Alternatives to ClaimBook
Compare ClaimBook alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to ClaimBook in 2024. Compare features, ratings, user reviews, pricing, and more from ClaimBook competitors and alternatives in order to make an informed decision for your business.
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1
Service Center
Office Ally
Service Center by Office Ally is a trusted revenue cycle management platform used by over 65,000 healthcare organizations processing more than 350 million claims annually. With it, providers can verify patient eligibility and benefits, upload and submit claims, correct rejected claims, check claim status, and obtain remits. With multiple claim types and submission options, providers can easily submit claims to any payer from any practice management system. Transactions are secure, ensuring the confidentiality of sensitive patient information. With no needed implementation, providers can quickly and effortlessly streamline their billing processes, increase their financial performance, simplify medical billing, and reduce claim rejections for faster reimbursements. -
2
Speedy Claims
SpeedySoft
Speedy Claims became the top CMS-1500 Software by providing the best customer service imaginable to our thousands of clients all over America. Medical billing isn't the kind of thing most people get excited about - it is just a tedious task you have to do. But while it will never be a fun task, it doesn't have to be as difficult or time consumimg as it is now. With Speedy Claims CMS-1500 software you can get the job done quickly and easily, allowing you to focus on the things you love about your job, like helping patients. With a simple interface, powerful features to eliminate repetitive work, and unrivaled customer support, it's simply the best HCFA 1500 software available on the market. A powerful built-in error checking helps ensure your HCFA 1500 form is complete and correctly filled out, preventing CMS-1500 claims from being denied. -
3
AZZLY
AZZLY
AZZLY Rize is the premier clinical and business platform for addiction treatment and mental health organizations. As an all-in-one substance use disorder and mental health specific EHR, Patient Engagement and RCM platform, we serve small, medium, and large clinics. Key features for OUTPATIENT Programs include: scheduling, appointment reminder, Zoom telehealth, treatment plans, progress notes, assessments and surveys. For RESIDENTIAL programs: census, medication management, bed board, withdrawal management, DrFirst e-prescribing, EPCS, PDMP, labs. For all levels of care: alerts, patient engagement portal, electronic billing and claims submission built in. AZZLY Rize empowers your staff through its 5 star training and support services, its simplicity and automation. As a true all-in-one EHR/PM/RCM platform, improved compliance, workflow and accurate billing are achieved real-time. We proudly serve programs in over 33 states and are hosted in Microsoft Azure's private cloud network. -
4
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. -
5
TherapyNotes
TherapyNotes
TherapyNotes is an easy-to-use and feature-rich practice management software for behavioral health practitioners. It combines robust scheduling tools, patient notes, electronic billing, and a custom patient portal. The software is also certified HIPAA- and PCI-Compliant, which helps to ensure that all practice and patient records are secure and encrypted. Managing a practice comes with plenty of paperwork that can keep you out of session. With features like simple electronic claim submission and assisted ERA payment posting, you'll have fewer data entry errors and less tedious paperwork. TherapyNotes™ integrates all aspects of your practice to help you improve patient care. Person‑centered documentation, searchable diagnoses, and more time in‑session help you provide your clients with the care they deserve.Starting Price: $49 per user per month -
6
Conexia
Conexia
Provide authorizations, claims processing and payment in real-time at the point of care. Enhance care coordination and improved outcomes to lower medical cost while streamlining administrative processes. Engage providers at the point of care to capture and share data in real-time resulting in an unparalleled exchange of health information. We partner with our clients to implement risk management strategies that result in better outcomes with lower costs. We strive to improve the user experience for everyone involved in the ecosystem. We deliver a minimum 3:1 ROI for our clients to allow them to optimize their resources. Conexia has developed a core technology platform (ONE) that is customizable to meet the diverse regulatory requirements and operational processes for each client in each geography. In most cases, our initial implementation is an overlay on the payer’s existing technology ecosystem to create real-time processes. -
7
PlanXpand
Acero Health Technologies
