration into existing claims systems. Automate processes and reduce costs. No longer is it a choice between saving costs and improving the customer experience. Better decisions with data-driven insights. Automate manual processes. Empower your claims personnel. Invest in your customers’ happiness. Seamlessly integrate incoming claims with your insurance core system. Tackle process inefficiencies with claim automation and watch your customer satisfaction skyrocket. Reduced manual claims incidence of low to moderate complexity by automating claims handling. Improved triaging and manual claims assignment increased case team effectiveness drastically. Decreased process time for remaining manual claims. Allowed a real-time claims settlement in significant amount of cases. Automated digital claims journey by applying FNOL-completeness check, coverage check, automated claims file creation. -
4
MyClaimStatus
Medical Payment Exchange
If your staff is wasting precious time and resources by manually statusing claims on web portals and sitting on the phone with payors you need myClaimStatus. Get real-time, actionable claim status information on all of your claims and eliminate the waste. myClaimStatus’s suite of data tools helps you reconcile claims faster. It doesn’t matter how big or small you are. Save more with every claim when you use myClaimStatus. Are you working efficiently? MedX medical claim services use robotic process automation to maximize your workflow efficiency. Easily reconcile reimbursement rates with your contracted amount ensuring you’re receiving what you should. Drill down with real-time data for every healthcare claim from every payor, no matter the dollar amount. This is not your standard healthcare claims processing software. Optimize AR follow-up activities to work by exception and get more done in less time. -
5
OneTouch Claims Processing Software
Apex EDI
OneTouch is a tool that allows a user to conveniently transmit claims or statements to Apex, login to the Apex website, or search for claims that have been sent in the past all from of your computer desktop. In order for OneTouch to work, the user must be a registered client with Apex EDI and have a username and password setup. Once a user has a username and password OneTouch can be configured so the user can utilize the tools described. With OneTouch Search you can search your claim and statement files that have been sent to Apex from the convenience of your desktop. The OneTouch search feature allows you to search your statement and claim files for patient names, subscriber IDs, or several other options. After you click the search button you will be logged into your Apex webpage and shown the results of your search. To perform a search first choose what you want to search for by clicking on the magnifying glass dropdown menu. -
6
NextGen Population Health
NextGen Healthcare
Meet the challenges of value based care—no matter your current EHR. Get a clear view into your patient population with aggregated multi-source data and an easy-to-navigate visual display. Use insights based in data to better manage chronic conditions and care transitions, prevent illness, lower costs, and implement care management. Facilitate care coordination with tools that encourage a proactive approach, including a pre-visit dashboard, risk stratification, and automated tracking of admission, discharge, and transfer events. Put care management in operation. Extend physician reach. Foster critical interactions with patients and valuable follow-up in between appointments. Identify patients with the greatest risk for high-cost utilization, using the Johns Hopkins ACG system for risk stratification. Accurately assign resources where intervention is needed most. Improve performance on quality measures. Participate successfully in value-based payment programs and optimize reimbursement. -
7
Snapsheet
Snapsheet
Snapsheet makes claims simple. We do this through a suite of innovative insurance software solutions which transform insurance companies' ability to seamlessly manage claims, reduce cycle time, increase appraisal accuracy, and deliver payments effortlessly. We started it all with virtual appraisals, and followed that up with our leading claims management system. Today we are driving an industry-wide movement in claims by delivering solutions that enhance customer experiences while our customers create innovative, data-driven claims organizations. -
8
Claimocity
Claimocity
