Alternatives to CoverSelf
Compare CoverSelf alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to CoverSelf in 2026. Compare features, ratings, user reviews, pricing, and more from CoverSelf competitors and alternatives in order to make an informed decision for your business.
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1
Cloud Claims
APP Tech
Improve claim outcomes with streamlined First Notice of Loss (FNOL), claim processing and flexible reporting. INCIDENT BASED CLAIMS MANAGEMENT Effective claims management is about more than simply managing claims outcomes. It is about having an automated process that ensures efficiency and accuracy across the organization, getting timely notice of losses, and taking swift action are keys to success. The incident-based approach of Cloud Claims covers all accidents and losses, delivering a complete picture of loss to executives and claims managers. Cloud Claims by APP Tech is an integrated solution that is highly configurable, with actionable reports to guide decision-making and a friendly UI so you can get work done faster and more confidently. Cloud Claims runs in the cloud, so there’s minimal IT burden and no installation required — just simple configuration, effortless system upgrades, best-in-class security, and the ability to scale quickly.Starting Price: $2,500 per month -
2
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. -
3
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. -
4
ZOLL Billing
ZOLL Data Systems
Progressive revenue cycle management is, in many ways, the backbone of a thriving medical services operation. Controlling costs, increasing productivity, and accelerating reimbursements are essential activities that keep EMS agencies rolling. Yet efficiently progressing a claim through its lifecycle has traditionally been labor-intensive and prone to delays caused by documentation and coding inaccuracies. ZOLL® Billing is a cloud-based solution that enables revenue cycle professionals to turbo-charge billing performance and deliver more revenue. By automating workflows and eliminating billing errors, ZOLL Billing helps you process more claims with fewer resources and address compliance risk at the same time. Increase productivity and revenue with automated workflows that enable you to process more claims. -
5
Anomaly
Anomaly
Anomaly is an AI-powered payer management platform built for healthcare revenue teams to “know your payers as well as they know you.” It surfaces hidden payer behaviors by decoding complex rules and detecting payment patterns across hundreds of millions of healthcare encounters. The core engine, Smart Response, continuously analyzes payer logic, adapts to shifting policies, and embeds learnings directly into existing revenue cycle workflows to provide real-time denial prediction, assisted claims correction, and alerts to revenue risks. By integrating payer-specific insights into existing systems, users can anticipate revenue loss, negotiate payer contracts from a stronger position, and proactively correct or reverse denials before they impact cash flow. The system helps level the playing field between providers and payers by turning opaque billing logic into actionable intelligence and embedding it into day-to-day financial operations. -
6
Asky
Asky
Asky is a Generative Engine Optimization (GEO/AEO) platform — the central hub for tracking, understanding, and improving how your brand appears in AI-generated answers across ChatGPT, Perplexity, Google AI Overviews, Claude, Copilot, and more. Modern buyers ask AI search engines for recommendations before they ever click a search result. Asky shows what these systems say about your brand and competitors, checks every AI claim against your actual brand profile to catch inaccuracies at the source, and turns all of it into clear action: - Monitor brand mentions, ranking, citations, sentiment, and competitor presence - Deep brand alignment analysis to fix what AI gets wrong about you - Technical audits covering 100+ issue types ranked by impact - Content gap analysis and content engine to claim topics customers search for - 3rd party content and social engagement opportunities to build brand recognition - An AI Agent to plan and execute your GEO strategy in natural languageStarting Price: $119/month -
7
Foothold Care Management
Foothold Technology
Get an overview of your clients with a user-friendly interface that includes encounters, core service encounters, segments, claims, and billable statuses. Care Managers can easily track progress when addressing gaps in member care. Link these files directly to care plans for efficient tracking and reporting. Send claims and documentation data directly to the MAPP HHTS, with a best-in-class MAPP sync and ongoing customer support. Generate claims and CMA statements efficiently, with Health Home billing requirements handled automatically by the system. Void and resubmit claims if HML rate codes change. Use built-in HML logic to complete HMLs with the necessary number of core services, face-to-face encounters, and other requirements. Attend roundtables with other customers to discuss our product roadmap and emerging Health Home requirements. We regularly check in with our customers to address their individual needs. -
8
PLEXIS Payer Platforms
PLEXIS Healthcare Systems