PlanXpand™ is Acero’s proprietary transaction processing engine, one that powers each of our products for health benefits administrators. Leveraging this engine, clients may choose to implement Acero’s products concurrently or incrementally. In addition to selecting one of our standard products, administrators also may choose to utilize PlanXpand™ to develop a custom solution to extend existing system capabilities. Acero’s unique, integrated solutions feature Service-Oriented Architecture, allowing health benefits administrators and insurers to add features and functions to existing adjudication platforms. At the same time, our sophisticated design and engineering enables real-time adjudication of every type of claim, all in direct interaction with the core claims system, resulting in more accurate processing, more satisfied customers and less need for claims adjustments. -
8
Waystar
Waystar
The financial and administrative challenges facing healthcare providers are daunting. Waystar’s technology platform simplifies and unifies healthcare payments across the revenue cycle. We empower healthcare organizations to automate manual work, gain insight into processes and performance, and ultimately collect more revenue. At Waystar, we know there’s a better, more efficient way forward. Let’s climb the mountain ahead of us to reach new heights in healthcare. We know that adopting new revenue cycle technology can seem like an obstacle. Whatever your existing systems, our cost-effective technology is compatible and gets up and running quickly. Our single sign-on platform lets you manage commercial, government and patient payments all in one place, so you can consolidate vendors and eliminate the hassle of multiple systems. Give your staff intuitive solutions that will make their jobs easier and their workflows more productive.Starting Price: $100 per month -
9
Enter
Enter, Inc
Enter gets Providers (doctors, practices & hospitals) paid faster than anyone in history. Enter processes health insurance claims and pays in 24 hours while automatically communicating and collecting patient responsibility with a white label collection engine, complete with payment plans. Enter is 30x faster at getting claims paid and 45x faster at getting patients billed at the same cost as existing medical billers. - $150mm+ of claims processed in just 1 year of operations. - $100mm credit facility actively being deployed for providers. - Revenue Cycle Management Partner for United Healthcare Nevada. - Enter supports a wide variety of specialties including ASC, Orthopedics, Neurology, Dermatology, Emergency Rooms, Behavioral Health, Pain Management and more. - Enter works with all commercial and government health insurance carriers. - Enter integrates with all EMR / practice management systems. - No monthly fees. No integration fees. - Enter is venture backed -
10
ResolvMD
ResolvMD
ResolvMD is an experienced full-service medical billing company that processes all health service claims (AHCIP etc.) on behalf of physicians. Our goal is to make physicians as confident and competent in their billing as they are in their practice through surfacing data-derived insights and democratized knowledge. We have the most modern, cost-effective, and secure platform on the market for processing claims. Our target audience are physicians (mainly specialists such as emergency physicians, urgent care, plastic surgeons, anesthesiologists, paediatricians, general surgeons etc.). They need a billing agent to process their health service claims. They value time, trust, cost, efficiency and knowledge. We are targeting physicians in Alberta today (mainly in Calgary, Edmonton, Red Deer, Medicine Hat, Lethbridge, Okotoks and any other centre with a population in excess of 25,000. -
11
Newgen Claims Processing
Newgen Software
Automate the end-to-end claims journey, from intimation of the first notice of loss and fraud detection to claims adjudication, and finally claims settlement. Experience the flexibility of addressing various claim types differently, like death and maturity claims, while improving regulatory compliance and eliminating non-compliant penalties. Enable faster, accurate, and effective processing through data capture, payment tracking, salvage and recovery tracking, legal matter processing, monitoring, and more. Effective registration, adjudication, tracking, and management of claim submissions. Built-in, comprehensive business rules for automatically categorizing claims as “fast track” or “non-fast track”. Flexibility to add or modify stakeholders— garages, assessors, loss adjusters, surveyors, investigators, claim officers, etc. -
12
bestPT
Billing Dynamix
bestPT is a complete, cloud-based physical therapy billing service and practice management software solution. Created for private practices of all sizes, bestPT helps solo practitioners and franchise owners of physical therapy clinics to manage payment and revenue generation as well as keep track of claims processes. Integrated with the most popular EHR systems, including webPT and Cedaron, bestPT helps streamline billing processes to make the entire office's workflow more efficient. -
13
HoudiniESQ
LOGICBit
