Alternatives to Anomaly
Compare Anomaly alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to Anomaly in 2026. Compare features, ratings, user reviews, pricing, and more from Anomaly competitors and alternatives in order to make an informed decision for your business.
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Paradigm
Paradigm
Paradigm Senior Services offers a full-service, AI-powered revenue cycle management platform specifically tailored to home-care agencies that bill third-party payers such as the U.S. Department of Veterans Affairs (VA), Medicaid, and other managed-care payers. It automates and streamlines every step of the billing and claims process: from eligibility/authorization verification, state- or payer-specific enrollment and credentialing, to submission of clean claims, denial handling, and payment reconciliation. It integrates with common agency management software and electronic visit verification tools to scrub shifts, verify authorizations weekly, and reconcile payments, reducing denials and minimizing administrative burden. Paradigm also supports “back-office as a service” for providers; even if they already have internal billing staff or scheduling software, Paradigm can take over claims processing as a specialized, expert billing department. -
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Droidal
Droidal LLC
Droidal is an AI-powered revenue cycle management platform that helps healthcare organizations reduce costs, increase revenue, and improve patient experiences. By leveraging Generative AI and large language models (LLMs), Droidal automates complex billing, claims, and payment workflows with precision and speed. The platform processes over 2 million claims monthly across 1,800+ locations while maintaining coverage for 3,500+ payers. Its AI agents streamline operations for hospitals, clinics, and care providers — cutting denials, accelerating payments, and boosting cash flow. Designed for seamless integration, Droidal enhances productivity without replacing existing systems or workflows. With enterprise-grade compliance and a subscription-based model, Droidal delivers measurable ROI while freeing up staff to focus on patient care. -
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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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Turquoise Health
Turquoise Health
Turquoise Health delivers a comprehensive suite of solutions built around healthcare price-transparency and contracting workflows, offering modules such as Clear Rates Data (which aggregates over a trillion provider, payer, professional, drug, and device rate records covering institutional and professional services) and Clear Contracts (a centralized cloud application that supports contract creation, negotiation, and storage for payers and providers). It also includes Compliance+ to help organizations remain compliant with machine-readable file requirements and Good Faith Estimate rules, Analytics tools to benchmark and query market-level rate data, Custom Rates extracts tailored for specialty healthcare segments, Standard Service Packages (pre-built bundles of common procedures), Search and Care Search dashboards for rate discovery and comparison, and a Turquoise Verified program enabling providers and payers to publish and manage price transparency data. -
5
MDaudit
MDaudit
MDaudit is a cloud-based platform that unifies billing compliance, coding audits, and revenue-integrity workflows for healthcare providers, hospitals, physician networks, ambulatory surgical centers, and the like. It supports all types of audits, scheduled, risk-based, retrospective, and denial-focused. MDaudit automates data ingestion from pre-bill charges, claims, and remittance data; triggers audit workflows; flags anomalies and high-risk patterns; and delivers real-time dashboards and drill-down analytics revealing root causes of billing errors, denials, and revenue leakage. Its modules, including a “Denials Predictor” for pre-submission claim validation and a “Revenue Optimizer” for continuous risk monitoring, help organizations prevent claim denials, reduce recoupments, and capture more legitimate revenue. MDaudit also provides payer-audit management: a secure, centralized workflow to respond to external audit requests and manage documentation exchange. -
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Madaket
Madaket Health
Get hours back in your day and millions back in your pocket with our automated solutions. Access the key players—providers, payers, and partners—and the real-time, accurate data you need to never miss a beat in care delivery. We handle all the complex connections across thousands of payers. All you need to know is fast and easy enrollments to any payer starts here. The cloud has never looked this good. Central command to manage, store, and share provider data in real-time—connected everywhere it needs to be. Provider verification made simple. You request it, our platform processes it fast. -
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Axxess Home Health
Axxess
Increase your organization’s cash flow by processing claims from Medicare, Medicaid and all other commercial payers. Automated processing of all payer claims in real time from anywhere at anytime ensures your claims get processed and get paid faster. Automatically submit and track your claims from anywhere at any time with real-time claims status updates. You are assigned a dedicated account manager that is a certified health care claims manager. You even have their mobile phone number. Diversify your revenue sources and improve your cash flow with our automated, anytime, anywhere claims processing with complete visibility to all your electronic funds transfers (EFT) and payment projections. Process, track and fix claims in real-time to capture all your revenue while eliminating costly time-consuming processes. Automate Medicare eligibility verification and claims processing. -