PLEXIS’ suite of best-in-class apps has a proven record of giving payers the extended functionality necessary for modern core administrative ecosystems. From real-time benefit administration and adjudication to automatic EDI transmission and self-service customer portals, PLEXIS Business Apps have you covered. Passport provides essential connectivity from the core admin and claims management engines to PLEXIS business apps, your own apps, and existing in-house systems. With its flexible API layer, Passport delivers real-time integration with portals, automated workflow toolsets, and business apps. Connectivity is limitless. Streamline workflows with a centralized, modern core administration & claims management platform. Process claims in a timely and accurate manner, and automate the complexities of benefit administration to capture a quick ROI and deliver superior customer service. -
9
IMPOWER
Unicomp Corp. of America
IMPOWER is a healthcare-specific document management system that is modular in architecture. It starts where EMR document management ends and can grow to an enterprise-wide system. Its user interface employs a paper filing system metaphor for ease of use and therefore a shorter time to full productivity. IMPOWER is a lot more than a scanning system. Imagine having an exact copy of every patient statement ever sent, indexed by patient and available at any time for viewing, printing, and faxing without scanning them. Visualize the possibility of having every claim you ever sent, whether electronic or on paper, overlaid on top of a standard claim form, with no additional effort. Ditto for every electronic remittance you've ever received from every payer. EDI-to-paper-equivalent conversion of healthcare-specific documents is what sets IMPOWER apart from its competition, but we don't stop there. -
10
Arrow
Arrow
Arrow is a healthcare revenue cycle management platform that modernizes and streamlines healthcare payments by automating billing, claim operations, and predictive analytics to help providers and payers reduce administrative burden, minimize denials, and accelerate collections. It brings workflows, data, and AI together so teams can detect errors in claims before submission, manage denials with root-cause analysis and one-click fixes, and get detailed real-time claim status updates directly from payers. It simplifies the ingestion of Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) data into a centralized, user-friendly format, provides revenue intelligence with actionable insights into the revenue cycle, and monitors payment integrity to highlight underpayments or overpayments according to payer contracts. -
11
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. -
12
ImagineBilling
ImagineSoftware
The industry’s first intelligent, multi-specialty medical billing software. Streamlining billing and patient collections for over 75,000 physicians across the country. Globalized data eliminates the need for duplicate entry. Visit-driven to allow for large volume and complex information. Flexible data structure accommodates requirements across multiple practices and specialties. Helping you get paid faster. Post payment manually or through electronic remittance. Automatically scrub claims for errors and missing information. Automatically refile insurance claims based on selected criteria. Fast review to evaluate and approve charges. Audit charges by modality, procedure, insurance, user, doctor or date of service. Intuitive reports for tracking the financial health of your front-end and back-end billing. Never lose another charge again. Integrates with your preferred clearinghouse or statement vendor. -
13
Majesco ClaimVantage
Majesco
Digital technologies are having a significant impact on insurance, and those keeping pace with this evolution are on track to maintain a competitive advantage. Traditional claim management tools, involving multiple systems, paper files and manual processes, are being replaced with cloud-native enterprise claim management platforms. The Majesco ClaimVantage Claims Management Software for L&H platform streamlines the claims process through the full life cycle of a claim, from intake through payment calculation, integrating multiple systems to improve the flow of information across your business. Improve the customer experience and drive operational effectiveness with accurate and timely claim decisions. Built on the Salesforce Lightning Platform, Majesco ClaimVantage Claims Management Software for L&H enables insurance companies and TPAs to modernize and optimize their claims operations today and into the future. -
14
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. -
15
I-CAPS
W.O. Comstock & Associates
I-CAPS is an Intelligent Claims Administration System that addresses all functional areas of the health claims payment environment with a single common architecture that spans the needs of payers including membership, billing, enrollment, mailroom, claims, network management, contracting, pricing, utilization review and customer service. Our Intelligent Claims Administration System (I-CAPS) and our coding compliance software (Advanced Value Scale-AVS) , support knowledge-based decision-making to help our clients contain costs. Guaranteeing the integrity of Provider information has never been easier with (Advanced Network Administrator-ANA) while our (RB-UCR) is the industry's first Resource-Based, Usual Customary, and RESPONSIBLE fee schedule based on RBRVS and NCCI. Need a check-up for your plan or provider, use Cost Containment Audit and Recovery Services (CCARS) for a completely noninvasive audit retrospective look at claims effectiveness. -