HoudiniEsq is an advanced, browser-based law practice management for today's modern law firms. Available in the cloud or on premise, HoudiniEsq offers a robust feature set that enables law firms to streamline workflows, capture and classify all types of documents, automate billing, task scheduling, and group calendaring, and more. The platform also integrates with solutions such as LawPay, Microsoft Office, Outlook, Evernote, QuickBooks, Acrobat, Calendar/Court Rules, WordPerfect, and Google Suite.Starting Price: $0 -
14
EvolutionIQ
EvolutionIQ
Our solutions drive lower loss costs, lower expenses, and higher customer satisfaction, and are proven at tier 1 carriers. EvolutionIQ enables the future of claim handling for complex lines of coverage, a deep partnership between skilled professional adjusters, and a highly specialized predictive guidance system. Equipped with clear prioritization, pro-active claim alerts, and rich context, empowered adjusters reduce losses and expenses while delivering an enhanced claimant experience. Reduce unwanted variability in the claims pipeline with a consistent, scalable claim guidance system. With the more efficient allocation of adjuster resources & fewer wasted claim reviews. With targeted claim investigations, litigation avoidance, and timely claim settlement. Our claims AI acquires and harnesses data to deliver the tactical guidance your team needs. EvolutionIQ combines structured and unstructured carrier data with our proprietary third-party data. -
15
Claims Software
Claim Ruler
A new and smarter way to process and settle claims. Modern, end-to-end solutions to settle claims for all lines of property, liability, and workers’ compensation insurance. ClaimRuler™ is a cloud-based claims management system designed specifically for I/A firms and Third-Party Administrators, CAT Adjusters, Insurance Carriers, Self-Insureds, and Municipalities. The platform supports end-to-end claims processing with built-in guided workflows, robust reporting capabilities, and a fully automated diary system to streamline the settlement of claims. ClaimRuler™ was purposefully built to service the needs of real people in the industry. Its functional and intuitive approach to design makes working with forms, lists, documents, and photos a simpler and more natural experience. From I/A firms, TPAs, and insurance carriers to municipalities and self-insured corporations, ClaimRuler™ adapts and scales along with your organization. -
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ClaimPilot
Quick Internet
A web-based claims management solution paired with unparalleled customer support. For claims management professionals who are looking to scale and manage their business, ClaimPilot offers its web-based claims management solution that provides the ease of use, features and functionality you need to gain visibility of claim and financial information with custom reporting. Address increasing demands of data inputs required with customizable features. Increase claims processing efficiency. Unlike unwieldy, feature-loaded risk management-focused claims software or lighter software packages that focus on document management only, ClaimPilot provides the features you need to manage your claims including Lloyd’s compliance, and workers comp functionality. Plus, you get our legendary customer support. Our team of experts partners with our clients to build custom reports and functionality to support your growing business. The way we see it, if you are successful, you’ll be successful. -
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Hi-Tech Series 3000
Hi-Tech Health
Series 3000 is a cloud-based claims administration solution for businesses within the healthcare industry. No matter what your adjudication, reporting, or plan needs are, this platform reduces time processing claims and increases productivity as it assists with: •Client management •Benefits input •Electronic claim submissions •Claims processing •Real-time status tracking Our built-in database efficiently manages clients and employee benefits. This platform allows users to make real-time updates including: •Claims statuses •Currency conversion •ACH deposits and disbursements •Document printing No matter what happens, our cloud-based software is reliable, and we pride ourselves on 99 percent up time. Series 3000 is HIPAA compliant and ensures secure data management and backup. We upgrade our communications and IBM hardware every two to three years and maintain System Critical Support with all our vendors, keeping our technology up to date.Starting Price: $3500 per month -
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Teamworks IRO
IRO Solutions
We offer upfront pricing with several options; monthly flat rate, per case, or a combination of both. Included at no additional charge is our Information at a Glance Dashboard, Customizable Task List, and Scheduler. This means all Case Information is available in one place without needing any additional software. Some of Teamworks IRO unique features. Simplified method to collect and maintain data for IRO, URA, Peer Review, Insurance Companies and Attorneys. At a glance, you will know what cases are due, what tasks are due, what documents are due, what payments are due, faxes and emails - System generated and easily managed. Task List - Automatically created for each new case. Reports - Case and financial reports generated by easy point and click. Case closing Report - Automatically generated and sent to the appropriate state agency. -