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 -
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Inovalon Insurance Discovery
Inovalon
Insurance Discovery reduces uncompensated care and underpayments by identifying active billable coverage previously unknown to the provider. Using sophisticated search capabilities, this solution identifies if patients have multiple active payers to help boost reimbursement opportunities. Prevent reimbursement delays and increase the speed of revenue capture by sending claims to the right payers on the first submission, enabled by more accurate coverage information. Run Insurance Discovery with verified patient demographic data to get accurate coverage and eligibility information. Replace manual insurance discovery methods with one quick, comprehensive search that inquires numerous databases in seconds to deliver detailed, accurate coverage information. Improve the patient/resident experience and estimate accurate out-of-pocket costs to improve their financial experience. -
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ESO Billing
ESO
Automate your workflow and integrations, and put an end to the repetitive manual work associated with revenue cycle management. ESO Billing frees your team to focus on what they do best. In today’s reimbursement world, efficiency counts. ESO Billing was built to save you time at every possible point in the billing process. Even its interface has been freshly redesigned for the ultimate in speed and ease of use. Customize your workflow based on your business process, task-based workflow moves each claim through its stages with minimal touches. It even alerts you automatically when payments aren’t on time, for the ultimate peace of mind. Our payer-specific proprietary audit process ensures that each claim contains all critical billing information prior to claim submission. The result? The lowest clearinghouse and payer rejection rate in the industry. Pair billing with ESO Health Data Exchange (HDE) and ESO Payer Insights to tap into hospital-generated billing information with one click. -
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Provider Credentialing
Visualutions
Our Provider Enrollment and Credentialing services enable practice providers to get and remain enrolled for the services they provide by ensuring that payers have the data they need to process claims for the services you provide. New Provider Enrollment. Establish relationships with new or missing payers to optimize revenue opportunities. Re-credentialing. Commercial payers and hospital applications. Annual Maintenance. CAQH Maintenance and Attestation, re-validations for Medicaid and Medicaid, Expirables: DEA, License, Malpractice, etc. Expert Credentialing Services For Healthcare Physicians Trying to manage and understand the required credentialing for your health center can be time-consuming, and take up valuable staff resources. As a full service revenue cycle management company we understand the impact provider credentialing can have on your cash flow. Our provider credentialing service includes options for new and existing providers. -
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symplr Provider
symplr
symplr Provider credentialing software helps create a single source of provider data, shrinks turnaround times, and shortens revenue cycles, all while prioritizing patient safety. symplr Provider credentialing software makes data gathering, secure access, reporting, and ongoing compliance less burdensome for providers, credentialing staff, and internal approval committees. Our customers report a 20% reduction in credentialing timelines, including a 50% reduction in committee review meetings. Collect, verify, store, and share provider lifecycle data and documents in one automated, user-friendly hub, resulting in time savings and cost containment. With a built-in payer enrollment module, you can enroll providers with payers and easily track applications step-by-step, to get reimbursed faster. Leverage automation to gather data from hundreds of primary sources and auto-check for expired/suspended licenses, NPDB, DEA, SAM, and more. -
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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. -
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Optimus Suite
EqualizeRCM Services
Innovative and industry-defining software solutions are at the heart of EqualizeRCM’s healthcare revenue cycle management strategy. Our RCM automation platform, Optimus Suite, seamlessly coexists with clients’ existing infrastructure (EMR, PM, Clearing House, Payer, and other systems). This platform, along with its set of intelligent applications, empowers facilities and practices to have efficient revenue cycle processes while reducing operational costs. Optimus can be tailored to integrate with your system and help bring your RCM performance to the next level. Denials and AR management system, enabling easy claim status, dashboard analytics, and root cause analysis of denials and AR. Platform to integrate 835 and 837 data into the denials and AR management process, enabling rapid claims analysis. A hosted, inexpensive, customizable contract payment calculator enabling calculation of expected payments per provider’s contracts and comparison to payments received. -
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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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MantraComply
MantraComply
MantraComply is a provider credentialing and enrolment platform. We deliver comprehensive services in provider credentialing, payer enrollment solutions, license verification, hospital privileging, and healthcare compliance management. Trusted by thousands of providers, health plans, payers, group practices, and digital health companies, MantraComply ensures faster provider onboarding, reduced denials, and improved regulatory compliance. Our model integrates AI-driven insights, customizable credentialing workflows, and 24/7 expert support, enabling providers and organizations to stay compliant while focusing on patient care. MantraComply is proudly backed by $15M in funding from Impanix Capital. -
