Alternatives to Adjudicator
Compare Adjudicator alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to Adjudicator in 2026. Compare features, ratings, user reviews, pricing, and more from Adjudicator competitors and alternatives in order to make an informed decision for your business.
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Service Center
Office Ally
Service Center by Office Ally is a trusted Revenue Cycle Management and patient payments platform used by more than 80,000 healthcare providers and health services organizations, which process more than 950 million transactions annually. Service Center is a cost-effective solution enabling providers to control their revenue cycle. With a user-friendly interface, Service Center helps providers check and verify patients’ eligibility and benefits, submit, correct, and check the status of their claims online, and receive remittance advice. Accepting standard ANSI formats, data entry and pipe-delimited formats, Service Center helps streamline administrative tasks and create more efficient workflows for providers. -
2
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. -
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Vitamin PBM
Rits Software
Vitamin PBM is a comprehensive pharmacy benefit management software developed to optimize prescription workflows, claims processing, and cost management for healthcare organizations. It enables pharmacies, insurers, and healthcare providers to efficiently manage pharmacy benefits while ensuring operational accuracy and regulatory compliance. The platform supports end-to-end pharmacy benefit management, including prescription validation, claims adjudication, formulary management, and reimbursement processing. It helps reduce manual errors, improve processing efficiency, and ensure accurate billing and cost tracking. Vitamin PBM includes advanced reporting and analytics tools that provide insights into drug utilization, cost trends, and operational performance. These insights support informed decision-making and help organizations optimize pharmacy benefit strategies. -
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HEALTHsuite
RAM Technologies
HEALTHsuite is a comprehensive benefit administration system and claims processing software solution designed for health plans administering Medicaid and / or Medicare Advantage benefits. HEALTHsuite is a rules-based auto adjudication software solution designed to automate all aspects of enrollment / eligibility, benefit administration, provider contracting / reimbursement, premium billing, medical management, care management, claims adjudication, customer service, reporting and more. RAM’s Medicare Advantage-in-a-Box offering is unique in the industry; the product of RAM’s extensive experience in Medicare Advantage and an unwavering commitment to changing our industry. HEALTHsuite Advantage™ and eHealthsuite™ are the cornerstones of our pre-configured Medicare Advantage-in-a-Box offering. HEALTHsuite Advantage is a fully integrated suite of modules providing our clients with an unmatched solution to administer their Medicare Advantage and Special Needs Plans (SNP’s). -
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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. -
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Complete Claims
Complete Health Systems
Claims Adjudication for medical, dental, vision, prescription, short and long-term disability claims. Available for on-site license or as a hosted application (ASP). Microsoft technology: SQLServer database with a Windows front end. Acclaimed Customer service staffed by health care claims experts with a minimum of 12 years’ experience in the field. Support calls are logged with status available via the internet. Plan copy and modification feature enable quick setup of plans. Auto-adjudication using benefit codes built using business rules based on over 25 variables from both the claim and the claimant records made available to the adjudication engine. Inbound claims can be scanned images, EDI or paper. HIPAA EDI 5010 transaction sets. Re-pricing fee and UCR Schedules can be loaded on the system in advance of the effective date. The date-driven logic will re-price based on the date of service. -
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Hi-Tech Series 3000
Hi-Tech Health
Series 3000 is a cloud-based claims administration solution for businesses within the healthcare industry. No matter what your adjudication, reporting, or plan needs are, this platform reduces time processing claims and increases productivity as it assists with: •Client management •Benefits input •Electronic claim submissions •Claims processing •Real-time status tracking Our built-in database efficiently manages clients and employee benefits. This platform allows users to make real-time updates including: •Claims statuses •Currency conversion •ACH deposits and disbursements •Document printing No matter what happens, our cloud-based software is reliable, and we pride ourselves on 99 percent up time. Series 3000 is HIPAA compliant and ensures secure data management and backup. We upgrade our communications and IBM hardware every two to three years and maintain System Critical Support with all our vendors, keeping our technology up to date.Starting Price: $3500 per month -