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GEMMS ONE
GEMMS
GEMMS ONE is a fully integrated EHR allowing for a seamless workflow throughout the patient care cycle. Fully integrated within GEMMS ONE, clients have the ability to track patient appointments, create charges, process claims, post electronic payments, run PM reports, and manage collections. GEMMS Patient Portal gives patients 24/7 access to personal health information and enhances patient-provider communications resulting in improved outcomes. Creating flexible, efficient integration between GEMMS ONE and other systems. Tailored to meet specific interoperability needs with the ability to import and export data or text. In multiple ways. -
17
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 -
18
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. -
19
iRely i21
iRely
iRely i21 is a commodity trading and risk management (CTRM) software that helps businesses handle processes related to logistics, procurement, finance, claims processing, and more on a centralized platform. It enables staff members to automatically receive risk notifications, view market exposure reports, track risk positions, generate margin analysis, and conduct stress testing. iRely i21 allows team members to reserve inventory based on customer sample approvals and buying decisions and monitor contractual parameters based prices. It lets employees set up custom time periods to analyze realized and unrealized profitability and avoid month-end profitability inaccuracies. With the real-time accounting tool, users can generate invoices based on multiple parameters, such as delivery, contracts, and fixation. It also lets supervisors generate documents and automatically update parcel status with shipping instructions, release orders, shipping advice, and more. -
20
Experian Health
Experian Health
Patient access is the starting point for your entire revenue cycle process. Ensuring correct patient information on the front end reduces the errors that cause rework in the back office. 10 to 20 percent of a health system's revenue is forced to remediate denied medical claims and 30 to 50 percent of those occur during patient access. By adopting an automated, data-driven workflow—not only are you reducing the errors that lead to claim denials, you’re also improving access to care for your patients through capabilities like online scheduling options that are available 24/7. Access is further improved by reducing the friction around patient billing by leveraging real-time eligibility verification to deliver accurate patient estimates at registration. Increase staff efficiencies by improving registration accuracy. Correct discrepancies and errors in real time to avoid costly denials and rework. -
21
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. -
22
Experian Address Validation
Experian
More than 50 percent of businesses do not have strong confidence in their data. Increase the confidence you have in your address data today with our real-time address validation service. Our address validation software cleanses, corrects and standardizes address data before mailing. The software is designed to overcome wide variations in addresses by fixing misspellings and inaccuracies, filling in omitted data elements, and standardizing records. Our address validation service is both U.S. Postal Service® CASS Certified™ and Canada Post SERP certified. -
23
Docta
WinBuilt Software
Our state-of-the-art system delivers instant patient financial and clinical results for private small and medium healthcare practices allowing a fast, smooth and seamless integration accommodating technology to daily operations. Regardless of the size of your practice Docta makes working with computers a much simpler task with a simplified interface that allows browsing your patients and finding records much faster and easier. A very simple way to keep track of consults, vital signs, medical notes, prescriptions, patient current medications, diagnoses, procedures, documents and all the features that help your practice succeed. Get paid faster! Regardless if you choose to submit claims electronically or not, start organizing patient insurance policies (primary, secondary and tertiary) and keep track of the status of paper and electronic claims. Communicate with patients and potential patients with the right office tools that help you build marketing campaigns.Starting Price: $299 one-time payment -
24
PwC SMART
PwC