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Valer
Valer
Valer’s technology speeds and simplifies prior authorization and referral management by automating submissions, status checking, verification, reporting, and EHR synchronization across all mid-to-large-sized healthcare settings, specialties, and payers from one platform and portal. Valer is the all-specialty, all-payer technology solution designed around your needs, not ours. Unlike off-the-shelf products that limit specialties, service lines, and payer mix (that don’t even automate submissions), Valer is explicitly customized to fit your needs. Because Valer is so easy to use, the dashboard increases staff productivity, simplifies staff training, and measures staff and payer performance across all service lines to enable continuous improvement. Valer doesn’t just connect to some of your payers for some of what you need. We link to all payers for all specialties, service lines, and care settings with real-time payer rule updates. -
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Myndshft
Myndshft
Experience a seamless workflow by having real-time transactions driven within existing technology platforms. Providers and Payers reduce time and effort by up to 90% for benefits and utilization management. Eliminate the current benefits and utilization management black box – eliminating confusion for patients, providers and payers. Self-learning automation and fewer clicks mean more time for patients, providers and payers to focus on care. Myndshft eliminates the quagmire of point solutions by providing a unified, end-to-end platform for in the moment payer-provider-patient interactions. Myndshft dynamically updates automated workflow and rules engines based on the actual responses and results from provider-payer interactions. Our technology continuously adapts to the rules in use by payers. The more you use it, the smarter it gets. A library of continuously-updated thousands of rules for national, state and regional payers. -
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Sift Healthcare
Sift Healthcare
Sift demystifies healthcare payments by integrating actionable intelligence into revenue cycle workflows to help healthcare organizations optimize payment outcomes and reduce the cost to collect. Sift equips healthcare providers with actionable denials intelligence that enables them to protect their receivables and accelerate cash flow. Sift captures insurance claim and patient financial data into a HIPAA-compliant, cloud-based and normalized database, providing a single source of truth for around your healthcare payments. Sift fills the gaps between a provider’s EHR, clearinghouse, workflow tools, and patient engagement platform. Sift unifies the data points from each system to build a unique and proprietary data set and provide holistic payments oversight. By applying multiple data science techniques, Sift provides comprehensive and integrated recommendations for denials management, payer assessment, patient collections and patient acquisition. -
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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. -
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PrognoCIS Practice Management
Bizmatics
Seamlessly integrating with, our cloud-based Practice Management solution allows for quick and easy billing management, which enables your practice to quickly identify and confirm patient insurance benefit eligibility level and copay. Work with many different clearinghouses. Efficiently manage your accounting books. Easily reconcile patient accounting and insurance billing. Quick and easy online patient payments and EOB/ERA processing. Our healthcare practice management system has a very robust tasking system. You can quickly find and assign claims to work on using a filter-based search function. You can filter and search outstanding claims by around 100 different parameters, including patient vs. insurance responsibility, primary/secondary/tertiary payer or payer grouping, provider, date of service, aging bucket, and denial reason. Filters can be saved and reused later.Starting Price: $250 per month -
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Ember
MetiStream
Unite and free your unstructured health data Interactive AI and NLP solution delivering health insights to Providers. Payers. Life Sciences. Interactive AI and NLP solution to unlock health insights from unstructured clinical notes data for: Provider. Accelerate data abstraction from and clinical validation of information contained in clinical notes. Decrease time and reduce costs required to identify care gaps, review care quality dashboards, and generate registry reports. Payer. Integrate and analyze both claims data and clinical notes to more effectively manage high risk and high cost member cohorts. Life Sciences. Rapidly match patients to clinical trials–and vice versa–using clinical trial databases and data from clinical notes. Leverage the power of real world clinical data and evidence. Ember is an end-to-end solution at the intersection of NLP and predictive analytics. Streamline. Healthcare Analytics for Unstructured Data to Improve Quality, Efficiency, and Outcomes -
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CoverSelf
CoverSelf
