Alternatives to Ebix FACTS
Compare Ebix FACTS alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to Ebix FACTS in 2026. Compare features, ratings, user reviews, pricing, and more from Ebix FACTS competitors and alternatives in order to make an informed decision for your business.
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1
Virtual Examiner
PCG Software
Virtual Examiner®, PCG Software’s flagship product, monitors the internal claims process of an organization to trend provider data for fraudulent and abusive billing patterns, and maximizes financial recoveries. PCG Software’s Virtual Examiner® allows healthcare organizations to enhance their current claims adjudication system with more than 31 million edits per claim. The software solution monitors an organization’s internal claims process to identify unclean claims and reduce payment for improper or erroneous coding to conserve premium dollars. Virtual Examiner® is more than a claims review solution with a focus on code combinations. It is a cost containment solution that evaluates the claim not only for abusive billing patterns but also identifies those claims that may involve third-party liability/coordination of benefits, case management opportunities, physician billing education and many other cost recovery reports. -
2
Guidewire ClaimCenter
Guidewire Software
Guidewire ClaimCenter is a leading claims management system designed to streamline the entire claims lifecycle for property and casualty (P&C) insurers. It offers comprehensive functionality from initial claim intake to resolution, enabling insurers to process claims efficiently and accurately. Key features include automated workflows, embedded analytics, integrated fraud detection, and real-time performance monitoring, all of which enhance operational efficiency and improve customer satisfaction. ClaimCenter supports various lines of insurance, including personal, commercial, and workers' compensation, and can be deployed as a standalone solution or as part of the Guidewire InsuranceSuite. By leveraging ClaimCenter, insurers can accelerate claims processing, make data-driven decisions, and adapt to evolving market demands. -
3
Duck Creek Claims
Duck Creek Technologies
Duck Creek Claims is a comprehensive claims management solution designed to streamline the entire claims lifecycle for insurers. From the initial report to final settlement, it automates workflows, simplifies data analysis through integrated analytics, and ensures seamless integration with existing systems. Key features include dynamic first notice of loss (FNOL) capabilities, automated assignment based on adjuster skills and workload, instant access to policy and coverage data, and efficient adjuster workflows. By enhancing operational efficiency and reducing manual workloads, Duck Creek Claims enables faster claims resolution, improved customer satisfaction, and compliance with the latest regulations. -
4
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. -
5
MediClaims
WLT Software
WLT’s MediClaims system offers a cost-effective, straightforward, and efficient approach to benefit and claims administration. WLT’s rules-based architecture and integrated EDI processes allow claims to be processed quickly, easily, and accurately. MediClaims’ administration and processing capabilities encompass a range of benefit and claim types, from Medical, Dental, Vision, and Prescription Drugs, to Consumer-Driven Healthcare, Disability, and Capitation processing. With WLT’s MediClaims system, you have the flexibility to configure your groups for a single line of coverage or for complex benefit packages with multiple lines of coverage. No plan can work efficiently without support from reliable information systems. WLT makes a point of always working with the most advanced technologies, providing you with the most sophisticated and flexible systems available today.Starting Price: $1 one-time payment -
6
SpyGlass
Beacon Technologies
SpyGlass, our enterprise-class health claims management software, offers a powerful, flexible solution for precise and timely claims processing. SpyGlass makes benefit and plan setup remarkably straightforward. BenefitDriven, fully-integrated with SpyGlass, delivers eligibility, contribution accounting, and pension management to the Taft-Hartley industry with the full range of data and processes for Participants and Employers. HIPAA Director, our all-in-one EDI gateway & scheduler, works as a hub by allowing you to directly connect with vendor partners to help avoid transaction costs, manage batch transfers, and automate transfers. SpyGlass provides a deep, landscape view of your population, with the ability to easily drill down to the higher resolution details. Hundreds of unique reports, fully customizable dashboards, and total control over your system are at your fingertips. -
7
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 -
8
Complete Claims
Complete Health Systems
Claims Adjudication for medical, dental, vision, prescription, short and long-term disability claims. Available for on-site license or as a hosted application (ASP). Microsoft technology: SQLServer database with a Windows front end. Acclaimed Customer service staffed by health care claims experts with a minimum of 12 years’ experience in the field. Support calls are logged with status available via the internet. Plan copy and modification feature enable quick setup of plans. Auto-adjudication using benefit codes built using business rules based on over 25 variables from both the claim and the claimant records made available to the adjudication engine. Inbound claims can be scanned images, EDI or paper. HIPAA EDI 5010 transaction sets. Re-pricing fee and UCR Schedules can be loaded on the system in advance of the effective date. The date-driven logic will re-price based on the date of service. -