19
mobile claims
Symbility Solutions
Virtual diagramming, voice annotation, photo documentation and full pricing capabilities in the palm of your hand. Quickly and accurately capturing claim information onsite eliminates the need for followup visits and provides a great chance to engage policyholders in the settlement process. Adjusters can document, estimate, and close a claim in a few easy steps leading to a faster, efficient and more accurate claim settlement. Mobile Claims ensures that onsite estimates become onsite settlements. Utilizing logic-based questionnaires, our algorithms can be applied to generate custom loss specific estimates in a fraction of the time than the standard estimate construction today. Easy to integrate, train, and use. Virtually eliminating the cost of change, creating enormous benefits for carriers, adjusters, contractors, and policyholders alike. Fully equipped with aerial imagery/measurement, 3D virtual diagramming, geospatial visualization, video collaboration, contents, etc. -
20
DrChrono
DrChrono
Increase the efficiency of your medical practice with an all-in-one practice management, electronic health records, and medical billing platform from DrChrono. With its modern and simple interface and dozens of advanced features, DrChrono empowers medical practitioners to better serve their patients. Users can easily schedule patient appointments, check and edit patient charts, and manage billing with ease. -
21
Claimocity
Claimocity
Claimocity was designed for busy clinicians who see patients in Acute Care or Step Down facilities. Claimocity is the first and only PM and RCM software designed exclusively for hospitalists. it is an All-In-One Mobile Billing & Practice Management Software App for Clinicians Who See Patients in Acute Care or Step Down Facilities. Clone previous notes in a way that other solutions, including EHR/EMRs, are not allowed to do. Combine and streamline two separate daily encounter documentation and billing processes in a way that saves significant time. Our note capture section can prepopulate the note with vitals and import elements from the chart. Support multiple complex templates inside a practice (calibrated encounter notes, procedure specific notes, single-section text based notes, or any combination of context-based pre-builds). Copy and paste any large available data groupings from third party available information sources directly into any text section and then sign and submit.Starting Price: $99 per user per month -
22
FileHandler Enterprise
JW Software
Built with insurance claims and risk management in mind, our software features live dashboards, detailed reporting functionality, business intelligence tools, and the latest security technology. FileHandler Enterprise™ has become the benchmark for claims administration and risk management information systems (RMIS) in the industry. Our intuitive claims management software is great for third party administrators (TPA's), insurance carriers, risk pools, risk management companies, and a variety of other business professionals looking to make better and faster claims management decisions. No matter your size, our software is scalable from one employee to thousands. FileHandler Enterprise™ software will help you manage and close claims quickly, process payments to parties or vendors, and provide advanced reporting necessary to manage your business. -
23
CaseGlide
CaseGlide
CaseGlide is driving the revolution in claims litigation management. Gone are the days of disconnected and siloed claims systems, manual and inefficient workflows, and hundreds of emails passing between defense counsel and claims teams containing unstructured case data. With CaseGlide you can focus on strategy, data, and driving efficiency to improve your litigation management program. Our clients better predict and manage their case outcomes, assign the right attorneys to the right cases, work cases more strategically, and significantly reduce their litigation costs. As your defense attorney partners work your cases in the platform, integrations allow you to push important case data to your claims system, data warehouse, document management, or accounts payable system. It’s simple: the longer a case is open, the higher your costs. -
24
Total Loss Pro
Vemark
The frequency of total loss claims continues to rise, now accounting for some 20 percent of collision and liability losses across the auto insurance industry. Yet, far too often, carriers’ total loss operations lack cohesive integrated digital workflows, leading to excessive costs, customer dissatisfaction, and poor visibility and oversight. Enter Total Loss ProTM from Vemark. It’s the one solution you need to transform total loss claims processing from a frustrating black hole to a well-oiled machine while allowing you to keep up with the rapid pace of change. Faster settlement for Improved policyholder experience and satisfaction. Higher employee morale from reduced frustration, and fewer tedious processes. Increased visibility and transparency for data-driven decision-making. Auto claims that result in a total loss are more complex than vehicle repair claims. Total Loss Pro is a cloud-based solution that improves all stages of this complex salvage vehicle workflow. -