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PLEXIS Payer Platforms
PLEXIS Healthcare Systems
PLEXIS’ suite of best-in-class apps has a proven record of giving payers the extended functionality necessary for modern core administrative ecosystems. From real-time benefit administration and adjudication to automatic EDI transmission and self-service customer portals, PLEXIS Business Apps have you covered. Passport provides essential connectivity from the core admin and claims management engines to PLEXIS business apps, your own apps, and existing in-house systems. With its flexible API layer, Passport delivers real-time integration with portals, automated workflow toolsets, and business apps. Connectivity is limitless. Streamline workflows with a centralized, modern core administration & claims management platform. Process claims in a timely and accurate manner, and automate the complexities of benefit administration to capture a quick ROI and deliver superior customer service. -
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AVIXA
AVIXA by Medvitaa
AVIXA (Advanced Virtual Intelligent eXecution Automation) by Medvitaa is AI automation software built for independent pharmacies processing 100–300 prescriptions daily. Unlike screen-watching tools, AVIXA integrates directly with PioneerRX at the data layer for stable, accurate automation. AVIXA Core automates e-script processing, SIG code mapping, NPI matching, and routes unresolved cases to the tech queue for review, reducing manual entry and saving staff time. AVIXA Nexus adds billing and workflow automation including auto-refill, cycle fills, rejection handling, prior auth fax routing, and the VaxFlow immunization suite. VaxFlow, also available standalone, automates patient signup, insurance capture, consent forms, PMS population, and claim adjudication under your pharmacy’s own brand and URL. AVIXA is locally installed with zero cloud storage, ensuring patient data never leaves your pharmacy. No onboarding fees, no contracts on Core and Nexus. -
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ClaimScape
DataGenix
Emerged in the year 2000, DataGenix is strongly resolved to provide TPAs, adjusters, and insurance companies with modern claims processing solutions. We understand that claims processing and health benefits management can include several complications. So that your business does not suffer any losses, our experts have created the advanced ClaimScape software that can automate the entire adjudication process. The goal of our business and the Claims software is to resolve the perplexities that hinder the reach of unmatched customer experience for your clientele network. Keeping in mind the modern trends and requirements, we can assure your business's optimum growth with our software products. We have won the trust of top TPAs of the nation and are willing to serve more. -
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DocStation
DocStation
DocStation is a medical billing and clinical services platform built for modern pharmacy, helping pharmacies move beyond prescription revenue and bill insurance for the clinical services they already provide. It captures revenue from vaccines, consultations, point-of-care testing, DME, MTM, and advanced care programs while managing patients and automating workflows. It brings patient records, billing, scheduling, messaging, workflows, and analytics into one unified system, so every action instantly enhances everything else with no duplicate data entry, no syncing gaps, and no piecing together different tools. DocStation handles intelligent claim processing with automated scrubbing, adjudication tracking, denial management workflows, eligibility checks, pre-submit validation, claim templates, fee schedules, per-line NDCs, modifiers, resubmissions, and remittance tracking.Starting Price: $99 per month -
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Oracle's Digital Insurance Platform empowers insurance providers to deliver innovative solutions and exceptional digital customer experiences. This comprehensive insurance management system streamlines operations from sales channels to back-office processes, enabling rapid deployment of new offerings and seamless implementation of necessary changes. With real-time analytics, insurers gain valuable insights into their business, facilitating informed decision-making. The platform supports both individual and group life and annuity insurance, consolidating underwriting, policy processing, billing, and claims into a single, efficient system. Health insurers benefit from simplified enrollments, premium billing, and claims adjudication, enhancing member satisfaction through transparent and personalized services. Additionally, the platform accelerates the bancassurance lifecycle by providing real-time connectivity between banks and insurers, ensuring speed, consistency, and reliability.