Claimocity was designed for busy clinicians who see patients in Acute Care or Step Down facilities. Claimocity is the first and only PM and RCM software designed exclusively for hospitalists. it is an All-In-One Mobile Billing & Practice Management Software App for Clinicians Who See Patients in Acute Care or Step Down Facilities. Clone previous notes in a way that other solutions, including EHR/EMRs, are not allowed to do. Combine and streamline two separate daily encounter documentation and billing processes in a way that saves significant time. Our note capture section can prepopulate the note with vitals and import elements from the chart. Support multiple complex templates inside a practice (calibrated encounter notes, procedure specific notes, single-section text based notes, or any combination of context-based pre-builds). Copy and paste any large available data groupings from third party available information sources directly into any text section and then sign and submit.Starting Price: $99 per user per month -
9
Mercury Policy & Claims Administration
Quick Silver Systems
Mercury by Quick Silver Systems allows Automobile, Property, and Casualty insurance carriers to easily rate, quote, bind, make payments, and report claims online. Minimize customer service calls through online document access, bill payments, and first notice of loss. Modular API based system allows seamless integration with new or existing data providers. Fully digital document production and 100% web-based system works on any device. Create custom, event-driven work-flows with our visual work-flow designer. Access the most up-to-date information on Written, Earned, and Unearned premiums. Automatically save every page, card, report, email, and more to review and share with associates. Collect currency in any digital format including: ACH, EFT, Electronic Checks, Credit, or Bank Card. Information Technology within an insurance company not only needs a system that provides wide accessibility. -
10
Coronis Health
Coronis Health
Through our personal, high-touch service, Coronis Health can provide an unparalleled level of professionalism you won’t find anywhere else. We won’t just help you collect your revenue. We will help you financially grow while progressing this industry into the modern technological age. Coronis Health is a global revenue cycle management company offering specialized solutions to healthcare practices and facilities. By using industry-leading technology combined with high-touch relationship building, Coronis Health allows healthcare practitioners to focus on patient care, maintain financial independence, and cultivate financial success. Coronis Health is comprised of the best of the best in medical billing. Thoughts leaders and experts in every practice area utilize global resources, technology, and best practices to provide successful partnerships for customers. -
11
Smart Data Solutions
Smart Data Solutions
Streamline Your Complete Healthcare Data Workflow. Smart Data Solutions has the tools and experience needed to streamline both your paper and electronic workflows. Our integrated validation, matching, and normalization tools ensure the highest quality data possible, increasing auto-adjudication and reducing manual processing. Whether you’re new to Smart Data Solutions or a long time partner, our development process helps guide you through projects to ensure the best possible position for overall success. Whether your needs are basic or complex, our staff will work with you to understand your needs and the impacts of your workflows. We believe in focusing on your goals, what you want to accomplish, and from that, identifying the best way to get there. Smart Data Solutions provides complete front-end pre-adjudication solutions for hundreds of Payers nationwide. Whether you need basic services or a completely custom workflow, Smart Data Solutions offers a variety of solutions. -
12
Inblue Request
inblueQMS
Solutions for specific needs. Maintain your ISO 9001:2015 certification, with inblueQMS. Deliver fast solutions to your customers, with inblueRequest. Register your customers requirements, measures your response times. Classify Registers. Do everything Online. With the assurance of more than 30 years experience in the development of information technologies. Benefits of our Software. Centralization Planning, recording and follow-up of processes and procedures. Reminders. Receive reminders about deadlines and notifications each time a task is assigned to you; via e-mail and/or dashboards. Manageable. Modify fields according to the realities of your company. Grant permissions and define deadlines. Easy to use. User-friendly design, with guided functions which make your work easy. Recording. Record comments and versions for a better follow-up. Includes a history of changes. Charts and Results-Reports.Starting Price: $8 per user, per month -
13
EXPEFLOW
EXPEFLOW
EXPEFLOW’s workflow intelligence unlocks the new normal of hybrid work environments, digital transformation, and “paperless processes”. Our no-code workflow intelligence frees up your employees to focus on customer engagement and growing your business! Workflows are manual, long, and error-prone processes that rely on employees to make repeated attempts to obtain missing information and key pieces of data. EXPEFLOW’s intelligent QuickStart file types increase focus on your customer experience while increasing your operational accuracy and efficiency. You are in control with our no-code platform! With our user interface, you can design your workflows without the need to wait for developers or additional resources. Engage employees and increase productivity to drive a greater customer experience! Workflows need to be flexible as customers and industries are unique. Our platform has the domain knowledge and expertise to help you work better and smarter! -