25
Mitchell WorkCenter
Mitchell International
Auto insurers need tools to simplify physical damage claims processing from the first notice of loss (FNOL) to settlement. Mitchell WorkCenter is an open, end-to-end modular solution that allows you to configure the modules and integrations specific to your unique business needs. Achieve better outcomes through improved accuracy and efficiency, while lowering the total cost of ownership. Our platform provides you with the ability to send and receive all information straight into your claims management system. With a proven track record of projects implemented in 90 days or less, your IT department will find integration with Mitchell WorkCenter simple. No two businesses work the same way. With WorkCenter, you can configure and manage your software based on your business needs. Access our entire suite or select certain features that best fit into your claims management workflow. -
26
FileTrac Evolve
Evolution Global
FileTrac has a long-standing legacy of being the #1 claims management system in the industry. Building on this reputation, it has now evolved into FileTrac Evolve. This enhanced version is a crucial component of the Evolve Suite, a comprehensive platform designed to revolutionize your claims management process. FileTrac Evolve is a leading web-based claims management system for independent adjusters, third-party administrators (TPAs), managing general agents (MGAs), and insurance companies of all sizes. Comes with a built-in diary system with reminders and provides integrations with Quickbooks, Outlook, Xactanalysis, Symbility, LEDES, NFIP/NFS, and Google Maps, FileTrac Evolve helps businesses manage their adjusters while ensuring accountability to their customers. Other key features include time and expense tracking, invoicing, adjuster timesheets, image and video uploads, accounting reports, quick notes, and more. -
27
ClaimSuite
Whitespace Software
The Whitespace Platform is the truly digital platform for the global (re)insurance marketplace. Contracts created and processed using Whitespace are made entirely of data. When digital data is used as the vehicle for risk transfer (not Word or PDF documents), the potential benefits of digital transformation of your business become realizable. And the possibilities are endless. Increases in speed, accuracy, availability, and quantity of in-depth data for risk analysis, all provide significant benefits to Brokers and Carriers. Above all, insurers act in the interests their customers, for whom a digital connection can mean real-time access to the risk placement, quicker payments and faster responses on claims. The complete end-to-end process is supported; with Whitespace, brokers and underwriters create risk submissions, collaborate on contracts, communicate via real-time instant messaging, request and provide quotes, bind, sign and endorse (re)insurance contracts digitally. -
28
ScanNStore
DocuStream
ScanNStore is a full-featured electronic document storage and retrieval system in a small package. It's the perfect solution for increasing productivity by electronically organizing and managing paper files. ScanNStore lets you and your staff quickly scan, index, store and retrieve your claims, attachments, remittance notices, and other documents. You can search by multiple indexes and display claims and all related information on-screen, as if you are looking at the original paper. Where instant access to the right claim information is critical, ScanNStore is the right solution. Contact us to download and try out a fully functional multi-user version of ScanNStore for 30 days. Volume seat licensing and vendor discounts available. Supports a wide variety of TWAIN scanners and production level scanners including HP, Fujitsu, Ricoh, Bell & Howell and Panasonic. Supports single page or multi-page batch scanning, automated document feeder, page size, contrast adjustment, etc. -
29
QuickCap
MedVision
MedVision Solutions' QuickCap is an administrative and clinical data process management solution that lets users focus on business and not the paperwork. With QuickCap, users have scalable control over their workflow and information to work smarter. QuickCap features a customizable dashboard for ease and gives them automation of their process for speed. QuickCap also streamlines claims work that makes users' work easier. QuickCap also allows users to easily determine profitability for individual providers with analytics. -
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Mercury Policy & Claims Administration
Quick Silver Systems