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13
SpyGlass
Beacon Technologies
SpyGlass, our enterprise-class health claims management software, offers a powerful, flexible solution for precise and timely claims processing. SpyGlass makes benefit and plan setup remarkably straightforward. BenefitDriven, fully-integrated with SpyGlass, delivers eligibility, contribution accounting, and pension management to the Taft-Hartley industry with the full range of data and processes for Participants and Employers. HIPAA Director, our all-in-one EDI gateway & scheduler, works as a hub by allowing you to directly connect with vendor partners to help avoid transaction costs, manage batch transfers, and automate transfers. SpyGlass provides a deep, landscape view of your population, with the ability to easily drill down to the higher resolution details. Hundreds of unique reports, fully customizable dashboards, and total control over your system are at your fingertips. -
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iA NEXiA
iA
iA’s proprietary software platform for pharmacy. The nexus of people, process, and technology, NEXiA software provides comprehensive and flexible fulfillment throughout the entire prescription lifecycle. Seamlessly manages inventory with prioritization and trend forecasting through iA’s sophisticated warehouse management system. Creates the opportunity for pharmacies to more easily and efficiently offer patients choice on prescription delivery. 700 configuration parameters and 70 existing bidirectional interfaces that can integrate with third-party hardware. Intelligent production control from adjudication through distribution. Ability to meet your unique operational needs with flexible configurations and dynamic routing. -
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Claim Agent
EMCsoft
EMCsoft’s Claims Management Ecosystem assures that healthcare providers and billing companies deliver clean claims to insurance payers for proper claim adjudication. It is the integration of our versatile claims processing software Claim Agent and comprehensive fitting process called the Four Step Methodology into your claim adjudication process. This approach enables, supports, and automates your work process to maximize claim reimbursement. Request our free online demo for a great introduction into the functionality/features of Claim Agent and how it fits into your claim adjudication process. Claim Agent scrubs and processes your claims from the provider system to the insurance payers in a efficient, cost effective, and timely manner. The software is compatible with any system making implementation process quick and simple. We provide custom edits, bridge routines, payer lists, and work flow settings that are unique to each user. -
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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. -
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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. -
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ImagineMedMC
Imagine Software
Manage your members' healthcare and networks with a cloud-based healthcare delivery system. Automate claims processing for managed care organizations. Includes eligibility, referral and authorization processing, provider contracting, benefit administration, auto claims adjudication, capitation (PCP and Specialty), EOB/EFT check processing, and EDI transfers and reporting. Deploy as a cloud solution or an in-house system. Ideal for managed care organizations (MCOs), independent physician organizations (IPAs), third-party administrators (TPAs), preferred provider organizations (PPOs), and self-insured groups. Streamline the complexities of administrating eligibility, referral authorization and claims processing. Features and functions maximize data integrity while reducing data entry. -
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MediClaims
WLT Software
WLT’s MediClaims system offers a cost-effective, straightforward, and efficient approach to benefit and claims administration. WLT’s rules-based architecture and integrated EDI processes allow claims to be processed quickly, easily, and accurately. MediClaims’ administration and processing capabilities encompass a range of benefit and claim types, from Medical, Dental, Vision, and Prescription Drugs, to Consumer-Driven Healthcare, Disability, and Capitation processing. With WLT’s MediClaims system, you have the flexibility to configure your groups for a single line of coverage or for complex benefit packages with multiple lines of coverage. No plan can work efficiently without support from reliable information systems. WLT makes a point of always working with the most advanced technologies, providing you with the most sophisticated and flexible systems available today.Starting Price: $1 one-time payment -
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Assurance Reimbursement Management
Change Healthcare
An analytics-driven claims and remittance management solution for healthcare providers who want to automate workflows, improve resource utilization, prevent denials, and accelerate cash flow. Increase your first pass claim acceptance rate. Our comprehensive edits package helps you stay current with changing payer rules and regulations. Heighten your staff’s productivity with intuitive, exception-based workflows and automated tasks. Your staff can access our flexible, cloud-based technology from any computer. Manage your secondary claims volume through automatic generation of secondary claims and explanation of benefits (EOB) from the primary remittance advice. Focus on claims that need your attention with predictive artificial intelligence into problem claims. Resolve errors faster, and avoid denials before submittal. Process claims more efficiently. Print and deliver primary paper claims, or add collated claims and EOBs for secondary claims. -
