Best Claims Processing Software - Page 5
View:
Compare the Top Claims Processing Software as of August 2025 - Page 5
Sort By:
-
1
Risk Manager
ERIC Systems
Risk Manager utilizes Microsoft SQL Server allowing the creation of custom views and queries for reporting purposes. ODBC compliant applications may also be utilized without dependency on ERIC Systems. Risk Manager is under constant development and updates are regularly published. Our policy for providing updates is simple. We offer newer versions at no additional cost to the standard technical support agreement. Dollar limits for individual check and reserve transactions are assigned to user logins. Not to exceed without acknowledgment controls are also provided for total paid to date and total incurred thresholds configured at the enterprise level. Our policy for development of new program features and standard reports is based on client suggestions.Starting Price: $19995.00/one-time -
2
ClaimAdept
Isoft
This product is an end to end claims system. The primary functions are claims adjudication, claim workflow and payment disbursement. The flexible design allows the addition of adjudication modules on a line of business basis. Each new line of business added reuses the core functionality of the system. This system takes advantage of the user friendly windows screen design and makes use of a relational database to store information within the system. The software platform is Powerbuilder with an SQL database such as Oracle or Sybase. This combination of software supports a client server based environment that is capable of processing large volumes of claims. Installation and training are available and source code is included as part of the licence fee. Expert staff is available for customizations and tailoring of the system to meet any special requirements identified by the client. All modifications are available with detail design and support for acceptance testing. -
3
InsurancePlus Software Series
United Systems and Software
USSI is proud to present its entire line of professional insurance software solutions designed and developed as an all-encompassing turnkey administration offering. USSI's comprehensive software solutions ensure that your insurance company is operating at the highest level in an ever changing and competitive marketplace. USSI's InsurancePlus Individual Life and Health Administration software solution manages books of business for traditional and non-traditional Life and Health insurance companies. Product lines supported include Whole and Term Life, Interest Sensitive, Final Expense, Annuities, Supplemental Health, etc. USSI's InsurancePlus Group Life and Health Administration software solution manages books of business for Group Health insurance companies, Self-Insured Funds, and TPA's. Supported plan offerings include Point of Service, Major Medical, Term Life, High Deductible, Traditional Indemnity, etc. -
4
HealthQx
Change Healthcare
Accelerate your value-based initiatives by quickly analyzing and understanding episode costs. Build provider adoption and engagement with data-driven, evidence-based discussions about total episode costs and individual provider practice patterns. Drive cost and quality improvements by targeting variations in care delivery and provider performance. Empower value-based strategies through analytics, providing insights to help guide network optimization and clinical transformation. Identify value-based care opportunities through an analysis of episode costs, leveraging clinically validated episode definitions. Target providers to engage in value-based discussions through an analysis of utilization, costs, and care variations. Leverage episode analytics to help optimize network designs, transform clinical guidelines, and improve consumer engagement. Streamline episode budget creation by defining average episode costs and associated clinical services. -
5
eobXL
Optiform
Given that remittance advice often contains thousands of detailed transactions, healthcare providers must resort to costly and labor-intensive manual data entry tasks to perform the necessary patient accounting activities. In an effort to automate this process and accelerate billing cycles, healthcare providers have turned to recently available computer-aided recognition technologies designed to extract transaction-based data from paper forms. While this technology has proven effective at extracting accurate data elements, there remain many processing tasks specific to EOBs that must be addressed for successful implementation to occur. The Optiform eobXL™ for Kofax Capture solution provides the necessary features to address these tasks, as well as the data and image integration requirements, all in an intuitive, “point & click” interface. -
6
Conexia
Conexia
Provide authorizations, claims processing and payment in real-time at the point of care. Enhance care coordination and improved outcomes to lower medical cost while streamlining administrative processes. Engage providers at the point of care to capture and share data in real-time resulting in an unparalleled exchange of health information. We partner with our clients to implement risk management strategies that result in better outcomes with lower costs. We strive to improve the user experience for everyone involved in the ecosystem. We deliver a minimum 3:1 ROI for our clients to allow them to optimize their resources. Conexia has developed a core technology platform (ONE) that is customizable to meet the diverse regulatory requirements and operational processes for each client in each geography. In most cases, our initial implementation is an overlay on the payer’s existing technology ecosystem to create real-time processes. -
