Alternatives to Alaffia
Compare Alaffia alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to Alaffia in 2026. Compare features, ratings, user reviews, pricing, and more from Alaffia competitors and alternatives in order to make an informed decision for your business.
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1
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. -
2
Arrow
Arrow
Arrow is a healthcare revenue cycle management platform that modernizes and streamlines healthcare payments by automating billing, claim operations, and predictive analytics to help providers and payers reduce administrative burden, minimize denials, and accelerate collections. It brings workflows, data, and AI together so teams can detect errors in claims before submission, manage denials with root-cause analysis and one-click fixes, and get detailed real-time claim status updates directly from payers. It simplifies the ingestion of Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) data into a centralized, user-friendly format, provides revenue intelligence with actionable insights into the revenue cycle, and monitors payment integrity to highlight underpayments or overpayments according to payer contracts. -
3
Broniec
Broniec
AUDITMAX® is our proprietary software developed over 48 years of history and experience, and is constantly enhanced to encompass the latest trends, categories, and technology. This innovative technology is continuously refined from the thousands of audits we have performed and identifies more overpayments by comparing our supplier database against your payments. This is a difference that others can’t match. We combine our extensive experience with our cutting edge technology, to provide our clients with better results and higher returns. At Broniec, technology is not just creating reports. Our auditors are skilled at using our state of the art technology to provide clues about overpayments and then take it a step further by digging into your systems and documents to uncover additional findings. Digging deeper is how we uncover and recover more money for you. Access to supporting documentation, overpayment sources, root cause, and recovery status. -
4
Shift Payment Integrity
Shift Technology
Shift’s Payment Integrity is an AI-powered solution for health plans designed to improve accuracy and reduce costs in the claims payment process. It works both pre-payment (before claims are paid) and post-payment, helping plan administrators catch issues early and recover overpayments. Key features include claims editing (with updated, dynamic rules), generative AI-assisted medical record review, anomaly & fraud/waste/abuse detection, and external data enrichment for deeper context. The system supports evolving policy and guideline changes, allowing automated policy analysis and edit logic workbench features so health plans can test concepts before deployment. It provides explainable flags/alerts (so reviewers understand why claims are flagged), tools to accelerate document review, highlighting relevant parts of records, data mining for emerging trends, and a unified case management UI for investigative workflows. -
5
Revenew
Revenew
gainIQ Prevent is a continuous monitoring software that identifies and prevents payment errors in real time. An internal financial control, gainIQ Prevent automatically delivers highly-targeted results that enable your staff to identify errors and irregularities before payment is made. Revenew handles the technical work needed to set up gainIQ Prevent. Once you’ve provided the payment and vendor files from your payment system, we’ll do the rest to get your system integrated, quickly and seamlessly. Our web-based monitoring platform is effective for many types of payment errors, such as duplicate payments. It automatically extracts and analyzes pending and historical payments on a continuous basis, pinpoints possible overpayments, and presents those results to your internal staff. It can be used to evaluate procurement card and T&E transactions as well. gainIQ Prevent comes with a robust claim management and tracking system to ensure timely corrections are made. -
6
DRG Claims Management
DRG Claims Management
It’s fair to say that “not all DRG vendors are created equal.” Despite overlapping marketing efforts, there are two general categories of DRG auditing products: those that primarily serve provider hospitals and those that are designed to identify overpayments on behalf of health plans and payers. Just as an attorney typically specializes in defense or plaintiff representation, auditing vendors specialize in the unique needs, cultures and priorities of the parties they respectively serve. Even within the category of payer-based vendors, there is also a wide range of approaches to DRG auditing and overpayment identification. We extend our scope of services to our physician review team to produce clinical validation findings for situations where the identified issues are unsubstantiated clinical diagnoses documented by treating physicians and therefore exceeds the scope of coders. Our results prove that our coding compliance model will produce verified savings. -
7
Inovalon Claims Management Pro
Inovalon