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Riskonnect Claims Management
Riskonnect
Riskonnect Claims Management Software is a comprehensive platform designed to streamline and automate the entire claims lifecycle from intake through final settlement. The software centralizes claim data, workflows, and communications into a single system that improves visibility and operational efficiency. Organizations can automate routine tasks, reduce manual work, and accelerate claims resolution with configurable workflows and intelligent claims processing tools. The platform supports features such as electronic injury reporting, reserve management, adjudication, subrogation, recovery tracking, and return-to-work management. Riskonnect also integrates predictive analytics, machine learning, and AI capabilities to help claims professionals identify risks, forecast claim outcomes, and improve decision-making. Real-time collaboration tools allow adjusters, stakeholders, and third parties to work together more effectively while maintaining compliance with industry regulations. -
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Southern Scripts
Southern Scripts
Southern Scripts simplifies the complexities of navigating through the Pharmacy Benefit Manager world by giving the employer group complete freedom, control, and choice as to how they structure their plan. Southern Scripts is a leading pharmacy benefits manager (PBM) founded by pharmacists to reinvent the traditional PBM approach. Our innovative pass-through PBM model and flexible solutions empower plan sponsors to achieve maximum cost savings, decreased risk, and optimum versatility in plan design to achieve true patient-centered clinical care at the lowest net cost. Plan sponsor is charged the exact price the pharmacy is paid. We pass all discounts and rebates that we secure at 100% to the plan sponsor. No additional fees for standard PBM services, such as prior authorizations, step therapy, and data reporting. Our robust clinical management program and high-performance drug formularies deliver the lowest net cost to protect plans from unnecessary expenses. -
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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. -
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FBCS Enterprise
DSS
FBCS Enterprise is a centralized system for guiding decisions about non-VA Purchased care to improve fee basis claims management and adjudication through efficient claims processing. A web-based solution, CTM Plus streamlines workflows and provides oversight to resolve consult and Return to Clinic (RTC) tracking pain points, and ensure patients are called and scheduled on time. Purchasing analytics help to reduce cost and waste, for greater overall accountability. Expired and recalled items are also monitored automatically to keep patients safer. Delayed or misplaced orders can have significant consequences for your bottom line and quality of care. Time spent sorting through paper records and scrolling through screens is time you won’t have for patients. Checking every patient for opioid prescriptions can be an exhausting, multi-step process. DSS PDMP streamlines everything into one simple step. -
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CyberSource Medical
ComCom Systems
The market's most powerful and accurate solution for claims processing. CyberSource Medical Claims Scanning Solution, a complete turn key system for HMO, PPO, TPA, or Self Funded Organization, is installed at your location for automated data entry of CMS-1500, ADA-2006 UB-04 and enrollment forms. Using advanced "intelligent" features combined with your business rules, CyberSource recognizes, validates and formats the data from medical claim forms. Fuzzy Matching performs an intelligent search of your member and provider database correctly identifying the exact match. The matched data is then utilized to verify and correct data on the medical claim before being passed through to adjudication. The combination of industry-leading OCR efficiency, your business rules and “Fuzzy Matching” results in exceptional accuracy of the data from your medical claims forms. -
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Majesco ClaimVantage
Majesco
Digital technologies are having a significant impact on insurance, and those keeping pace with this evolution are on track to maintain a competitive advantage. Traditional claim management tools, involving multiple systems, paper files and manual processes, are being replaced with cloud-native enterprise claim management platforms. The Majesco ClaimVantage Claims Management Software for L&H platform streamlines the claims process through the full life cycle of a claim, from intake through payment calculation, integrating multiple systems to improve the flow of information across your business. Improve the customer experience and drive operational effectiveness with accurate and timely claim decisions. Built on the Salesforce Lightning Platform, Majesco ClaimVantage Claims Management Software for L&H enables insurance companies and TPAs to modernize and optimize their claims operations today and into the future. -