7
CLAIMSplus
Addiox Technologies
Expedited claims. Multiple interfaces sync with your corporate brand. Digitized data environment that can be accessed from anywhere, at any time. Health and Life processing via faster systems that aligns with your processing needs. Speeding up the claims life cycle to match the influx of your claims—while reconciling and resolving the more complicated claims at record velocity. It’s in. It’s out. No interruptions or claims processing delays. CLAIMSplus moves claims faster, working with employers, TPAs and insurers with robust in-the-cloud processing platforms. CLAIMSplusis in the business of optimizing processes and expediting medical claims through secure, reliable and efficient electronic claims management. More to the point, our technology—first and foremost—manages claims quickly and efficiently. We’ve asked our clients, and the timescale of the claim is the most important element for claims processing. -
8
Claim Leader
ClaimLeader
Claim Leader develops and provides technology solutions to automate the communications and workflow processes across the business enterprises of insurance claims organizations. Our software solutions allow to simplify your operations, while providing superior productivity through an advanced, and integrated web platform. Feature-rich modules within Claim Leader systems create a simplified workflow for internal administrators and on the field users. Management tools allow internal users to dispatch assignments to field staff, sort workload, pinpoint files for review, and streamline workflow. -
9
Terra
Terra
Antiquated on-premise systems are a liability. Streamline your claims operations and improve efficiency with Terra's Automation, Integration, and Intelligence. Terra's products include Claims Management, Policy Management, Benchmark, and an Ancillary Services Marketplace. Manage risk with Automation, Cloud-Native, Integration, and Intelligence! Terra is a Cloud-Native Risk Management Information System for Property & Casualty Insurance. -
10
ClaimLogik
Claim Central Consolidated
Connect everyone in your property claim. ClaimLogik connects everyone in a property claim from first notice of loss through to completion. Property assess & repair ecosystem. We connect everyone in your property claim from start to finish. Stakeholder Management. ClaimLogik connects EVERY stakeholder in a claim with real time access, to complete tasks and manage activities at the right time, in the right order and with complete transparency. All stakeholders have access to workflow modules that have been customized to enable them to track, manage and complete tasks throughout the claim. Stay connected. All stakeholders connected on one claim. Complete transparency on claim status for all stakeholders. Line of sight for all activities across the entire claim. Digital contracts between Insurer and supply chain. Service level agreements with all suppliers and trades KPI management to measure and compare supplier performance. Automated exception management when tasks fall outside SLAs -
11
Enterprise Health Solution
HM Health Solutions
HM Health Solutions provides an end-to-end solution to health plans. Get the support you need and business outcomes you want from one comprehensive health plan administration platform: the Enterprise Health Solution. Platform applications and tools manage functions from sales through enrollment and billing, including claims, provider and clinical management, and customer service. The Enterprise Health Solution (EHS) is the only proven end-to-end solution, and can move your member seamlessly from enrollment to claims payment. You’ve heard others claim to offer a fully integrated solution. What they don’t specify is that you may need to purchase all modules in sequence to achieve this integration. On the Enterprise Health Solution, health plan administration has always been the one and only focus. No other company rivals our expertise in the health plan payer space. -
12
CoreLogic Claims Connect
CoreLogic Australia
CoreLogic’s Claims Connect is a powerful solution designed for the insurance industry to streamline and manage claims processes efficiently. The platform allows insurance companies to quickly assess property damage, automate claims handling, and access real-time property data, helping to accelerate claims resolution. By integrating advanced property data analytics, Claims Connect helps insurers improve decision-making, reduce processing times, and enhance customer satisfaction. With features such as automated workflows, reporting tools, and access to accurate property information, this platform optimizes the claims lifecycle from start to finish. -
13
CaseGlide
CaseGlide
CaseGlide is driving the revolution in claims litigation management. Gone are the days of disconnected and siloed claims systems, manual and inefficient workflows, and hundreds of emails passing between defense counsel and claims teams containing unstructured case data. With CaseGlide you can focus on strategy, data, and driving efficiency to improve your litigation management program. Our clients better predict and manage their case outcomes, assign the right attorneys to the right cases, work cases more strategically, and significantly reduce their litigation costs. As your defense attorney partners work your cases in the platform, integrations allow you to push important case data to your claims system, data warehouse, document management, or accounts payable system. It’s simple: the longer a case is open, the higher your costs. -