CoverSelf’s healthcare-specific, next-gen, cloud-native, and customizable claims accuracy platform is built from the ground up using modern software development techniques. It empowers users' long-term success by smoothly adapting to ever-evolving, dynamic claims, and payment inaccuracies, reducing complexities and administrative costs. This platform provides open access to all partners working to address claims inaccuracies, administrative waste & inefficiency, enabling them to build, customize, innovate & release at a faster pace. CoverSelf’s payment integrity platform engages modern technologies to address payment leakage & inaccuracies while remaining transparent & accessible to payers. Helps create new scenarios & data mining algorithms, innovating products, and expediting customization through this purpose-built platform, and increases speed to innovation. Claims are corrected and processed automatically, ensuring that there’s no additional human intervention or effort required. -
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Infosys HELIX
Infosys
Driving AI - first as a business strategy for payers, providers and PBMs with products and platforms which are built on AI and runs on cloud. A “healthcare digital platform” is the integration of applications and emerging technologies to provide a tailored healthcare solution that drives business outcomes—a significant modern and accelerated approach to disintermediate legacy core administration processing systems (CAPS). To better understand the role of digital platforms and emerging technologies in achieving business objectives, the impact of digital platforms on healthcare payer KPIs, and the relative attractiveness of healthcare platforms, Infosys, in partnership with HFS, reached out to 100 C-suite healthcare payer executives in US. -
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Encipher Health
Encipher Health
Encipher Health is a comprehensive AI-powered healthcare technology platform that automates medical coding, risk adjustment, and revenue-cycle processes across specialties. Using Neuro-Symbolic AI, OCR, ML, and knowledge-graph logic, it converts unstructured clinical documentation into accurate, audit-ready codes (CPT, ICD-10, HCC, HCPCS) while enforcing payer, CMS and compliance rules. Its products — including GI coding automation, radiology coding (Conrad AI), anesthesia coding (Sedate AI), HCC/risk adjustment (Cogent AI / RiskGen‑Core / RAF Totalizer), E/M coding, home-health coding, ICD-10-AM support, AR follow-up and denial resolution — streamline workflows, reduce manual effort, minimize denial risk, and accelerate reimbursements. Real-time and retrospective workflows, seamless EHR integration, MEAT-criteria validation, modifier logic, and compliance guardrails ensure high accuracy, regulatory alignment and audit readiness. -
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Harris Affinity RCM
Harris Healthcare
Optimize transforming patient care into cash with clear insight into every financial decision. Affinity Revenue Cycle Management reduces the need for bolt-on applications thus lowering an organizations overall cost to collect from both payers and guarantors. Bringing together the best of healthcare software solutions under one integrated platform. Lower the cost to collect by automating the revenue cycle and expediting claim processing. Harris Affinity helps healthcare organizations focus on what matters most: patient care. We do this through our RCM software, which helps automate the revenue cycle, expedite claim processing and lower the cost to collect. Use electronic transactions (EDI) to send & receive data directly to a payer or clearinghouse. Unlock screens without needing to contact support. Analyze data with easy to read dashboards. Optimize complex scheduling procedures. Send automatic appointment reminders to patients. -
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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. -
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symplr Payer
symplr
Save on costs, eliminate data silos, and deliver better outcomes for your members with a unified, automated provider data solution. symplr Payer provides a single source of truth for provider data that is consistently reconciled and validated against primary sources. It improves data quality, access, and transparency. Further, it eliminates duplicate requests for information, reducing provider frustration. Using symplr Payer as the enterprise-wide hub for provider data, payers can feed timely, accurate information to other downstream systems. Our highly configurable, end-to-end provider data management solution manages all pre-contract and renewal contract negotiations. Standardize and streamline your contracting processes, while capturing contract details such as sentinel events, trigger dates, configuration efforts, process steps, fee schedule info, and more. symplr Payer’s unique design allows your organization to consolidate contracting and credentialing. -
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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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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 -
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HealthRules Payer
HealthEdge Software
HealthRules® Payer is a next-generation core administrative processing system that provides transformational capabilities to health plans of all types and sizes. For more than ten years, health plans implementing HealthRules Payer have been able to quickly address market opportunities and stay in front of their competition. HealthRules Payer is unlike any other core administrative solution because of its use of the patented HealthRules Language™, an English-like vernacular that delivers a revolutionary new approach to configuration, claims processing and transparency of information. HealthRules Payer helps transform health plans looking to grow, innovate and compete beyond any other core system today. -
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HexIQ
HexIQ