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Newgen Claims Processing
Newgen Software
Newgen’s Insurance Claims Automation & Management software, built on AI-first low-code platform, streamlines the full claims lifecycle, from first notice of loss to final settlement, through automated workflows, smart routing, and integrated document management. Customers can register and track claims through a web or mobile self-service portal, while the system automatically retrieves policy details, prevents duplicate entries, and routes cases based on workload and expertise. Built-in rules classify claims as fast-track or non–fast track, with flexibility to add assessors, investigators, and other stakeholders. Adjusters gain a unified view for registration, adjudication, document review, and communication. AI-driven insights support fraud detection, highlight missing information, and improve decision accuracy. Real-time dashboards monitor KPIs, SLAs, and escalations for transparent and timely processing. -
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MarvelX AI
MarvelX.ai
MarvelX builds agentic AI for financial services and highly regulated industries, starting with AI claims agents for insurance. The platform handles autonomous claims processing at high volume, from first notice of loss (FNOL) through policy validation, adjudication, and settlement, so insurers cut claims handling time from days to under an hour. Built for P&C, motor, travel, health, life, and embedded insurers, plus MGAs and TPAs, MarvelX validates policy details, checks document completeness, and routes edge cases to human reviewers, keeping a human in the loop with audit-ready output. It also offers AI document data extraction for insurance: structured fields from documents, each with a source reference. Beyond insurance, MarvelX is extending the same agent architecture to other regulated workflows, such as KYC/KYB verification for notarial services. MarvelX connects to the systems teams already run, including HubSpot and Dutch registries (KVK, RDW, SchadeGarant).Starting Price: Price on request -
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VerifyRX
LexisNexis
VerifyRx is a real-time, compliance-driven prescriber verification solution, designed specifically for pharmacies and PBMs, that seamlessly integrates into existing workflows. VerifyRx processes millions of transactions a day, updating comprehensive prescriber data in real-time, including Drug Enforcement Administration (DEA) and State data (when available) and daily National Technical Information Service (NTIS) data. As part of the pharmacy workflow, VerifyRx processes millions of transactions a day, updating comprehensive prescriber data in real-time, including Drug Enforcement Administration (DEA) and State data (when available) and daily National Technical Information Service (NTIS) data. The highly configurable and responsive tool provides real-time compliance checks on all prescription transactions before they are transmitted to payers, helping retail and specialty pharmacy reduce regulatory risk. It identifies potential claims submission errors prior to dispensation. -
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EnterpriseRx
McKesson
Customers review their favorite aspects of the EnterpriseRx pharmacy management system, including mail order prescription drug delivery, centralized pharmacy operations, pharmacy inventory management, and pharmacy load balancing. Whether you already own multiple pharmacies or plan to expand your business, EnterpriseRx will empower you to improve patient care and manage your pharmacy operations more efficiently. Customizable and fully hosted, our cloud-based application integrates every aspect of your business, including workflow, clinical programs, and pharmacy data and reporting. Pharmacies ultimately exist to improve patient wellness, and your patients will notice the EnterpriseRx difference from day one. Our pharmacy software integrates medication adherence tools to promote healthy outcomes, including convenient prescription fulfillment through synchronization of multiple prescription refills and mobile delivery systems. -
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Turn Rx
Change Healthcare
An intelligent inventory management solution, driven by predictive analytics, that allows you to manage and track inventory at a pharmacy or corporate level. Drive improved inventory management with an automated solution that helps manage and track at the pharmacy and corporate levels. Set appropriate order points for each drug in your inventory to ensure you always have the right amount on hand. Take control of non-used inventory, to increase inventory annual turns, and reduce frozen capital. Gain more detail in inventory management by automating the daily order process and creating individual pharmacy, region, or chain-level rules on inventory replenishment. Evaluate and identify drug diversion and outlier behavior based on known industry risk factors. Discover how our flexible pharmacy claims processing and efficient pharmacy benefit management services support improved processes while controlling drug costs. -
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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. -
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PrimeRx
Micro Merchant Systems