Keep revenue flowing with a powerful tool that speeds up reimbursements with eligibility checks, claims status tracking, audits and appeals, and remittance management for government and commercial claims, all in a single system. Leverage an advanced rules engine that immediately scrubs claims against the most up-to-date CMS and commercial payer rules, allowing you to correct errors before claims go out the door. Verify eligibility across all payers during claim upload and see flagged errors so claims can be edited before submission. Decrease days in A/R with automated workflows for audit responses, appeal submissions, and ADR tracking. Customize staff workflow assignments based on the type of claim and action needed. Automate secondary claims submissions to stop timely filing write-offs. Increase claims revenue with automated workflows for faster, more successful audits and appeals. -
8
Axora
Axora.AI
Axora AI is an intelligent, end-to-end claims engine that blends AI-powered automation with billing expertise - managing everything from eligibility to payment posting. But it’s more than automation. Axora AI prevents denials before they happen, adapts to payer rule changes, and prioritizes what matters - so you recover more revenue with less effort. 1. Manages your full claims cycle from start to finish 2. Flags denial risks before submission 3. Prioritizes actions that improve cash flow 4. Seamlessly fits into your EHR, payer, and finance systems 5. No migrations. No disruption. Just faster, cleaner paymentsStarting Price: $30/month -
9
CommissionCalc
Flaum Technologies
CommissionCalc will compute your commissions and rebates automatically, slash time, eliminate errors, and supercharge salesperson motivation. It eliminates 90% of the time your Accounting Department spends computing commission. Equally important, it slashes the time salespeople and their managers spend on “shadow accounting” – i.e. checking their commissions instead of selling. Error rates when computing complex commission manually are typically 2% to 5%, and uncorrected errors always result in net overpayment because commission recipients are best at correcting underpayments. Although companies frequently install CommissionCalc to save time, once they start using it they often find that improved accuracy has even more value. Commissions have one purpose: motivating people to sell. To accomplish this, recipients must see their rewards promptly, get easy-to-understand reports, and have confidence in the accuracy of the payments.Starting Price: $2500.00/one-time -
10
Hyperform
Act21 Software
Reduce pay-out cycles by up to 87% with Hyperform, our Disruptive Compensation Automation solution. We understand there is a dire need for financial institutions to effectively administer, calculate, analyze and report incentive compensation programs to reduce potential errors and overpayments to employees, business partners, collection agents and more. Design and test policies in policy modeling platform before releasing. Real-time computation of complex calculations across both internal and external sales network. Multiple data source integration (CRM, billing, POS, DW, etc.) and Integration with payment platforms. Automated invoice generation post payout approval and physically/ digitally signed invoice uploads enabled. Payout dashboard with multiple key performance indicator metrics providing critical business insights. -
11
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. -
12
RevCycle Engine
Aptarro
RevCycle Engine applies built‑in, customizable rules and AI‑powered automation to correct coding and charge errors at the source, ensuring billing data is accurate before claims are submitted. By integrating seamlessly with EMRs and practice management systems, it ingests claims data in real time, applies industry‑proven rules tailored to each organization’s needs, and fixes errors automatically, reducing preventable denials and costly rework. Streamlined workflows prioritize and route only complex or exception claims for human review, boosting team efficiency and reducing burnout. With AI‑driven charge accuracy, the platform increases clean claim rates, lowers cost‑to‑collect, and stabilizes cash flow, all visible through clear dashboards and real‑time insights. Scalable automation handles high claim volumes without overtime or late‑night efforts, while features such as charge accuracy validation, denial prevention, coding review optimization, payment collection support, and more. -
13
apexanalytix
apexanalytix
apexanalytix is the world’s leading provider of supplier portal software; trusted supplier data; controls, audit and analytics software; and AP recovery audit services. We protect $9T in spend and prevent or recover over $9B in overpayments annually, and our client portals actively support over 8.5M+ suppliers – more than any other supplier network. Our software and audit services are built on our smartvm® database of 90M+ supplier records with contacts, scored for accuracy and age, based on integration with over 1,000 government, regulatory and authoritative third-party data sources and 10M+ communications with suppliers each year. apexarchimedes™, an advanced cognitive technology and innovation system, supported by IBM Watson®, is integrated into apexanalytix software and services to harness the power of the future through smarter recoveries, controls, analytics, working capital and supplier data. -
14
AltuMED PracticeFit
AltuMED