9
Thoughtful AI
Thoughtful.ai
Thoughtful AI offers a comprehensive, AI-driven solution for healthcare revenue cycle management (RCM). With its human-capable AI agents, such as EVA for eligibility verification and CAM for claims management, the platform automates the most complex and time-consuming RCM processes. Designed to boost efficiency and accuracy, it reduces operating expenses, minimizes denials, and accelerates payment posting. Trusted by leading healthcare providers, Thoughtful AI provides seamless integration, guaranteed ROI, and the ability to reduce cost-to-collect, all backed by HIPAA-compliant security and performance-based guarantees. -
10
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. -
11
VCA Software
VCA Software
Dreaming of happy, efficient claim handlers; fast, accurate claims resolution; and 5-star policyholder ratings? Our agile, future-ready platform enables your people to perform like rockstars, and equips your company with scalable, intuitive processes to fuel profitable growth. By simplifying and automating the workflow, our clients reduce the cost of the claims journey by as much as 30%. VCA Software is one of the most scalable and integration-friendly platforms in the market. Our robust features, at a mid-range price point, make us a favorite among TPAs and adjusting firms. Yes, VCA is lightning fast, but the system is also whip-smart – equipped with a cutting-edge analytics suite so you can make fact-based decisions. You can count on VCA for industry-leading uptime, privacy, and data security. Our Tier 1 data centers are located in the USA, UK, Canada, and Australia. Our solutions can be easily customized to meet your team’s unique requirements.Starting Price: $65 per month -
12
Virtual Benefits Administrator (VBA)
Virtual Benefits Administrator
Virtual Benefits Administrator (VBA) is the industry's leading cloud-based benefits administration software solution. With a robust functionality and unlimited flexibility, VBA allows users to build and manage medical, vision, dental, disability, Medicaid, Medicare, Medicare Supplement, care management, long-term care health benefits, health savings accounts (HSAs), flexible spending accounts (FSAs), health reimbursement accounts (HRAs), and COBRA. -
13
HEALTHsuite
RAM Technologies
HEALTHsuite is a comprehensive benefit administration system and claims processing software solution designed for health plans administering Medicaid and / or Medicare Advantage benefits. HEALTHsuite is a rules-based auto adjudication software solution designed to automate all aspects of enrollment / eligibility, benefit administration, provider contracting / reimbursement, premium billing, medical management, care management, claims adjudication, customer service, reporting and more. RAM’s Medicare Advantage-in-a-Box offering is unique in the industry; the product of RAM’s extensive experience in Medicare Advantage and an unwavering commitment to changing our industry. HEALTHsuite Advantage™ and eHealthsuite™ are the cornerstones of our pre-configured Medicare Advantage-in-a-Box offering. HEALTHsuite Advantage is a fully integrated suite of modules providing our clients with an unmatched solution to administer their Medicare Advantage and Special Needs Plans (SNP’s). -
14
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. -
15
PLEXIS Payer Platforms
PLEXIS Healthcare Systems
PLEXIS’ suite of best-in-class apps has a proven record of giving payers the extended functionality necessary for modern core administrative ecosystems. From real-time benefit administration and adjudication to automatic EDI transmission and self-service customer portals, PLEXIS Business Apps have you covered. Passport provides essential connectivity from the core admin and claims management engines to PLEXIS business apps, your own apps, and existing in-house systems. With its flexible API layer, Passport delivers real-time integration with portals, automated workflow toolsets, and business apps. Connectivity is limitless. Streamline workflows with a centralized, modern core administration & claims management platform. Process claims in a timely and accurate manner, and automate the complexities of benefit administration to capture a quick ROI and deliver superior customer service. -
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Urbest
Urbest
Goodbye to slow and ambiguous job processes. Hello to structured and easy collaboration. Urbest's collaborative job tracking platform allows organisations to seamlessly capture, organise, track and take actions in workloads between issuers, managers and workers. Involve building users to know better what they need. By structuring this data, you can reveal what matters and think about new services to provide. Maintaining structured digital data on your buildings and analysing this in Urbest helps to provide facts and insights that enable you to increase value e.g. which contractors are the most effective, which recurring issues could be readily fixed? By using the tool, it shows your stakeholders e.g. prospective tenants that you are serious about increasing value. Minimise time consuming tasks to their lowest level. Gain efficiency by providing the right information to the right person at the right time. -
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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. -
18
HIPAAsuite
HIPAAsuite