PrimeRx is a robust pharmacy management platform designed to optimize every part of pharmacy operations, from prescription intake and automated refill management to dispensing, inventory tracking, label printing, billing, and patient engagement, with modules that support retail, specialty, long-term care, compounding, mail order, 340B, and physician office workflows. PrimeRx’s intuitive dashboard shows scheduled refills and compliance metrics, maintains complete patient profiles with medication history and clinical notes, and actively alerts for potential medication conflicts to support safety and adherence. Integrated features include two-way SMS and email communication, an online refill portal, secure payment capture, real-time insurance and adjudication, and flexible inventory management with automatic reordering and wholesaler EDI ordering; complementary mobile apps extend refill, delivery, and inventory tools to handheld devices.Starting Price: $150 per month -
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GPS Pharmacy System
CareSmart
The GPS Pharmacy System is the intelligent software solution for Retail, Combo, & LTC. The GPS Pharmacy Management System strategically positions your pharmacy for operational success. Pharmacies rely on GPS to gain a competitive advantage by increasing profitability and service levels. The system is ideal for any closed-door or combo pharmacy and those retail pharmacies looking to expand into the LTC market. GPS is fast, easy to use, and it's easy to train your staff with its intuitive design and logical content layout. GPS' productivity-enhancing tools and efficient style were shaped by pharmacists like you, pharmacists who understand that increased speed and accuracy mean better service and a competitive edge. GPS processes every prescription individually in real-time, so there is no need to gather orders and batch process them by each group separately for both prescription and claims processing. -
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PBM Express
Laker Software
The core of PBM Express is the adjudication program. Claims undergo hundreds of edits to achieve accurate processing results, regardless of the difficulty of the plan design. The parameter drive program provides for an extremely flexible architecture that allows for client customization as needed. Laker's advanced software solution provides clients with superior performance and industry-leading uptime. As a technology leader, Laker continually updates and enhances our systems to meet the growing needs of our customers. Laker customers have the marketplace advantage of the fastest, most flexible and most durable system available. What’s more, Laker works closely with our customers to develop, test, and implement new products which allow them to better compete and win new business. Laker grows as our customer's claim volume grows. It is in the best interest of both Laker and our customer’s to provide changes to the software in a timely and efficient manner to allow for that growth. -
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Sanela Pharmacy
Sanela
Whether you are a small single outlet pharmacy or a chain of stores processing thousands of daily orders, Sanela Pharmacy software is designed to enable your pharmacy to take a confident step forward in this direction. From processing and maintaining electronic prescriptions and claims to building up your pharmaceutical network, our software is specially tailored to streamline all the working needs of your pharmacy. Sanela Pharmacy software is built with the newest healthcare technology that will help you grow your business with maximum client satisfaction and build an industry-wide presence. One of the major management issues faced by multi-location owners is keeping an organized real-time inventory record that functions across locations. With our software, you can effectively manage and create real-time inventory accounts of all locations as well as access particular location specifics individually. -
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Free Market Health
Free Market Health
Free Market Health is a healthcare technology company dedicated to improving the specialty pharmacy ecosystem with a care-driven marketplace platform. Free Market Health partners with forward-thinking payers and specialty pharmacies of all sizes to streamline the complex and opaque specialty medication fulfillment process, ensuring patients have prompt access to life-saving and life-altering medications. The platform addresses inherent challenges by automating submission pack creation and validation, facilitating transparent and equitable access to specialty drug prescriptions, and enabling real-time decision-making. This dynamic marketplace empowers stakeholders to optimize resources, maximize opportunities, and balance the cost of care with the value it provides. Free Market Health has managed over 200,000 specialty drug claims annually, representing nearly a 400% increase year over year. -
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InsightPro.ai
MDI NetworX