Conducting thorough checks on the financial eligibility of the patients, running their insurance’s analysis and monitoring discrepancies, the eligibility checker covers all. If however any error does creeps in the data submitted, our scrubber working on deep AI&ML algorithms is capable of scrubbing errors be it coding errors, incomplete or wrong patient financial information. The software, at present, has 3.5 Million edits pre-loaded in its memory. To further streamline the process, automatic updates are issued by the clearing house to inform about the status of in-process claims. Covering the entire billing spectrum from verifying the patient financials to working on denied or lost claims and also has a through follow-up feature for appeals. Our intuitive systems warns if a claim could be denied, taking corrective actions to prevent it but also is capable of tracking and appealing for lost or denied claims. -
15
Global Business Commerce
Global Business Commerce
E-Commerce Made Simple - Building a better E-Commerce with our powerful tools, you can list, sell, and manage products across many channels, simplifying your eCommerce operation. When the founders of Global Business Commerce ran their retail and eCommerce businesses, the systems that were designed to make life "easier" didn't live up to the promise. Broken integrations, accounting errors that caused thousands in overpayment for sales tax, discrepancies in different reports, the list of disappointments go on. We built this platform from a HUGE wish list of features we hoped to see in systems like ShipStation, SellerCloud, ChannelAdvisor, ADP, Quickbooks (and others) but never came to fruition. -
16
eClaimStatus
eClaimStatus
eClaimStatus provides simple, practical, efficient and cost effective real time Medical Insurance Eligibility Verification system and Claim Status solutions that power value added healthcare environments. At a time when healthcare insurance companies are reducing reimbursement rates, medical practitioners must monitor their revenue closely and eliminate all possible leakages and payment risks. Inaccurate insurance eligibility verification causes more than 75% of claim rejections and denials by payers. Furthermore, refiling rejected claims cost an organization $50,000 to $250,000 in annual net revenue for every 1% of claims rejected (HFMA.org). To overcome the revenue leakages, you need a no-fuss, affordable and effective Health Insurance Verification and Claim Status software. eClaimStatus was designed to solve these specific challenges. -
17
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. -
18
TaxInterest
TimeValue Software
TaxInterest IRS/State interest and penalty software gives you interest and penalty expertise. Easily and quickly calculate interest and penalties for an IRS transcript, an amended return or a return for a late or non-filer, or doing FIN 48 UTP interest accruals . TaxInterest software is the professional standard that helps you calculate the correct amounts – easily, reliably, and with no guesswork. Simplify calculation of interest on both federal and state tax underpayments and overpayments. • A user-friendly interface for tax and payment details • Audit the calculations and totals on transcripts and notices • Calculate interest and penalties for amended returns, and late or non-filers • Relied on by the IRS, CPA firms, and corporations for over 30 years • Output reports that are widely recognized by taxing authorities for accuracy and detail Used by most of the top 100 accounting firms in U.S. and by the IRS. TimeValue Software offers a one year, money back guarantee.Starting Price: $99 per year, per user -
19
Conduent Legal Invoice Analytics
Conduent
More than 50% of a law department’s budget is spent on outside law firms, requiring some companies to validate payment for invoices consisting of thousands of line items annually. Drive compliance & eliminate overpayments- clients save 5-10% of their outside counsel spend. Optimize invoice review & reduce manual work – clients reduce the time wasted on invoice review by up to 80%. Deliver reliable data & drive strategic insights- reliable legal spend data that law departments can analyze to drive additional savings. Reduce overspend by outside counsel up to 10% and deliver ROI day 1. Through consistent billing review and accelerated payments. Automated analysis of invoices eliminating up to 80% of analysis time otherwise spent by law department attorneys and staff. -
20
DATABASICS Vendor Invoice Management
DATABASICS
DATABASICS' Vendor Invoice Management System empowers you to efficiently manage invoices, from approval workflows to real-time tracking, ensuring unmatched precision and control over your payables process. Vendor invoice management can be a challenge. How you meet the challenge can have a big impact on cash flow, discounts, penalties, overpayments, fraud detection, vendor relations, and more. DATABASICS Vendor Invoice Management puts you in control. DATABASICS Vendor Invoice Management Software is the true enterprise solution for managing your invoices. It's a complete, easy-to-use software for all your vendors, whether they are domestic or international, small or large. At DATABASICS, we believe in the power of better, in the power of better solutions driving better decisions for better results. -
21
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. -
22
Wise-Pay
Wise-Sync