The HexIQ software provides fast and easy access to negotiated rate data and tools that help users search, download, and analyze complex healthcare reimbursement rates for any code, payer, provider (NPI), or tax identification number (TIN) of interest so they can leverage transparency in coverage requirements to inform business decisions and negotiations. It ingests hundreds of machine readable files (MRFs) from payers every month, cleans and enhances the data with provider names, addresses, and network relationships, and updates it regularly so users can benchmark their negotiated rates against peers in the same specialty and region without manual Excel manipulation. Advanced search features let users filter by code, specialty, state, place of service, payer, NPI, or TIN and download results in CSV format for further analysis, while built-in analytics and visualization tools show rate distributions, average and mode rates, and contracted provider networks to reveal market insights.Starting Price: $25 per month per code -
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OptiPayRCM
OptiPayRCM
OptiPayRCM’s platform delivers seamless, “last-mile” revenue cycle management automation by integrating with EHRs, clearing houses, payer portals, and other systems via flexible adapters so your billing workflows can be processed end-to-end. Its unified core engine handles eligibility checks, claim submissions, payment postings, denial management, and full accounts receivable workflows using AI and robotic process automation to reduce manual effort and accelerate cash flow. Real-time dashboards and reports provide visibility into key metrics and enable predictive insights, while customizable automation supports exceptions and unique workflows. It reduces first-pass denials by up to 63%, speeds claim status checks up to 50 times faster than human processing, and reduces payment cycle time by up to 35%. It is compatible with more than 200 healthcare systems and supports direct integrations via EHRs, FHIR, EDI, and HL7. -
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Talix
Talix
The Talix platform powers intelligent workflow applications that enable risk-bearing healthcare organizations to succeed in the age of value-based care. Our workflow solutions for payers and providers require intelligent underlying technologies to work in unison and at scale. We’ve engineered the Talix Platform to support the needs of thousands of end-users, anywhere in the world simultaneously. Moreover, our platform architecture enables multiple SaaS application solutions in order to harness the efficiencies derived from being able to process millions of patient charts and encounter data. The Talix Platform is comprised of several technology components, intricately linked, to power software applications at scale for healthcare payers and providers. These components form the building blocks of artificial intelligence (AI). -
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Payer
Payer Financial Services
Pioneering online B2B payments. Enterprise payments. No matter how big or small the purchase is, Payer can do it. Endless opportunities with Payer. Digitise your business, globally. Whether you have local, regional or global ambitions, Payer is the online B2B payments partner you need because we can easily future-proof how you manage payments online. We are designed for the new era of B2B e-commerce. Automated online B2B payments experiences. Our system is designed to seamlessly integrate with your customers’ journeys. Payer does this by giving you complete UI freedom. Automated online B2B payments result in workflows with little manual work, for you or your customers. Seamless integration with your ecosystem. We are specialized in online B2B payments and know first hand the complexity that comes with having multiple system suppliers in your ecosystem. Payer can easily be integrated into your ERP and bookkeeping systems so you can reduce administrative costsStarting Price: $800 per year -
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Inovalon Payer Cloud
Inovalon
Improve clinical quality metrics, risk score accuracy, patient and provider engagement, patient outcomes, operational transparency, and economic performance, all with one comprehensive suite of software solutions. The Inovalon Payer Cloud transforms traditional workflows into data-driven processes that support your health plan’s key objectives. Backed by industry-leading analytics capabilities, our converged SaaS solutions deliver the member-centric insights and speed, accuracy, and flexibility you need to stay ahead in this diverse, ever-changing marketplace. Inovalon's SaaS suite of healthcare payer solutions delivers member-centric insights and actions to help health plans measure, manage, and improve healthcare outcomes, economics, and quality of care. Payer solutions to improve member care and outcomes while achieving greater operational performance and efficiency with sophisticated analytics and dynamic business intelligence. -
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SKYGEN’s Provider Data Management (PDM) is an on-demand solution that helps healthcare payers strengthen provider network management and provider relationships. PDM also strengthens payers’ ability to effectively build provider networks, improves provider and member satisfaction, and lowers administrative costs. It’s a smart solution that helps payers and providers meet the needs of today’s technology-savvy healthcare constituents. Lower contract acquisition costs via fast, efficient, paperless provider recruitment and supplemental network rental. Lower credentialing costs and improved provider satisfaction through online credentialing. Eliminating expensive outreach by automating provider self-verification and ensuring accurate and verified provider data for online directories. SKYGEN powers dental and vision connectivity solutions that inspire clients to move confidently into the future by employing technology that creates unparalleled efficiencies.