InsightPro is a web-based workforce analytics and operations platform for health insurance payers, third-party administrators, benefit administrators, and health plans. It supports claims operations, quality assurance, and member contact-center teams. Claims features include inventory tracking, task assignment and distribution, production planning, forecasting, KPI dashboards, activity monitoring, and query resolution. Quality teams can use configurable audits, sampling, capacity planning, error feedback, rebuttal workflows, and performance reporting. Contact-center features include member and call-history views, configurable workflows, real-time highlights, and performance analytics. Workforce dashboards help managers monitor productivity, workload, quality, and operational trends, while administrative tools support user and workflow management. The platform is delivered as a configurable SaaS service for payer operations; plan scope and pricing are tailored to customer requirements. -
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ApotheSoft-Rx
ApotheSoft
The ApotheSoft pharmacy management software was designed by a Pharmacist who fills prescriptions every day with the Apothesoft pharmacy software. We strive to make software easy to use and affordable. Our system is not a stripped-down system but includes a Tabbed Windows interface with Patient and Doctor profiles only a mouse click away. Scroll down to see some screen pictures. The ApotheSoft pharmacy software does dual third-party insurance billing. The ApotheSoft program has been designed and is intended for small retail pharmacies that have script volumes of up to 500 scripts per day. Apothesoft pharmacy software was designed by a pharmacist to meet the special requirements of an independent retail pharmacy. The program was originally designed in 1990 and has been used in hundreds of pharmacies around the USA and in a few pharmacies overseas, as in the Bahamas.Starting Price: $160 per month -
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TotalEclipse
Startech Software
Startech Software’s TotalEclipse™ product is a fully featured single-database Claims Management & Medical Bill Review Software application. Representing the culmination of over three years of development and testing, TotalEclipse™ is designed by real claims adjusters, bill reviewers, and administration managers who use this mission-critical software to do their jobs every day. Many companies develop their software with the user in mind. TotalEclipse is developed with our users involved. The result is an application designed around real-world workflow with a strong focus on making easily available the information most often needed on the job. Eclipse offers the specific processing power, functionality and reporting capabilities you need to maximize productivity while controlling costs. The single-database backend is scalable for use with either the Microsoft SQL Server™ or Oracle™ platform. -
41
Doccure
Dreams Technologies
Doccure can be integrated with any Electronic Health Record EHR and Practice Management platforms. Also, Doccure can be easily integrated with Drug Database and can work well with any Electronic Prescription API’s. Doccure Solutions include: Telemedicine: Doccure telemedicine is an online consultation service where the patients are enabled to consult doctors through audio and video meets. Online Appointment Management: The application facilitates ease in booking appointments. Patients can access the feature 24/7 to plan their schedules and reserve their appointments. Hospital and Clinic Management: This solution aids in customizing the clinical management system to streamline online appointment schedules, billing, accounting, patient care management, insurance, etc. e-Pharmacy: e-Pharmacy is a pharmacy management system that enables digitalizing the entire pharmacy process. Patients will be given access to purchase medicines or other pharmaceutical products online.Starting Price: $10 -
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MDToolbox e-Prescribing
MDToolbox
MDToolbox-Rx is a Certified, Award-Winning, complete electronic prescription writer that can run stand-alone or synced with your other office software. The e-Prescribing Software is a highly customizable, simple to use e-prescribing system that allows you to easily select drugs, find drug information, and create and electronically send a prescription quickly and efficiently. MDToolbox-Rx is Certified for e-Prescribing, Eligibility, Formulary, EPCS (e-Prescribing of Controlled Substances), and Electronic Prior Authorization. Search for drugs by name, nickname, generic, brand, rx, OTC, class or indication in the most comprehensive drug database available. Higher productivity due to less pharmacy calls and time spent for renewal requests. -
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Millennium Pharmacy Systems
Millennium Pharmacy Systems
A pharmacy service must be your partner in reducing cost, enabling better clinical and financial outcomes, and improving staff productivity and satisfaction. A pharmacy service must be easy to do business with and a seamless part of your organization's operations. To that end, we provide Millennium pharmacy services for Care, Cost, and Compliance. Millennium replaces frustration, inefficiency, and waste with responsiveness, efficiency, and cost savings. We deliver on the promise of "the right drug, for the right patient, at the right time, for the right price" so you can deliver the best patient care while reducing costs, improving efficiency, and more easily meeting compliance demands. Only Millennium combines Just-In-Time Dispensing with electronic prescription ordering, formulary management, medication and treatment administration, and corresponding medical records. -
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Forus
Forus, Inc.