PwC SMART (Systematic Monitoring and Review Technology) increases the efficiency and effectiveness of your inpatient and outpatient coding quality evaluation process, and enables a mechanism for quality and compliance review. Coupled with the support provided by PwC Health Information Advisory, SMART bolsters your efforts to monitor coding and data quality. SMART Inpatient includes 1,000+ pre-defined business rules that identify potential coding inaccuracies and documentation improvement opportunities. You can also customize business rules for your specific areas of focus. Reporting and data analysis help you evaluate your staff’s performance and pinpoint education opportunities for Coding, Clinical Documentation Improvement (CDI), Quality and Providers. SMART Outpatient improves the accuracy of claims and identifies charge capture issues and areas for workflow improvements. It also improves regulatory compliance by decreasing the risks caused by inaccurate coding. -
25
SeeWare
SeeChange
Our state-of-the-art recognition platform, SeeWare®, offers a modular and scalable architecture designed to interpret and understand the real world. This enables a deep understanding of activity in physical locations, unlocking insights that improve and optimize operations for a truly unified retail estate. Using existing infrastructure, SeeChange’s innovative solutions tackle the most challenging problems facing retailers. Reduce friction at self-checkout for an improved shopping experience and reduced inventory inaccuracies, whilst enjoying increased sales and profitability. Spill detection offers retailers the opportunity to take control of these challenges. Our award-winning spill detection solution uses existing CCTV infrastructure to quickly detect liquid spills and debris, delivering real-time alerts to reduce risks and prevent accidents. -
26
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. -
27
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. Clive™ by Five Sigma is the industry's first AI-powered claims adjuster, transforming how claims are processed by insurers, MGAs, and TPAs. Leveraging advanced AI and automation, Clive streamlines the entire claims lifecycle, from FNOL (First Notice of Loss) through to settlement. The AI agent enhances claims handling efficiency, accuracy, and cost reduction by automating tasks. -
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Claims Signal
Athenium Analytics
Claims Signal™ is the next-generation open claims quality platform from Aon & Athenium Analytics that enables insurers to identify high-risk claims sooner. Enhance the policyholder experience while achieving a 4-6% improvement in claims indemnity and expenses. Today’s claims teams are under increasing pressure to improve the customer experience, operate more efficiently and mitigate leakage. Routine quality audits are effective at identifying root causes and deviations from best practices, but audit results may not be available for weeks or even months after claims are closed. What if you could monitor open claim files and address quality issues before they affect outcomes? The Claims Signal platform from Aon & Athenium Analytics uses artificial intelligence to analyze open claims, spot potential issues and push instant alerts so your front-line managers can intervene before a claim is closed. Reduce claims leakage by up to 4% with predictive analytics and proactive alerts. -
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EIS Suite
EIS
EIS provides a cloud-native, API-first, digital insurance SaaS platform that enables ambitious insurers to innovate like a tech company. Their platform supports all lines of business, including group benefits, property and casualty, protection, and life and annuities. EIS's open, event-driven, and real-time-responsive architecture offers agility and efficiency, allowing insurers to accelerate and scale innovation, launch products faster, deliver new revenue channels, and create customer-centric insurance experiences. The platform includes core systems such as PolicyCore for policy administration, BillingCore for billing management, ClaimCore for claims management, and CustomerCore for customer-centric management. These components can be used individually or as a unified suite, providing end-to-end support for the full insurance lifecycle, including policy administration, underwriting, claims, billing, and customer management. -
30
Cashforce
Cashforce
Slice and dice your data across user-defined dimensions and retrieve relevant insights on actual cash flows and your cash forecasts. Visualize and centralize key information on your own dashboard. Monitor your balances and flows in different currencies using your FX rate sets. Roll-up to consolidate local input and evaluate your cash flows at a global level. Drill-down to investigate and analyze areas of interest, up to transaction-level detail. Process millions of transactions to get a consolidated forecast, while drilling down to transaction-level detail, and accurately pinpoint the inaccuracy in your cash flow forecast. Understand improvement areas by comparing actuals versus forecast in our elaborate variance analysis environment. Make this variance analysis part of your forecasting process to find inaccuracies and apply improvements to the overall forecasting process. -
31
Sensei CRM
Sensei CRM