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Veradigm EHR
Veradigm
Ambulatory practices today face many challenges. From optimizing schedules, to streamlining documentation and diagnoses, it can often be tough efficiently connecting with other physicians, payers and pharmacies while complying with changing regulatory mandates. Originally created by physicians, Veradigm Professional EHR™ is the preeminent solution for physician practices that want to provide safer patient care, streamline operations and improve revenue. Professional EHR has efficient, one-click templates that enable physicians to thoroughly and efficiently document patient visits based on what they have ordered in the past under similar circumstances, and then make changes with just a few clicks—all improving provider satisfaction. Physician Desktop gives providers an easy way to manage patient populations, by providing complete clinical information from a single screen. -
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Remittance360
GAFFEY Healthcare
All organizations across the healthcare revenue cycle sector can utilize Remittance360. If an entity receives standard 835, business office staff of all levels will find this tool useful in making actionable decisions regarding cash and accounts receivable workflow. Remittance360 is simple and easy to use, start-up time is minimal, and the uploading process of 835 data takes seconds. Utilizing the standard 835 data set, information upload is obtainable for all organizations, with minimal IT involvement. Remittance360 takes advantage of the data organizations have, but delivers relevant reporting of denials, trends, and individual payer activities. Gaining insights into this information can determine specific workflow needs. The ability to query data is simple in Remittance360, and common queries can be saved for easy user functionality. Querying denials by remark code and by department can assist in identifying and fixing root cause issues. -
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Stedi
Stedi
Stedi is the only 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.Starting Price: $2,000 per month -
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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. -
42
Rhyme
Rhyme
Rhyme connects payers and providers intelligently inside the prior authorization workflow, reclaiming the time lost on back-and-forth efforts and returning it to the patient. Automating manual tasks is critical (that’s why we do it), but it isn’t enough. When the nuances of clinical decision-making require collaboration between payers and providers, Rhyme keeps your workflow clear, agile, and fluid. We created the largest integrated prior authorization network, to leave a disjointed system behind and replace it with intelligent collaboration. Deep relationships and connections to EHRs, payers, and benefits managers, all on one platform. No scrambling, no screen-scraping, no secondhand info. We meet providers and payers right where you are, in your existing systems and workflows. Connections are easy so we can adjust to you, not the other way around. Prior authorizations aren’t an add-on to our platform, they’re all we do. -
43
Medinous
Medinous
Medinous is a fully integrated web enabled Hospital Management System for large & mid-size hospitals and clinics, specially crafted for streamlined operations, superior patient care, enhanced administration & control and improved profitability. Our goal is to completely automate and integrate your Hospital’s entire process flow covering Clinical areas, Support functions, Finance, Supply Chain, Administrative and Billing functions. For ease of use, we facilitate quick integrations with PACS, Lab/Medical equipment, Drug databases and Payer connections. -
44
RCM Cloud
Medsphere Systems Corporation
The RCM Cloud® “software as a service” (SaaS) model strives to replace resource-intensive medical billing processes with digital solutions that reduce manual processes and optimize workflow thru automation. This approach significantly improves operational efficiency and further allows the business to expand service delivery capacity with only minor increases in administrative staff. Leverage your investment in technology to grow and sustain your business as opposed to increasing the headcount necessary to expand. On the administrative side, RCM Cloud® and associated services are delivered via the powerful, proven and secure medsphere cloud services platform. RCM Cloud® modules include patient/resource scheduling, enterprise registration, in-stream payer eligibility checking, contract management, medical records, billing, claims, payer and self-pay collections, POS payment posting and bad debt which enable all types of healthcare entities to truly transform their revenue cycles. -
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Charta
Charta
Charta Health offers an AI-powered platform that automates chart review by analyzing every medical chart (pre-bill, pre-visit, or post-bill) to capture missed revenue opportunities, ensure coding accuracy, and support payer-compliance needs. Its proprietary AI engine reviews 100% of patient charts, surfacing under-coding, missed billable services, coding errors, and documentation gaps, with evidence-based justifications and dashboards for auditing and tracking. For revenue integrity, the platform can increase RVUs per patient by up to 15.2% and average revenue uplift of 11%, while enabling full audit coverage at one hundred percent for a fraction of the typical audit cost. It also addresses clinical-quality workflows by validating documentation against standards such as HEDIS/STARS, integrating with clinical-decision support tools, and generating provider feedback loops, which help improve patient outcomes and reimbursement tied to quality. -