14
Service Hub CRM
Service Technologies
Service Hub CRM provides stellar service with ease. On average it can take more than 3 phone calls to reach a customer to schedule an appointment. Put the power to Provide Stellar Customer Service in your employees’ hands. Communication is the key to any relationship. We know that every little detail must be accounted for. We’re able to customize our software to specifically fit your business needs. Why use separate systems when you can consolidate. Our team will help you navigate our system and learn how to properly use it. Get all the information you need right from your dashboard. Have your technician give you and your customers up to date status on their tickets. Keep track of all your orders right from your app for more efficiency. Never get lost going to your next call. Upload files right from your device and for instant access. Receive notifications right to your phone on the status of your orders. -
15
PwC SMART
PwC
PwC SMART (Systematic Monitoring and Review Technology) increases the efficiency and effectiveness of your inpatient and outpatient coding quality evaluation process, and enables a mechanism for quality and compliance review. Coupled with the support provided by PwC Health Information Advisory, SMART bolsters your efforts to monitor coding and data quality. SMART Inpatient includes 1,000+ pre-defined business rules that identify potential coding inaccuracies and documentation improvement opportunities. You can also customize business rules for your specific areas of focus. Reporting and data analysis help you evaluate your staff’s performance and pinpoint education opportunities for Coding, Clinical Documentation Improvement (CDI), Quality and Providers. SMART Outpatient improves the accuracy of claims and identifies charge capture issues and areas for workflow improvements. It also improves regulatory compliance by decreasing the risks caused by inaccurate coding. -
16
Ventiv Claims
Riskonnect
Lower costs by administering claims with unparalleled efficiency and accuracy. With 500+ global customers and counting, Ventiv is one of the premier leaders in the risk management, insurance claims and advanced analytics space. Helping some of the biggest brands on the planet with products like our industry leading risk analytics solution. -
17
Five Sigma
Five Sigma
Five Sigma set out on a mission to allow claims organizations to innovate. With the set of claims management tools and unique platform, Five Sigma's suite is what Insurers need to bring their claims operation to the rapidly changing world. With our suite of Claims-First Cloud-Native and User-Centric products, we enable adjusters to handle claims better and faster. With Automating administrative tasks, Adjusters can focus on making the right decisions, while the system takes care of everything else. Clive™ by Five Sigma is the industry's first AI-powered claims adjuster, transforming how claims are processed by insurers, MGAs, and TPAs. Leveraging advanced AI and automation, Clive streamlines the entire claims lifecycle, from FNOL (First Notice of Loss) through to settlement. The AI agent enhances claims handling efficiency, accuracy, and cost reduction by automating tasks. -
18
Thoughtful AI
Thoughtful.ai
Thoughtful AI offers a comprehensive, AI-driven solution for healthcare revenue cycle management (RCM). With its human-capable AI agents, such as EVA for eligibility verification and CAM for claims management, the platform automates the most complex and time-consuming RCM processes. Designed to boost efficiency and accuracy, it reduces operating expenses, minimizes denials, and accelerates payment posting. Trusted by leading healthcare providers, Thoughtful AI provides seamless integration, guaranteed ROI, and the ability to reduce cost-to-collect, all backed by HIPAA-compliant security and performance-based guarantees. -
19
Newgen Claims Processing
Newgen Software
Automate the end-to-end claims journey, from intimation of the first notice of loss and fraud detection to claims adjudication, and finally claims settlement. Experience the flexibility of addressing various claim types differently, like death and maturity claims, while improving regulatory compliance and eliminating non-compliant penalties. Enable faster, accurate, and effective processing through data capture, payment tracking, salvage and recovery tracking, legal matter processing, monitoring, and more. Effective registration, adjudication, tracking, and management of claim submissions. Built-in, comprehensive business rules for automatically categorizing claims as “fast track” or “non-fast track”. Flexibility to add or modify stakeholders— garages, assessors, loss adjusters, surveyors, investigators, claim officers, etc. -