Your must-have payment solution is Wise-Pay. Shorten your cash gap with the ultimate add-on: Wise-Pay, the preferred choice for 26,000+ payers, providing integrated payment automation across some of the world’s largest payment providers - you’ll never have to chase a payment again. Each time you handle an invoice, it costs you money. Wise-Pay seamlessly reconciles invoice payments in your accounting platform, and automatically creates client invoices for credit card surcharge payments, overpayments and pre-payments. Wise-Pay removes the obstacles that prevent you from accessing a vast number of platforms - enabling a payment process that makes it super simple (and fast) for your customers to pay you. Some integrations include: ConnectWise Customer Portal, CW Sell, Invarosoft IT Support Panel, Desk Director, QuoteWerks, CloudRadial, iSell eCommerce Platform. Say goodbye to monotonous tasks, everywhere from banking checks to reconciling accounts. -
23
Fakturia
Luminea IT Services
Fakturia keeps track of your customer contracts : minimum contract term, billing interval, period of notice, prepaid or postpaid - Fakturia knows what needs to be done when and does it for you - fully automatically! Fakturia is multi-currency capable and supports multiple languages as well as country-specific tax rates . Thus, it is well prepared for use on international markets. Time-consuming cancellation processing is done with Fakturia with just a few clicks: the customer receives a confirmation of cancellation by e-mail and, if necessary, a correction invoice in the event of overpayment. Any number of brands can be managed with one Fakturia account via the project management . Articles, contracts etc. can be grouped according to the projects. With the integrated text management , you can maintain all texts fully internationalized in all desired languages. Thanks to the scripting support , logical dependencies can also be easily resolved.Starting Price: $29 per month -
24
Toolspend
Toolspend
Toolspend is an AI-powered spend management platform designed to give organizations complete visibility into their AI and SaaS costs through a unified, automated dashboard. It connects directly to AI providers and financial data sources to reveal real usage patterns, show which teams drive consumption, and reconcile token metrics with actual billing. It goes beyond simple subscription tracking by analyzing usage behavior to identify underutilized licenses, duplicate tools across departments, and potential overpayments. It provides real-time monitoring, anomaly alerts for unusual spikes, and month-end forecasting so teams can anticipate costs before invoices arrive. It also delivers AI-driven recommendations such as switching to cheaper models or pausing idle resources, helping companies reduce waste and control budget growth.Starting Price: $14.99 per month -
25
Veradigm Payerpath
Veradigm
Veradigm Payerpath is an end-to-end revenue cycle management suite of solutions built to assist organizations to improve revenue, streamlining communications with payers and patients, and boosting practice profitability for practices of all sizes and specialties. Eliminate missing information, incorrect coding, and data entry error to ensure clean claim submission. Ensure claims pre-submission are correctly coded, have no missing information, and are error-free. Compare performance against peers at the state, national, and specialty levels to optimize productivity and improve financial performance with advanced analytical reporting. Remind patients of their appointments and confirm their insurance coverage and benefits information. Automate the billing and collection of patient responsibility. Veradigm Payerpath’s integrated solutions are practice management (PM) agnostic, interfacing seamlessly with all major PM systems. -
26
Artsyl ClaimAction
Artsyl Technologies
Processing high volumes of medical claims through intelligent automation helps businesses deliver higher levels of efficiency that does more than reduce costs. For organizations that rely on manual processes, managing medical claims documents and data is labor-intensive and error-prone, injecting unnecessary risk into the process. With ClaimAction medical claims processing software from Artsyl, your organization can improve margins, minimize touch points and eliminate processing bottlenecks. Capture medical claims data without the need for custom software coding. Route claims data and documents automatically to the right claim examiner, based on your business rules. Configure complex benefits and reimbursement rules to streamline processing and reduce payment delays. Respond quickly to changing government regulations and support data, document and process compliance. -
27
Qobra
Qobra
Qobra is the all-in-one sales compensation platform that empowers operations, finance and sales teams to leave Excel behind and deliver real-time commission automation, accuracy and transparency. With Qobra you can automate complex commission calculations, build flexible compensation plans via a no-code editor, and give every rep real-time visibility into their earnings, driving trust, alignment and performance. Our intuitive interface supports multiple currencies, hierarchies, bonus structures, and integrates natively with your CRM and data warehouse systems for seamless data flow. Qobra also provides audit trails, validation workflows, and actionable analytics so finance and revenue leaders can prevent over-payment, model scenarios and optimise their go-to-market strategy. Customers report up to 15-20% increase in sales performance and a dramatic reduction in commission-processing time. Choose Qobra to align your GTM teams on one platform, ensure payouts are accurate and timely.Starting Price: $39/month/user -
28
TimeMaster
Sierra Workforce Solutions