14
Reserv
Reserv
We power the entire claims ecosystem with solution-first products and services that deliver better outcomes and solve critical resource challenges. -
15
Sumex
Sumex
Efficient checks, integrated expertise and a high degree of automation reduce the transaction costs of vouchers to a minimum. Sumex Core is the basis for automated electronic invoice verification. It contains the business components and workflows, which can be assembled and parameterized in a modular way. Current and correct tariff and reference data are central to efficient invoice verification. Sumex reference data is compiled from publicly available sources, processed in a timely manner and made available on the Sumex tariff server. The data is additionally presented in an information system and can be consulted directly by the experts in the context of the current billing. DRG Expert supports the controlling of billing for services in acute care, created according to SwissDRG regulations. DRG Expert presents case data in the context of regulations, contains statistical key figures and offers what-if analyses. -
16
Jopari ProPay
Jopari
Jopari ProPay is a cloud-based payment processing solution for healthcare payers. It offers a comprehensive suite of payment methods, including EFT/ERA, virtual card payments, and paper checks, as well as a self-service provider portal for EOB/R delivery and support for compliant 835 delivery for eBilling transactions. Jopari ProPay helps healthcare payers to eliminate paper and reduce operational expenses by streamlining their payment and remittance processing. It also allows payers to outsource their payment processing, which can free up their resources to focus on other core tasks. For providers, Jopari ProPay offers a multi-tiered choice of payment delivery options, so they can choose the method that best meets their needs. Providers can also access a self-service portal to view their EOBs/Rs and track their payments. Jopari ProPay is a secure and compliant payment processing solution that is trusted by over 50,000 ERISA health plans and fully insured groups. -
17
HealthRules Payer
HealthEdge Software
HealthRules® Payer is a next-generation core administrative processing system that provides transformational capabilities to health plans of all types and sizes. For more than ten years, health plans implementing HealthRules Payer have been able to quickly address market opportunities and stay in front of their competition. HealthRules Payer is unlike any other core administrative solution because of its use of the patented HealthRules Language™, an English-like vernacular that delivers a revolutionary new approach to configuration, claims processing and transparency of information. HealthRules Payer helps transform health plans looking to grow, innovate and compete beyond any other core system today. -
18
IMPACT
Managed Care Systems
IMPACT is the core to our suite of Healthcare administration software that supports all facets of health care 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 has tremendous flexibility and provides a wide offering of industry-specific features. Nothing makes us happier than gratitude and accolades from our customers. We enjoy our client interactions and the delivery of software that makes their work lives easier. Technology is meant to serve the customer. MCSI focuses on the development of solutions that fit well within a client's enterprise allowing them to grow and change with their market. We have experience in all aspects of healthcare data management and solutions deployment. We pride ourselves in creating software that focuses on automation, accuracy and reliability. -
19
KMR Medical Claims Manager
KMR Systems
KMR Claims Processing Manager is a state-of-the-art, fully integrated, customizable claims processing solution for TPAs, Self Insured and Claims Administrators. Our system includes a comprehensive Medical & Dental Reimbursement module, allows for electronic claims, integrates with Document Imaging systems, has the ability for debit card processing and is totally HIPAA compliant. -
20
DWF 360
DWF Group
Our software is built on industry expertise and with expert consultancy. We use this knowledge to inform the business processes that need to be embedded into our platform. 360 delivers end-to-end claims and risk management transparency and integrity that allows our clients to lower their total cost of claims. We create better outcomes for our clients by providing cost-effective technology that transforms how they do business. Our software can be configured to specific client needs and is pre-built to ensure a smooth integration into existing systems, releasing in-house resources for value-added activities that allow businesses to differentiate and grow. -
21
Virtual Examiner
PCG Software
Virtual Examiner®, PCG Software’s flagship product, monitors the internal claims process of an organization to trend provider data for fraudulent and abusive billing patterns, and maximizes financial recoveries. PCG Software’s Virtual Examiner® allows healthcare organizations to enhance their current claims adjudication system with more than 31 million edits per claim. The software solution monitors an organization’s internal claims process to identify unclean claims and reduce payment for improper or erroneous coding to conserve premium dollars. Virtual Examiner® is more than a claims review solution with a focus 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. -
22
RLDatix
RLDatix