Mercury by Quick Silver Systems allows Automobile, Property, and Casualty insurance carriers to easily rate, quote, bind, make payments, and report claims online. Minimize customer service calls through online document access, bill payments, and first notice of loss. Modular API based system allows seamless integration with new or existing data providers. Fully digital document production and 100% web-based system works on any device. Create custom, event-driven work-flows with our visual work-flow designer. Access the most up-to-date information on Written, Earned, and Unearned premiums. Automatically save every page, card, report, email, and more to review and share with associates. Collect currency in any digital format including: ACH, EFT, Electronic Checks, Credit, or Bank Card. Information Technology within an insurance company not only needs a system that provides wide accessibility. -
31
PayorIQ
Compliance PT
Receive notifications when Payors make policy changes. Staying informed makes all the difference. Instead of reading through hundreds of pages of insurance-speak, our software detects policy changes and writes easy-to-digest notes for your billing and coding staff to implement. Quickly find policy specifics for a given claim date. Use our data as evidence to win more cases.Starting Price: $199 per user per month -
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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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omni:us
omni:us
Seamless integration into existing claims systems. Automate processes and reduce costs. No longer is it a choice between saving costs and improving the customer experience. Better decisions with data-driven insights. Automate manual processes. Empower your claims personnel. Invest in your customers’ happiness. Seamlessly integrate incoming claims with your insurance core system. Tackle process inefficiencies with claim automation and watch your customer satisfaction skyrocket. Reduced manual claims incidence of low to moderate complexity by automating claims handling. Improved triaging and manual claims assignment increased case team effectiveness drastically. Decreased process time for remaining manual claims. Allowed a real-time claims settlement in significant amount of cases. Automated digital claims journey by applying FNOL-completeness check, coverage check, automated claims file creation. -
34
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. -
35
Claimable
Claimable
Claimable is claims management software for businesses that removes the headache of managing insurance claims. Increase your claims handling capacity by spending less time on admin. Stop searching shared folders and inboxes. Your claims data is just a few clicks away! Your data is securely stored in the cloud and is accessible from anywhere. No more paper! Be ready for an audit with a complete history of each claim at your fingertips. Keep track of your documents and access them whenever and wherever you need! Filter and report on your claims data, to drive productivity and stay informed. Label your claims to categorize and organize them to suit your workflow. Keep detailed notes on each claim and collaborate and share with your team. Assign tasks to your team and see at a glance which are due or completed. Build and manage your claims contact database, and find contacts in an instant.Starting Price: $79 per month -
36
Five Sigma
Five Sigma
Five Sigma set out on a mission to allow claims organizations to innovate. With the set of claims management tools and unique platform, Five Sigma's suite is what Insurers need to bring their claims operation to the rapidly changing world. With our suite of Claims-First Cloud-Native and User-Centric products, we enable adjusters to handle claims better and faster. With Automating administrative tasks, Adjusters can focus on making the right decisions, while the system takes care of everything else. Full end-to-end suite for claims management with in-system omni-channel communication platform, automated documentation, automated workflows, reporting and open APIs. Go live in weeks with the state of the art claims management platform. With the unique SaaS offerings and agile methodology, Five Sigma's solutions are deployed in weeks instead of months and with weekly upgrades, we enable carriers to continuously improve claims operations. -
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Remove time and complexity from document processing while supporting straight-through processing efforts. Shift Claims Document Decisions is an AI-powered solution that analyzes documents for relevant details and creates a contextual view of action items required to move the claim forward. Our models are specifically trained with insurance documents in mind, allowing them to process forms with accuracy matching or surpassing that of an experienced human claims adjuster. Automatically evaluate documents against available data to create a complete picture of each claim and accelerate processing. Industry-specific AI continually learns to combine claims data with document details to deliver claims document decisions that drive impact. Minimize manual reviews, identify complexity, and direct handlers to claims details requiring action. We are 100% focused on insurance and hire the industry’s best talent to provide our customers with unmatched support.