Sierra’s TimeMaster is a “full-featured” time and attendance solution tool that will help you gain greater control over productivity and provide the accuracy needed in your business operations. It is an easy-to-use, powerful time and attendance solution that allows you to automate your company’s timekeeping, attendance tracking, job costing, benefit administration, labor scheduling, data collection and access control. TimeMaster eliminates paper time sheets, which are the root of most HR/payroll nightmares! Employees enter data at an electronic data terminal using magnetic stripe, bar code or biometric time clock technology. Optional PC entry is available along with time submittals for exempt employees. The TimeMaster time and attendance solution collects transactions and your pay rules are applied automatically, consistently, and impartially. The TimeMaster reporting system produces valuable management reports, which help control the overpayment of employees. -
29
DocuVantage OnDemand
Document Advantage
DocuVantage OnDemand® offers an affordable, cloud-based solution for your critical Accounts Payable process, to automate routing, approval, collaboration, and even records retention, while seamlessly integrating related documents into an intuitive and fully auditable process customized for your needs. Securely access information from anywhere, anytime, and from any device that connects to the web. There is never any hardware to maintain, software to install, or upgrade fees to pay, and you can be up and running in hours or days instead of months. With DocuVantage OnDemand®, you can secure and track all incoming invoices and related documents, ensure early payment discounts, and eliminate late payments. Data entry errors are reduced with automated OCR, and you can compare approved purchase order amounts to invoices to eliminate overpayments. Contact us today to schedule a demo, and we'll show you how to streamline your AP process so you can focus more on growing your business!Starting Price: $20.00/month/user -
30
Model N
Model N
Model N delivers an end-to-end platform empowering companies to maximize revenue as they transform Sales, Marketing, Channels, Finance, and Legal processes. Model N’s revenue management solutions help you maximize revenue by transforming siloed, tactical activities into strategic end-to-end revenue processes through automation and intelligence. Revenue Cloud bridges the gap between front-office and back-office activities providing a unified system of record for all revenue execution. Model N allows customers to easily configure and quote complex products, quickly come to terms on complicated contracts, have more accurate and timely channel data ensuring visibility into channels, and efficiently manage incentive programs avoiding overpayments. Model N Rebate Management helps you better engage your channels to improve and optimize revenue. -
31
TriZetto
TriZetto
Accelerate payment while decreasing administrative burdens. With 8,000+ payer connections and longstanding partnerships with 650+ practice management vendors, our claims management solutions can result in fewer pending claims and less manual intervention. Quickly and accurately transmit professional, institutional, dental, workers compensation claims and more for fast reimbursement. Meet the shift to healthcare consumerism head on by providing a straightforward and seamless financial experience. Our patient engagement solutions empower you to have informed conversations about eligibility and financial responsibility while reducing hurdles that may impact patient outcomes. -
32
E-COMB
KBTS Technologies
EDI Compatible Medical Billing (E-COMB) is a web based solution for generating medical claims complying with the HIPAA transaction and code set standards, regulated by the US Government following the recommendations of American National Standards Institute (ANSI). The application is designed to generate, submit and reconcile the claims to the insurance carriers, guarantors and/or patients. This is one of the most important tools for doctors in realizing their revenue by reducing the turnaround time in the claims reimbursement. All the information related to environment of the Doctor’s Office/Hospital is grouped together as Master Data. This information is frequently used for claims processing and is less likely to change quite often. Master Data contains details of the Procedures, Diagnoses, Doctors, Payers, and Billing Providers etc. This data is created as part of the initial set up and can be updated easily at any time. -
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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. -
34
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. -
35
Veritable
314e Corporation
Veritable accelerates patient insurance eligibility verification and claims-status checks by providing instantaneous results in a clean, intuitive interface. It supports real-time, batch uploading of patient lists to verify eligibility across more than 1,000 payers (including national Medicare and all state Medicaid) and multiple service types. It also enables tracking of claims status, from submission through reimbursement, so practices and billing companies can proactively identify issues to reduce payment delays and denials. Key benefits include automating eligibility and claims workflows to reduce manual entry and phone calls, improving front-desk patient experience by validating coverage and copayments at check-in, and offering seamless integration for both technical and non-technical users with strong data-security controls. It includes a “Code Explorer” for instant lookup of ICD-10-CM, ICD-10-PCS, HCPCS Level II, and CPT codes.Starting Price: $50 per month -