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ARIA RCM Services
CompuGroup Medical US
ARIA RCM Services is an end-to-end medical billing and revenue cycle management solution designed to enhance financial operations for practices, hospitals, and laboratories. The service offers flexibility by allowing clients to leverage their existing billing technology or utilize ARIA's systems, ensuring full transparency through a dedicated RCM team. Services are tailored to address specific needs, ranging from comprehensive revenue cycle management to focused areas such as aging accounts receivable and coding oversight. ARIA's team of regulatory and payment experts assists clients in navigating the latest CMS and payer requirements, aiming to minimize denials, reduce AR, and accelerate payment processes. The service emphasizes operational efficiency by combining industry best practices with proprietary workflow technology, delivering optimal results at a lower cost. -
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Camber
Camber
We're on a mission to make behavioral health more available and accessible. At Camber, we build software for behavioral health clinicians to improve the quality of care. We streamline and replace manual efforts so clinicians can focus on what they do best. Camber is a software platform designed to streamline administrative tasks for behavioral health clinicians, enabling them to focus on providing high-quality care. It automates daily claim validations and submissions, incorporating pre-submission error detection and payer-specific claim formatting to enhance accuracy and efficiency. By leveraging AI-driven workflows, Camber has achieved first-pass collection rates of approximately 93%, significantly improving financial outcomes for healthcare providers. The system also offers data-driven insights, assisting clinics in identifying optimal locations for expansion and facilitating payor contract negotiations. -
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Rivet
Rivet Health
Patient cost estimates and upfront collection. Understand patient responsibility instantly with automatic eligibility and benefit verification checks. Hyper-accurate estimates based on your own practice data, creating better care and a healthier business. Send estimates via HIPAA-compliant text or email. It's time to treat 2020 like 2020. Collect more than ever with upfront mobile patient payments. Ditch the write offs and decrease patient AR. Run eligibility checks and provide accurate cost estimates, even for multiple payers, treatments, facilities or providers. Collect payment up front via HIPAA-compliant text or email. Reduce A/R days, collect more revenue and increase patient satisfaction all at once. Identify, analyze and resolve denials, as well as track ROI from reworked claims. Automate denial assignments to team members via Rivet, and leave notes and links along the way to resolve future denials even faster. -
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XSOLIS CORTEX
XSOLIS
A new category of utilization management software, CORTEX provides a 360° approach to addressing the intricacies of utilization management and revenue cycle processes. Powered by real-time predictive analytics and machine learning engine, CORTEX ensures that the right cases are handled at the right time, by the right staff or by exception. CORTEX incorporates precision medicine upon a foundation of evidence-based medicine. Machine learning models operate in real-time to better assess your patient population. Our analytics have been deployed in hospitals and health plans across the nation. With clear inpatient cases, CORTEX does the heavy lifting by automating inpatient determinations on cases that meet your unique threshold. For difficult cases, CORTEX offers your staff the insight they need to make a strong determination. This approach offers incredible value to payers and providers alike. -
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Enable Healthcare
Enable Healthcare
Enable Healthcare’s Electronic Health Records (EHR) is an AI‑powered clinical solution that accommodates solo practices through large multispecialty groups by unifying robust documentation, administrative workflows, and patient engagement in a single interface. It visualizes interactive clinical data to inform decisions for individual patients and entire populations, while its real‑time dictation app eliminates manual typing with accurate voice recognition. Built on HPI‑based algorithms, the intelligent coding engine automates code detection, integrates payer‑specific codes, and issues care‑gap alerts to optimize revenue integrity. With enableAssist, clinicians leverage AI‑driven charting prompts to generate assessment and plan narratives instantly, and eApredict computes and displays color‑coded patient risk levels. Integrated telehealth capabilities facilitate virtual visits and simplified transition‑of‑care reviews.Starting Price: $500 per month