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KMR Medical Claims Manager
KMR Systems
KMR Claims Processing Manager is a state-of-the-art, fully integrated, customizable claims processing solution for TPAs, Self Insured and Claims Administrators. Our system includes a comprehensive Medical & Dental Reimbursement module, allows for electronic claims, integrates with Document Imaging systems, has the ability for debit card processing and is totally HIPAA compliant. -
39
Claims Manager
JDi Data
Claims Manager is a comprehensive, integrated RIMS system built to streamline your process from FNOL to settlement. A unique, configurable business rules engine automates workflow, reduces manual and duplicate work, saves time, and improves outcomes for all stakeholders. Claims Manager’s integrated solutions streamline workflow by helping you administer, adjust, and report your property and casualty claims. Claims Manager is a versatile, and simple to use Risk Management Information System that offers tomorrow’s solutions, today. Its intuitive interface seamlessly integrates with an automated workflow that is accessible anytime, anywhere, from any device. Letting you easily capture, benchmark, administer, and report claims for all lines of property and casualty insurance. -
40
CLAIMExpert
Acrometis
The Acrometis flagship claims processing solution offers unparalleled workflow management, with documents automatically routed by a configurable rules engine. Based around claim assessment scoring, body part to claim compensability matching, jurisdictional directives, relatedness scoring and a host of other claim elements the Acrometis business rules are designed to reduce claim duration and costs. CLAIMExpert automatically processes 65 percent of incoming medical bills and non-medical documents with no user intervention. Documents requiring adjuster intervention are flagged and sorted for easy review and straightforward decision making. Automatically processes incoming documents with NO adjuster intervention. Clients typically see between 11 and 23 points medical loss improvement in the first year. CLAIMExpert contains rules for over 190 different document types, quickly handling whitemail and any other documents that come across your adjuster’s desk. -
41
Claim Leader
ClaimLeader
Claim Leader develops and provides technology solutions to automate the communications and workflow processes across the business enterprises of insurance claims organizations. Our software solutions allow to simplify your operations, while providing superior productivity through an advanced, and integrated web platform. Feature-rich modules within Claim Leader systems create a simplified workflow for internal administrators and on the field users. Management tools allow internal users to dispatch assignments to field staff, sort workload, pinpoint files for review, and streamline workflow. -
42
EvoClaim
DWF Group
Claims management software that is ideal for claims, complaints and customer service. Settle claims quickly, reduce the cost per claim and manage claim load with trend analysis, fraud detection and intelligent reporting. Easy cloud-based access one central resource for real-time information sharing and actioning. Built-in report generator to create your own ad-hoc reports and intelligent MI through to heatmaps, dashboards, and trend analysis. Our systems have no restrictions built-in, maximizing your ability to link with any of your back-office systems. Microsoft-based enterprise technology that scales with your business. Less onboarding time means your team can hit the ground running. Empower your managers with automated and “real-time” reporting. Smoother onboarding for legacy systems and multiple technology requirements. Multi-sector expertise for easier discovery, development, and integration. -
43
Complete Claims
Complete Health Systems
Claims Adjudication for medical, dental, vision, prescription, short and long-term disability claims. Available for on-site license or as a hosted application (ASP). Microsoft technology: SQLServer database with a Windows front end. Acclaimed Customer service staffed by health care claims experts with a minimum of 12 years’ experience in the field. Support calls are logged with status available via the internet. Plan copy and modification feature enable quick setup of plans. Auto-adjudication using benefit codes built using business rules based on over 25 variables from both the claim and the claimant records made available to the adjudication engine. Inbound claims can be scanned images, EDI or paper. HIPPA EDI 5010 transaction sets. Re-pricing fee and UCR Schedules can be loaded on the system in advance of the effective date. The date-driven logic will re-price based on the date of service. -
44
CyberSource Medical
ComCom Systems
The market's most powerful and accurate solution for claims processing. CyberSource Medical Claims Scanning Solution, a complete turn key system for HMO, PPO, TPA, or Self Funded Organization, is installed at your location for automated data entry of CMS-1500, ADA-2006 UB-04 and enrollment forms. Using advanced "intelligent" features combined with your business rules, CyberSource recognizes, validates and formats the data from medical claim forms. Fuzzy Matching performs an intelligent search of your member and provider database correctly identifying the exact match. The matched data is then utilized to verify and correct data on the medical claim before being passed through to adjudication. The combination of industry-leading OCR efficiency, your business rules and “Fuzzy Matching” results in exceptional accuracy of the data from your medical claims forms. -