36
Amazing Charts Practice Management
Amazing Charts
Amazing Charts Practice Management is a comprehensive solution designed to streamline administrative tasks and enhance the efficiency of independent medical practices. Developed by a practicing physician, this system automates processes such as capturing patient demographics, scheduling appointments, pre-registering patients with insurance eligibility checks, and generating analytical reports. It also determines patient financial responsibilities at the point of care, maintains insurance payer lists, and ensures prompt and accurate billing to assist in payment collection efforts. Key features include the ability to view unpaid claims to ensure timely resolution, a claims manager who reviews submissions to reduce denials, and an integrated secure connect clearinghouse for high-level support and quick responses to payer changes. The system offers intelligent, interactive role-based dashboards that automatically prioritize work lists across all office areas.Starting Price: $229 per month -
37
Essential RCM
edgeMED Healthcare
edgeMED's Essential medical billing and collection service handles the complete revenue cycle to ensure your organization is running at maximum efficiency and profitability. Medical practices and health systems strive to provide the best possible outcomes among their patients. But at the heart of what allows them to provide the best quality care are the strong financial outcomes resulting from a well-managed revenue cycle. With edgeMED Essential, we increase your collections and dig deeper to analyze cost and profitability, monitor contract under and overpayments and investigate new revenue opportunities, resulting in mutual success and long-lasting partnerships. Whether you are an independent physician practice, health system, Accountable Care Organization (ACO) or medical home, we are your revenue cycle management experts so you don't have to be. At edgeMED, we utilize our more than 40 years of expertise in medical billing and consulting to achieve maximum revenue.Starting Price: $149 per month -
38
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 -
39
Vyne Trellis
Vyne Dental
You have better things to do than sit on the phone. That’s why our real-time eligibility tool allows you to quickly verify your patients’ benefits, regardless of their plan. Gone are the days of paying transaction fees for claims, attachments, and checking eligibility! Our plan includes all features for one monthly fee. Subscribe to Vyne Trellis™ and gain the benefit of our team of industry professionals. With us, you can keep a tab on claims, claims that put money back in your firm’s pocket. Regardless of the size of your practice, our platform can handle any volume of claims. Vyne Trellis™ is integrated with the claims administrators and clearinghouses you need. Our dashboard sends you rejection reasons, status updates, and other smart notifications, so you can keep your claims moving. And if you get a little stuck on a claim, our support team is here to help! No more multiple tabs or windows. You can access virtually all of your data and documents, like ERAs and attachments. -
40
Seller Locker
Seller Locker
Sellers can use our tool to dive even deeper and uncover more cases for our team to recover. With a platform for sellers to interact with our cases become more accurate leading to a higher success rate. Sellers are working smarter instead of harder automating FBA related manual task. Maximize results without the workload. Gain full transparency into your account. Submit accurate claims with one click. Increase profits by reducing FBA fees. Fight for every last dollar and go after the balance of cases using our responder. Built to manage the biggest Enterprise sellers and those just getting started. Unique pricing structure fit for all seller types. Approved in the Amazon Marketplace Appstore. We specialize in recovering FBA fees. We are constantly monitoring fee fluctuations and submit claims the instant we identify a discrepancy. We’ve recovered over $20M in FBA fees and prevented almost double in losses by correcting FBA fee discrepancies. -
41
Stedi
Stedi
Stedi is the only programmable healthcare clearinghouse built on modern APIs, while supporting both real-time and batch EDI processes. It enables health techs and incumbents to exchange mission-critical transactions - from eligibility to claims and remits. With a security-first cloud infrastructure, built-in payer redundancy via 3,400+ route connections, and market-leading sub-10-minute support response times, Stedi provides reliability and responsiveness to avoid billing outages and reduce denials. -
42
ImagineBilling
ImagineSoftware
The industry’s first intelligent, multi-specialty medical billing software. Streamlining billing and patient collections for over 75,000 physicians across the country. Globalized data eliminates the need for duplicate entry. Visit-driven to allow for large volume and complex information. Flexible data structure accommodates requirements across multiple practices and specialties. Helping you get paid faster. Post payment manually or through electronic remittance. Automatically scrub claims for errors and missing information. Automatically refile insurance claims based on selected criteria. Fast review to evaluate and approve charges. Audit charges by modality, procedure, insurance, user, doctor or date of service. Intuitive reports for tracking the financial health of your front-end and back-end billing. Never lose another charge again. Integrates with your preferred clearinghouse or statement vendor. -