Forus is a medication access and prior authorization platform for healthcare practices. It automates work between prescribing and treatment, including prior authorizations, benefit verification, appeals, financial-assistance enrollment, pharmacy routing, renewal tracking, and patient updates. The service integrates with electronic health records and supports workflows across medical and pharmacy benefits. Providers and patients use Forus at no charge. -
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Zipdrug
Zipdrug
Give your members a simple and cost-effective pharmacy experience. Zipdrug is a proprietary medication delivery platform that helps health plans manage medication adherence and cost. Long lines. High copays. Busy staff. Members find it challenging to fill prescriptions at their pharmacies. With Zipdrug’s platform, you can deliver a friendly, convenient and cost-effective pharmacy experience right to your members’ doors. We make it easy for your members to get their medications. They’ll be happier and healthier for it. We partner with insurers and employers in all major cities. Learn how you can offer Zipdrug as a benefit to your members. -
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Quva BrightStream
Quva
Quva BrightStream is a cloud-based intelligence platform designed for health-system pharmacy operations that aggregates, normalizes, and integrates clinical and operational data across all sites of care to deliver quantified and prioritized insights. It includes AI- and machine-learning-driven modules such as Shortage Navigator (predictive supply-chain shortage detection), Diversion Surveillance (drug-diversion monitoring), Supply Advisor (aligning inventory to patient demand), Script Revenue Capture (identifying prescription revenue leakage), Contracts Value Maximizer (ensuring contract compliance and price-performance), and Clinical Process Optimizer (order-set, formulary, and protocol management). It supports senior leadership dashboards offering one “single pane of glass”, while enabling drill-downs into prioritized opportunities such as cost reduction, inventory optimization, diversion control, and revenue growth. It claims proven community results. -
47
Enablemypractice
EnableDoc
Advanced calendaring with reminders, patient registration with benefits checking, electronic claims, claim status, payment, and electronic invoicing. Custom templating built into wordprocessor, quick condition based documentation, electronic prescriptions and pharmacy pricing, electronic labs and radiology results, post to registries. Advanced custom templates in custom formats and tables. Emha engages patients in their daily wellness and managing appointments. Every patient gets a free Wellness Assistant to assess their health, set goals, and continuously track their nutrition, exercise, biometrics, medications, and medical conditions. Have remote video call visits with one or a group of patients. A white board and screen sharing let's you communicate and collaborate. Text or email patients for quick mobile or web video calls. -
48
FINEOS
FINEOS
The FINEOS Platform provides clients the only complete end-to-end SaaS core product suite that includes FINEOS AdminSuite enabling quote to claim administration as well as add-on products, FINEOS Engage to support digital engagement and FINEOS Insight for analytics and reporting. The foundation of your digital insurance strategy. The FINEOS Platform seamlessly blends FINEOS AdminSuite + FINEOS Engage + FINEOS Insight + Platform Capabilities to create the most modern single core insurance platform for Life, Accident and Health. Legacy core systems utilized a ‘one size fits all’ business technology approach that no longer fits the needs of an agile business. Today, consumers, employers and brokers have access to powerful SaaS computing platforms and software tools that set a much higher bar for an insurer’s digital strategy. Monolithic insurance software models of the past focused solely on details of the insurance contract. -
49
QuickCap
MedVision
MedVision Solutions' QuickCap is an administrative and clinical data process management solution that lets users focus on business and not the paperwork. With QuickCap, users have scalable control over their workflow and information to work smarter. QuickCap features a customizable dashboard for ease and gives them automation of their process for speed. QuickCap also streamlines claims work that makes users' work easier. QuickCap also allows users to easily determine profitability for individual providers with analytics. -
50
RWA Pharmacy
RWA Pharmacy
RWA Pharmacy is a business intelligence and analytics platform designed specifically for the pharmacy industry that consolidates, analyzes, and visualizes pharmacy data to give operators real-time actionable insights into cash flow, claims, stock, services, and operational performance so they can make data-driven decisions that increase efficiency and profitability. It unites data from multiple pharmacy management systems and other sources into a single version of the truth, reducing manual reporting and providing automated, easy-to-digest reports that highlight areas needing attention, trends, and opportunities to improve outcomes, such as unclaimed prescriptions and stock optimization. Solutions include Dispensary+ Insights for automated data-driven decision support, Retail Insights for streamlining retail operations, and NHS Insights to simplify complex NHS payment and trend data.