45
CaseworksPro
Insurance Technology Solutions
CaseworksPro is an affordable web-based claims administration system designed to support a wide range of claim processing requirements. Developed by Insurance Technology Solutions, CaseworksPro is purpose-built for carrier claims departments, self-insured retentions (SIRs) and third-party administrators (TPAs). This easy-to-use solution offers a host of features that include SIR client-centric workflows, policy data capture, one-ff and scheduled payments, user-defined access permissions, check printing, electronic reporting, and NCCI and ISO stat code capture.Starting Price: $25000.00/one-time -
46
Quadient Correspondence
Quadient
Quadient® Correspondence, manage claims correspondence, in the cloud. Quadient® Correspondence is a subscription-based SaaS solution that enables insurers to create, approve and deliver regulatory compliant, accurate and personalized claims correspondence to customers across print and digital channels, with no reliance upon IT. Quadient Correspondence was designed and priced for insurers who want to further their transformation to digital, but don’t have the resources to invest in an end-to-end customer communications management (CCM) solution. Business analysts create and update templates. Claims managers and compliance experts edit & approve templates for use. Business users write correspondence using a controlled editing experience. Designated personnel review and approve correspondence for delivery. Instant delivery via email, PDF and SMS. Business users start by selecting the appropriate claims correspondence template and customizing the content within pre-defined editable fields. -
47
A1 Tracker
A1 Enterprise
A1 Tracker is presented by the vendor as a robust & configurable risk management software offering either stand-alone or fully-integrated risk management software covering many business segments across an organization. Claims & Incident Management Claims & incident reporting for claims of any type: injuries, medical, commercial, customer, insurance, work comp, asset, auto, liability. Risk Management & Threat Assessment: Risk register for tracking risks at any level in an organization, including by entity, project, asset, contract, vendor, division, business, unit, region, and more. Real-time risk reports & heat maps, dashboard metrics, alerts, & notifications. Contract Management: Contract module for tracking contracts of any type with vendors, employees, customers, and any other parties. Insurance Policies & Certificates: Policies & certificates of insurance tracking with reminders & renewals. For agencies & carriers policy management includes tracking clients.Starting Price: $800/month -
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OneTouch Claims Processing Software
Apex EDI
OneTouch is a tool that allows a user to conveniently transmit claims or statements to Apex, login to the Apex website, or search for claims that have been sent in the past all from of your computer desktop. In order for OneTouch to work, the user must be a registered client with Apex EDI and have a username and password setup. Once a user has a username and password OneTouch can be configured so the user can utilize the tools described. With OneTouch Search you can search your claim and statement files that have been sent to Apex from the convenience of your desktop. The OneTouch search feature allows you to search your statement and claim files for patient names, subscriber IDs, or several other options. After you click the search button you will be logged into your Apex webpage and shown the results of your search. To perform a search first choose what you want to search for by clicking on the magnifying glass dropdown menu. -
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Context 4 Health Plans Suite
Context4 Healthcare
Protect the integrity of your health plan and determine accurate pricing with the Context4 Health Plans Suite, our modular, cloud‑based technology platform. Immediate, actionable, and defensible Fraud, Waste, and Abuse (FWA) detection built by our team of certified clinical, dental, and health benefits experts. Accurate data and cutting-edge cloud technology combine to create a proven and defensible medicare reference-based pricing (RBP) solution. More than 100 healthcare data sets, with professional support to optimize efficiency and compliance. Advanced medical coding software designed to expedite claim submission and minimize denials. Our cloud based Payment Integrity Platform utilizes our proprietary analytics engine to identify coding errors, medical necessity, unbundling, fraud-waste-abuse, audit risks, pricing and other aberrations that can impact your business. -
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Coronis Health
Coronis Health
Through our personal, high-touch service, Coronis Health can provide an unparalleled level of professionalism you won’t find anywhere else. We won’t just help you collect your revenue. We will help you financially grow while progressing this industry into the modern technological age. Coronis Health is a global revenue cycle management company offering specialized solutions to healthcare practices and facilities. By using industry-leading technology combined with high-touch relationship building, Coronis Health allows healthcare practitioners to focus on patient care, maintain financial independence, and cultivate financial success. Coronis Health is comprised of the best of the best in medical billing. Thoughts leaders and experts in every practice area utilize global resources, technology, and best practices to provide successful partnerships for customers.