Sensei CRM puts you in control. With its state-of-the-art pricing engine, you can price complex metal buildings in minutes. We have several manufacturing partners, and we update their pricing regularly, so you won’t have to worry about price changes. The holistic customer experience should be personalized and unique. After all, effective inbound marketing is all about putting your customers front and center. The integrated workflow management system allows managers to review orders and quotes for pricing inaccuracies. With Sensei CRM, sales executives won’t waste time by manually filling out order forms. Simply select the manufacturer, and Sensei’s streamlined software automatically fills the manufacturers’ PDF and emails it to them. The integrated workflow management system allows managers to review orders and quotes for pricing inaccuracies. -
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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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Payapps
Payapps
Reduce administration of progress claims by up to 50%. Quickly and easily access and review standardized claims created within Payapps by your supply chain. Configurable approval workflows and automated alerts remind you to respond to and issue payment schedules, enabling compliance with security of payment legislation and helping you maintain your reputation as a good payer. Whether used as a stand-alone solution or integrated with leading construction ERPs or accounting software, Payapps provides standardization of your processes and documentation. You'll have full oversight of where received claims are at within the approval process. Integrating with your construction finance software automates the transfer of critical financial data to drive efficiency, eliminate duplicate data entry, and reduce the risk of errors. Payapps automatically brings forward and reconciles previously approved claims so you don't have to waste time working in spreadsheets or duplicating last months claims. -
34
Thrizer
Thrizer
Thrizer is a payment platform designed to simplify out-of-network therapy billing for both therapists and clients. For therapists, Thrizer functions similarly to platforms like Stripe or Square, allowing them to charge clients while automatically submitting out-of-network claims, eliminating the need for superbills and reducing administrative burdens. Clients benefit by paying only their co-insurance after meeting deductibles, with Thrizer covering the remaining fees upfront and awaiting insurance reimbursement on their behalf, thereby reducing upfront costs and expediting access to therapy. It also offers a free real-time benefits calculator, providing transparency on out-of-network benefits and estimated out-of-pocket costs before sessions. Additionally, Thrizer provides a superbill upload feature for clients whose therapists do not use the platform, enabling them to manage their claims efficiently.Starting Price: $2 per session -
35
Jet Budgets
insightsoftware
Significantly reduce the time and resources required to complete a budgeting exercise company-wide with an intuitive, Excel, and web-based interface that automates checks and balances and controls the budget workflow. Easily see actual-to-plan for accurate decision making through an Excel-based reporting platform that reduces redundant tasks and the risk of inaccuracy by eliminating error-prone copy, pasting, and exporting. -
36
Measmerize
Measmerize
Measmerize offers a seamless size recommendation solution for fashion retail brands. Shoppers can easily access the size advisor from any product page in the online store and receive accurate size recommendations covering apparel, footwear and kids. Sizing inaccuracies often lead to costly returns and frustrated customers. Measmerize leverages advanced AI technology to deliver a reliable and accurate size recommendation solution for fashion retail brands. By analyzing a wide range of data points, including body measurements and product specifications, Measmerize ensures that shoppers receive tailored recommendations, resulting in a more enjoyable and efficient shopping experience. Measmerize empowers shoppers to make informed decisions, reducing the risk of returns and enhancing overall customer satisfaction. This innovative approach not only streamlines the shopping process but also drives significant improvements in key metrics such as Conversion Rate and Average Order Value. -
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Vertikal Systems HMS
Vertikal Systems
Without a digitized system, an efficient hospital or clinic cannot function in this day and age. Store in one place patient records, scheduling, billing and financials, all optimized for fast searching and collaboration. Save monthly on your budget, by cutting the cost of hiring additional employees, office space and time used in your organization. Use the enhanced patient workflow and increased productivity, to ultimately increase the number of patients served per day. With your database on premise, no third party can peek and read your sensitive information, like business financial or patient records. Reduce invoicing and dispensing errors, by turning to the automated way of generating medical invoices and claims. -
38
RiskEnvision
Ebix