20
EvolutionIQ
EvolutionIQ
Our solutions drive lower loss costs, lower expenses, and higher customer satisfaction, and are proven at tier 1 carriers. EvolutionIQ enables the future of claim handling for complex lines of coverage, a deep partnership between skilled professional adjusters, and a highly specialized predictive guidance system. Equipped with clear prioritization, pro-active claim alerts, and rich context, empowered adjusters reduce losses and expenses while delivering an enhanced claimant experience. Reduce unwanted variability in the claims pipeline with a consistent, scalable claim guidance system. With the more efficient allocation of adjuster resources & fewer wasted claim reviews. With targeted claim investigations, litigation avoidance, and timely claim settlement. Our claims AI acquires and harnesses data to deliver the tactical guidance your team needs. EvolutionIQ combines structured and unstructured carrier data with our proprietary third-party data. -
21
EMSmart
EMS Management & Consultants
EMSmart™ claims processing technology raises the bar and your bottom line. At EMS IMC our priorities are clear, to employ a compliant, accurate, and efficient system to manage an increasingly complex billing process while quickly maximizing your revenue. For clients across the country, EMS IMC has done just that with a new solution called EMSmart™ which frees you to focus on the important work of patient care, while having confidence that the maximum amount of revenue is being collected in a compliant manner. EMSmart™ is our new, proprietary claims processing platform that delivers the industry’s best rulesbased process automation while retaining human judgment at the appropriate points in the revenue cycle process. EMSmart™ is our internal processing engine, but we’re excited to share this information with you so you can have confidence that your claims are in the industry’s best hands, both human and automated. -
22
HealthAxis
HealthAxis
HealthAxis equips payers, providers and health organizations with integrated solutions from an advanced claims processing system and TPA services to actionable analytics. We streamline operations and improve client and patient outcomes. As healthcare becomes more technologically enabled, it remains inhibited by coordination challenges, legacy technology, and information management. We strive to bring innovation and a growth mindset to all struggling with these challenges. Our client philosophy is to serve as a complete business partner. HealthAxis believes our success does not stem from selling our solutions but from our business partners’ sustained success and growth. We enable our partners to add value to the communities they serve. As they build their membership and scope, we flourish with them. Every level of our team understands our responsibility to help unlock our partners’ potential. -
23
Total Loss Pro
Vemark
The frequency of total loss claims continues to rise, now accounting for some 20 percent of collision and liability losses across the auto insurance industry. Yet, far too often, carriers’ total loss operations lack cohesive integrated digital workflows, leading to excessive costs, customer dissatisfaction, and poor visibility and oversight. Enter Total Loss ProTM from Vemark. It’s the one solution you need to transform total loss claims processing from a frustrating black hole to a well-oiled machine while allowing you to keep up with the rapid pace of change. Faster settlement for Improved policyholder experience and satisfaction. Higher employee morale from reduced frustration, and fewer tedious processes. Increased visibility and transparency for data-driven decision-making. Auto claims that result in a total loss are more complex than vehicle repair claims. Total Loss Pro is a cloud-based solution that improves all stages of this complex salvage vehicle workflow. -
24
BirchNotes
BirchNotes
The most intuitive practice management and client-centric EHR software for mental health and substance abuse treatment professionals, BirchNotes is built to help you grow and manage your practice with ease. An EHR is designed with a behavioral health therapist in mind. Features and tools chosen and tailored for both substance abuse and mental health professionals. Your EHR, billing, insurance, scheduling, and telehealth are all in one integrated solution. No need for multiple log-ins, systems, or additional tools! No matter your practice setting or size, BirchNotes offers the flexibility and scalability to meet your needs. Our workflows are insights are configured to best suit your practice. Easily manage your practice with our smart workflows, automation, and customizable settings to help save you time and focus more on what matters to you. A better solution for better outcomes. Group, telehealth, and recurring appointments are fully supported, plus customizable calendar views. -