The most widely deployed patient safety platform. Comprehensive patient safety software that helps drive lasting change and performance improvement across your organization. A global community of patient safety experts. When you join RLDatix you’re connecting with a worldwide community of patient safety changemakers. Get proven best practices and inspirational ideas from RLDatix customers, industry and thought leaders. RL Suite Comprehensive patient safety solutions to support your safety and healthcare quality initiatives. Reduce and mitigate risk by turning your data into actionable intelligence for today and tomorrow. Intervene early and keep patients safe by identifying clinical risks and reducing infections. Engage patients in real-time to ensure they receive the best possible experience. Centralize policies and procedures to drive institutional learning and compliance. -
23
ResolvMD
ResolvMD
ResolvMD is an experienced full-service medical billing company that processes all health service claims (AHCIP etc.) on behalf of physicians. Our goal is to make physicians as confident and competent in their billing as they are in their practice through surfacing data-derived insights and democratized knowledge. We have the most modern, cost-effective, and secure platform on the market for processing claims. Our target audience are physicians (mainly specialists such as emergency physicians, urgent care, plastic surgeons, anesthesiologists, paediatricians, general surgeons etc.). They need a billing agent to process their health service claims. They value time, trust, cost, efficiency and knowledge. We are targeting physicians in Alberta today (mainly in Calgary, Edmonton, Red Deer, Medicine Hat, Lethbridge, Okotoks and any other centre with a population in excess of 25,000. -
24
Context 4 Health Plans Suite
Context4 Healthcare
Protect the integrity of your health plan and determine accurate pricing with the Context4 Health Plans Suite, our modular, cloud‑based technology platform. Immediate, actionable, and defensible Fraud, Waste, and Abuse (FWA) detection built by our team of certified clinical, dental, and health benefits experts. Accurate data and cutting-edge cloud technology combine to create a proven and defensible medicare reference-based pricing (RBP) solution. More than 100 healthcare data sets, with professional support to optimize efficiency and compliance. Advanced medical coding software designed to expedite claim submission and minimize denials. Our cloud based Payment Integrity Platform utilizes our proprietary analytics engine to identify coding errors, medical necessity, unbundling, fraud-waste-abuse, audit risks, pricing and other aberrations that can impact your business. -
25
Curacel
Curacel
Curacel’s AI powered platform enables insurers track fraud and automate claims seamlessly. Collect your claims from your Providers in real-time and easily auto-vet the claims. Curacel Detection helps you detect and curb fraud, waste and abuse in the Claims Process. Collect claims from their providers and prevent fraud, waste and abuse in the claims process. We studied the Health Insurance industry to understand where the most value is lost by Insurers. This was identified to be the Claims Process. The Process is mostly manual and is fraught with a lot of fraud, waste and abuse. Our solution, driven by AI, helps to curb wastage and make the Insurer more efficient, thereby making them unlock hidden value. ravel insurance is peculiar in that it is built on on-demand policies that cover relatively short periods of time. Should a policy holder want to make a Claim, both the insurer and the insured want claim settlement to be as efficient and accurate as possible. -
26
Waystar
Waystar
The financial and administrative challenges facing healthcare providers are daunting. Waystar’s technology platform simplifies and unifies healthcare payments across the revenue cycle. We empower healthcare organizations to automate manual work, gain insight into processes and performance, and ultimately collect more revenue. At Waystar, we know there’s a better, more efficient way forward. Let’s climb the mountain ahead of us to reach new heights in healthcare. We know that adopting new revenue cycle technology can seem like an obstacle. Whatever your existing systems, our cost-effective technology is compatible and gets up and running quickly. Our single sign-on platform lets you manage commercial, government and patient payments all in one place, so you can consolidate vendors and eliminate the hassle of multiple systems. Give your staff intuitive solutions that will make their jobs easier and their workflows more productive.Starting Price: $100 per month -
27
zHealth
zHealth
A really easy to use Practice Management Software for Chiropractors. It includes Electronic Health Records (EHR), Billing as well as ability for patients to schedule appointments online. zHealth offers fully customizable SOAP Notes with ability to click, type or dictate SOAP Notes. Give patients a modern experience at every touchpoint in your practice with zHealth software. The end result? Happier patients and more business. Innovative products in zHealth software will help you manage everything from appointment scheduling, notes, billing, payment, and more. More personalized. More modern. More efficient. zHealth software is designed to help you manage and grow your practice and patient connections. Our one-on-one meetings and group calls help you better understand our zHealth software and discover easy ways to manage your practice with our chiropractor software.Starting Price: $119 per month