RiskEnvision is a modular, comprehensive suite of enterprise-level RMIS products that offers a 100% web-based total risk management and claims administration solution. RiskEnvision can be deployed to support risk management and claims administration functions including payment processing, reserve management, form letters and correspondence, policy management, diary, reporting, and more for Auto, GL, Product, Property, and Worker Compensation lines of insurance coverage in a user-friendly application, with minimal maintenance overhead. RiskEnvision is ready for an immediate deployment so you can get a quick start on realizing the benefits of using a 100% web-based application for risk management and claims administration. ACES has been developed in response to the growing need for innovative cost containment and claims management tools in the workers' compensation and property and casualty marketplaces. -
39
mDOC
Mack Software
Using our claim listing page you can quickly resolve errors and omissions prior to submitting your claims. After all information has been posted, diagnosis and modifier codes applied, you can submit a group of claims to Trizetto Provider Solutions® in one quick step to upload the claims. Trizetto Provider Solutions® will in turn perform additional claim scrubbing and then send your claims on to the payers. Post payments from insurance companies against claims indicating allowed amounts, adjustments and copay, coinsurance and deductible. Payments are entered in batches to ensure accuracy. Statements are prepared at your desired frequency - daily, weekly, monthly. These statements are presented in a simple, clear format that is easy for patients to read and understand. No more confusion!! A credit card authorization area is included on the statement for convenient payment of balances due. -
40
Venue Claims Management
KLJ Computer Solutions
Venue ™ Claims Management for Independent Adjusters provides end-to-end management of the entire claims processing workflow. Whether you are an adjustment firm, third-party administrator, insurance carrier, or a self-insured organization, Venue ™ is for you. The user-configurable interface allows for extensive self-customization of the claim system by an end client. Built-in web service interface that allows for real-time or batch data import, update and export to virtually any third-party data sharing source of ALL claim-related information. Integration with policy and billing systems allows real-time synchronization on all policy-related details, which may include critical policy dates and flags such as active fraud investigation and assumed policy. Comprehensive capabilities for every aspect of claims processing, including claim payments and recovery, reserves tracking, contact management, excess and trust accounts, forms templates, reporting etc.Starting Price: $5 per month -
41
Enterprise Health Solution
HM Health Solutions
HM Health Solutions provides an end-to-end solution to health plans. Get the support you need and business outcomes you want from one comprehensive health plan administration platform: the Enterprise Health Solution. Platform applications and tools manage functions from sales through enrollment and billing, including claims, provider and clinical management, and customer service. The Enterprise Health Solution (EHS) is the only proven end-to-end solution, and can move your member seamlessly from enrollment to claims payment. You’ve heard others claim to offer a fully integrated solution. What they don’t specify is that you may need to purchase all modules in sequence to achieve this integration. On the Enterprise Health Solution, health plan administration has always been the one and only focus. No other company rivals our expertise in the health plan payer space. -
42
BRMS
Benefit and Risk Management Services
BRMS processes and manages all Medical, Dental, Vision and Retiree claims efficiently and accurately with an impeccable turnaround time. With eligibility transferred from our MyHealthBenefits system nightly, eligibility is completely current. And, with PPO negotiation expertise, we specialize in reducing employer claims costs. From receipt to eligibility to negotiation and payment, we handle the entire claims administration process. Completely centralized, all claims, medical management, PPO network management, and billing is managed in-house, allowing us to provide you with flexible and quick service with a personal touch. For self-insured organizations, BRMS provides an excellent resource to process Medical, Dental and Vision claims efficiently and accurately. -
43
Snapsheet
Snapsheet
Snapsheet makes claims simple. We do this through a suite of innovative insurance software solutions which transform insurance companies' ability to seamlessly manage claims, reduce cycle time, increase appraisal accuracy, and deliver payments effortlessly. We started it all with virtual appraisals, and followed that up with our leading claims management system. Today we are driving an industry-wide movement in claims by delivering solutions that enhance customer experiences while our customers create innovative, data-driven claims organizations. -
44
Shift Payment Integrity
Shift Technology
Shift’s Payment Integrity is an AI-powered solution for health plans designed to improve accuracy and reduce costs in the claims payment process. It works both pre-payment (before claims are paid) and post-payment, helping plan administrators catch issues early and recover overpayments. Key features include claims editing (with updated, dynamic rules), generative AI-assisted medical record review, anomaly & fraud/waste/abuse detection, and external data enrichment for deeper context. The system supports evolving policy and guideline changes, allowing automated policy analysis and edit logic workbench features so health plans can test concepts before deployment. It provides explainable flags/alerts (so reviewers understand why claims are flagged), tools to accelerate document review, highlighting relevant parts of records, data mining for emerging trends, and a unified case management UI for investigative workflows. -