25
SSI Claims Director
SSI Group
Elevate your claims management process and decrease denials through unmatched edits and an industry-leading clean claim rate. Health systems require access to technology that facilitates accurate claim submission and rapid reimbursement. Claims Director, SSI’s claims management solution, streamlines billing practices and provides visibility by guiding users through the electronic claim submission and reconciliation process from beginning to end. As payers change or modify reimbursement criteria for services, the system actively monitors and incorporates these changes and requirements. And with a comprehensive mix of edits at the industry, payer and provider levels, the solution aids organizations in making the most of reimbursement efforts. -
26
Anagram
Anagram
Anagram Prosper puts money back in the hands of your patients — at no cost to your practice. Increase your margins, delight your patients, and forget courtesy discounts. We partnered with the best vendors to develop wholesale price lists that better align with the needs of you and your patients. Provide rebates on the same products you already stock. Incentivize your patients, drive more conversions, and collect more revenue. With Anagram Prosper, you can save patients money without offering discounts or lowering your margins. Use our rebate program to drive more sales and make your patients happy. Most patients don’t know about their out-of-network benefits. Anagram Access can pull real-time vision plan eligibility to maximize savings for your patients. With Anagram Access, you can quickly calculate how much your patient owes and how much their vision plan reimburses. -
27
Beagle Labs
Beagle Labs
Streamlining the claims process from end to end. Technology-driven, people-centric, and built on integrity. A robust claims service interaction platform for insurance carriers, MGAs, captives, and self-insured entities. Deployments, claims organization, and advanced file management at your fingertips. At Beagle, we understand the unique challenges faced by insurance service providers and independent adjusters when it comes to claims handling. Our core software functionality is designed to streamline the process, reduce costs, and provide rapid responses to your claims. Our technology brings efficiency and expertise to every step of the adjustment process. Express claims and inspection responses that reduce liability and drive efficiency. New policy inspections, policy renewals, and daily losses. Beagle was developed to handle the processes required on a daily basis. Streamlined claims handling by leveraging the latest technologies that enable a more efficient resolution. -
28
Duck Creek Claims
Duck Creek Technologies
Duck Creek Claims is a comprehensive claims management solution designed to streamline the entire claims lifecycle for insurers. From the initial report to final settlement, it automates workflows, simplifies data analysis through integrated analytics, and ensures seamless integration with existing systems. Key features include dynamic first notice of loss (FNOL) capabilities, automated assignment based on adjuster skills and workload, instant access to policy and coverage data, and efficient adjuster workflows. By enhancing operational efficiency and reducing manual workloads, Duck Creek Claims enables faster claims resolution, improved customer satisfaction, and compliance with the latest regulations. -
29
Guidewire ClaimCenter
Guidewire Software
Guidewire ClaimCenter is a leading claims management system designed to streamline the entire claims lifecycle for property and casualty (P&C) insurers. It offers comprehensive functionality from initial claim intake to resolution, enabling insurers to process claims efficiently and accurately. Key features include automated workflows, embedded analytics, integrated fraud detection, and real-time performance monitoring, all of which enhance operational efficiency and improve customer satisfaction. ClaimCenter supports various lines of insurance, including personal, commercial, and workers' compensation, and can be deployed as a standalone solution or as part of the Guidewire InsuranceSuite. By leveraging ClaimCenter, insurers can accelerate claims processing, make data-driven decisions, and adapt to evolving market demands. -
30
bestPT
Billing Dynamix
bestPT is a complete, cloud-based physical therapy billing service and practice management software solution. Created for private practices of all sizes, bestPT helps solo practitioners and franchise owners of physical therapy clinics to manage payment and revenue generation as well as keep track of claims processes. Integrated with the most popular EHR systems, including webPT and Cedaron, bestPT helps streamline billing processes to make the entire office's workflow more efficient.