43
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. -
44
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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QuickClaim
Hype Systems
We understand that people don't need their software to do everything. Especially not across specialties, practices, clinics, and hospitals. That is why we have created systems that are modular and will fit what YOU need. The front end (users) offers an intuitive, clutter-free interface; while the back end utilizes cutting-edge technology and database engines to ensure your data is safe and secured. And so you get paid... the first time! Used and loved by over 1,200 Ontario physicians, billing agencies and small to large multi-location clinics and hospitals. QuickClaim’s finesse has the feel of a well-thought-out tool. QuickClaim fulfills many roles. QuickClaim works with other systems like QuickReq, QuickDOCs and third-party systems via HL7 and flat files. Additionally, QuickClaim acts as the offline version of HYPE Medical during rare occasions of Internet failure. As an offline system, it runs independently of the Internet.Starting Price: $1400 one-time payment -
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ediLive!
Texas Medical Systems
ediLive! claims processing software works with any NSF, ANSI, or print file claim image, allowing the HIPAA complaint transmittal of any practice management software's claim file. Additionally, ediLive! customers benefit from real-time connectivity and claim collections workflow management. ediLive! attaches all claim status messaging from payers directly back to the claim for easy follow-up and correction, taking all incomplete claims and compiling them into a single on-screen worksheet for fast corrections and resubmittal. If you use ediLive!, we have a wonderful product call claims scrubber that can help you to get your claims paid – not only faster, but better! Call our office to schedule a free on-line demonstration. We can scrub the first 100 claims for you as a free trial. Every coding error you make costs your practice money. -
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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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Availity
Availity
Collaborating for patient care requires constant connectivity and up-to-date information. Simplifying how you exchange that information with your payers is more important than ever. Availity makes it easy to work with payers, from the first check of a patient’s eligibility through final resolution of your reimbursement. You want fast, easy access to health plan information. With Availity Essentials, a free, health-plan-sponsored solution, providers can enjoy real-time information exchange with many of the payers they work with every day. Availity also offers providers a premium, all-payer solution called Availity Essentials Pro. Essentials Pro can help enhance revenue cycle performance, reduce claim denials, and capture patient payments. Availity remains your trusted source of payer information, so you can focus on patient care. Our electronic data interchange (EDI) clearinghouse and API products allow providers to integrate HIPAA transactions and other features into their PMS. -
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NovoHealth Dental
NovoDynamics
Our platform automatically flags and prioritizes anomalous claims for review. NovoHealth Dental ensures exceptional claim quality and offers real-time analysis. Our platform provides accurate and consistent dental disease assessment. The future of dental claims processing is here. Our proven AI platform is in use within some of the country's largest dental payer organizations. We offer pilots to demonstrate the value of our solution. NovoHealth Dental saves time and money by making dental insurance claim review faster, easier and more efficient. It helps your analysts uncover anomalies that may indicate errors, omissions or potential fraud. We use AI to quickly verify and assess the quality of submitted claims and their attachments. The platform quickly, accurately, and consistently assesses dental diseases. Our AI fingerprints and analyzes every claim and attachment to detect high-confidence anomalies. -
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EzyMed Online 4
Top Tech Computing Systems
EzyMed Online 4 is a fully integrated Medical Practice Management software for General Practices, Radiology and Specialists Centres. Developed for the Australian medical practice environment, EzyMed Online 4 encompasses all functions required for the Medicare Australia's Online Claiming Online process, Department of Veterans Affairs (DVA) Claims and Australian Childhood Immunisation Register (ACIR) claims. EzyMed Online is a comprehensive system designed to manage your practice efficiently with just a few clicks of the mouse. A secure database management ensures your system consistently maintains its performance even with a million or more records. From the time a patient is registered at the reception, the consultation is tracked by EzyMed Online 4 and stored in the patient’s database as paperless recording. The patient’s medical history can be retrieved at anytime even to all appointments ever recorded.