45
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. -
46
LGI RPA
Boston Software Systems
LGI RPA (formerly Boston WorkStation) helps hospitals and health systems bridge the gaps left by system vendors who don't deliver on interoperability claims, leaving providers and staff struggling to complete time-consuming manual workflows. It’s a flexible, client-to-client implementation, designed to work the way you do, aligning to existing workflows and business constraints. It’s time to take a look at the processes — and bottlenecks — in place and think about how to automate them. LGI RPA (formerly Boston WorkStation) is a digital ally that works 24/7/365, alongside human employees, completing tasks, ensuring accuracy, and eliminating the workflow issues faced by manual data entry. It’s not just an automation engine, it's a workflow improvement tool, that identifies errors before they occur. -
47
Athelas
Athelas
Athelas is an AI-driven RCM, EHR, and ambient AI platform built to grow modern healthcare organizations. It brings revenue cycle management, clinical documentation, EHR workflows, and healthcare AI agents into one practice platform designed to accelerate payments, reduce administrative work, and help providers focus on patients. Athelas RCM transforms claim management, denial defense, remittance reconciliation, and reimbursement tracking with AI-powered tools that identify the right approach for each claim, automate portal information retrieval, extract payer decisions from the web or phone calls, and surface insights into practice financial health. Ambient AI works as more than a scribe, adapting to each clinician’s documentation style, automatically syncing chart notes to the EMR, generating CPT and ICD-10 codes, supporting parallel scribing, answering questions, retrieving data, running tasks, and providing compliance nudges during encounters.Starting Price: Free -
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Trella Health Marketscape
Trella Health
There are patients who desperately need your home health services — yet many physicians who could be referring them aren’t. That’s likely because your sales and marketing teams aren’t seeing the 75% of Medicare claims associated with office visits. Demonstrate your ability to lower costs and improve patient outcomes. Home Health Agency A can quickly demonstrate how it outperforms Home Health Agency B on hospitalization and readmission rates. Marketscape for Home Health helps you redefine your sales and marketing strategy to ensure you’re focusing on high-potential physician and facility referral sources. Our breakthrough technology and support help you: Quickly evaluate how you compare to your peers by hospital and readmission rates, diagnostic category, acuity level, time to start of care, total cost of care, and many other quality metrics. -
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Sapiens P&C
Sapiens International
The Sapiens Platform for Property & Casualty is end-to-end, cloud-based, or on-premise set of software offerings with advanced digital capabilities. It can be implemented as a pre-integrated platform, or as standalone systems. The diverse solutions address all P&C carrier needs, across all lines of business and distribution channels, offering a wealth of digital features. Sapiens CoreSuite for Property & Casualty is comprised of the Sapiens PolicyPro for Property & Casualty, which manages the full policy administration lifecycle from initial quote, through rating and policy issuance; Sapiens BillingPro for Property & Casualty, which ensures that premiums are collected, claims payments are made, and agent commission payments and receipts are managed accurately; and Sapiens ClaimsPro for Property & Casualty, which controls claims management handling and the settlement process. It also includes a reinsurance solution. -
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Lentra
Lentra
A future where errors and inaccuracies are eliminated using cutting-edge AI, go-to-market is faster and simpler, and customer acquisition is accelerated with tailored lending products and elevated experiences; this future is here, and it’s called Lentra. Lentra is a new-age domain-native platform built from the ground up. It is designed and developed to tick all boxes on the wish list of any financial institution. Ready-to-use with rapid deployment and curated journeys. Microservices architecture with customizable customer journeys. No CapEx with pay-per-user/transaction SaaS model. Always-on, with dedicated data centers. In-built industry-grade secure infrastructure. API-driven for quick 3 rd party integrations. Horizontal scaling to keep pace with growth. From personal loans to credit cards, including giving the ability to transform merchants into cross-sell agents, Lentra has a solution that covers the entire spectrum of a financial institution’s lending needs.