Since 2001, HIPAAsuite has been providing the healthcare industry with a suite of HIPAA compliant EDI solutions to simplify the complexity of the EDI files. Our HIPAA EDI software products are strategically designed by industry experts to streamline medical processing workflows electronically, in a standardized and HIPAA compliant way. -
19
ALYCE Claims Management
Brightwork
ALYCE is specifically designed for self-insureds, municipalities and small TPAs handling Workers’ Compensation, Auto Liability, Auto Property, General Liability, and Property claims. ALYCE has an intuitive design with important data elements on the main claim page, including the claim’s financial summary, with all of the other important details available with a quick scroll or a single click. Multi-tiered infrastructure for employer reporting requirements, based on locations and departments. Recoveries, including salvage, subrogation, and excess carrier payments. Automated scheduled and repeating payments with diary alerts. Automatic diaries based on events, time lines, and financial transactions. Automatic generation of form letters to claimants, lawyers, and other claim parties. -
20
MedTunnel
MedTunnel
MedTunnel salutes our frontline healthcare heroes in the fight against COVID-19. We are proud to have our free HIPAA-compliant messaging support you in this fight! MedTunnel is a free service that provides secure HIPAA-compliant communication for healthcare. It allows providers and patients to communicate and exchange private health information using their computers and mobile devices. The main purpose of MedTunnel is to provide a free, secure, and HIPAA-compliant messaging service for transmitting private health information (PHI) through the Internet. The core architecture of our product was designed to meet HIPAA and security guidelines. MedTunnel provides a secure conduit through the Internet for PHI transmission. In fact, our security protocol is such that no one at MedTunnel, even at the CEO level can access PHI even if they wanted to. Message instantly and securely with your office staff, other providers, other practices, or your patients, using any device, anywhere, anytime.Starting Price: Free -
21
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: $59 per user per month -
22
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. -
23
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 -
24
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. -
25
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. -
26
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. -
27
InsurancePlus Software Series
United Systems and Software
USSI is proud to present its entire line of professional insurance software solutions designed and developed as an all-encompassing turnkey administration offering. USSI's comprehensive software solutions ensure that your insurance company is operating at the highest level in an ever changing and competitive marketplace. USSI's InsurancePlus Individual Life and Health Administration software solution manages books of business for traditional and non-traditional Life and Health insurance companies. Product lines supported include Whole and Term Life, Interest Sensitive, Final Expense, Annuities, Supplemental Health, etc. USSI's InsurancePlus Group Life and Health Administration software solution manages books of business for Group Health insurance companies, Self-Insured Funds, and TPA's. Supported plan offerings include Point of Service, Major Medical, Term Life, High Deductible, Traditional Indemnity, etc. -
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ppoONE Connect
ppoONE
This application automates the repricing of claims in a Web environment. WebCR verifies provider participation and patient coverage, validates dates of service, and identifies possible duplicate claims. It is supported by a data management team and system, WebDM, that works to ensure accuracy and currency of data. This application automates the repricing of claims in a client/server environment. WebCRX verifies provider participation and patient coverage, validates dates of service, and identifies possible duplicate claims.Starting Price: $1000.00/month -
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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. -
30
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 -
31
Shift Claims
Shift Technology
Shift Technology’s Claims solution uses Agentic AI to transform how insurers handle claims from start to finish. It combines automation with human collaboration to assess, triage, advise, and process claims across both simple and complex cases. Shift’s AI Agents are trained with insurance expertise and continuously learn through its “insurance common sense layer.” They handle tasks like policy coverage review, liability evaluation, fraud detection, and damage assessment. Seamlessly integrated with existing claims systems, the platform ensures no disruption while improving efficiency and accuracy. The result is faster resolution, lower costs, and better customer satisfaction for insurers and policyholders alike. -
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ClaimsControl
Claims Control
Our goal is to digitize the data exchange between all claims handling participants: insurers, brokers, their customers, loss adjusters, and all others. Use our platform to account and share your claims or connect your claims system to our API hub to get integrated with your partners. Connect your claims system to our API hub to start exchanging the data with your partners. Direct integration of all claims systems is impossible, therefore information is exchanged manually. This slows down the process, increases costs and complicates claims process automation. The purpose of ClaimsControl is to enable digital data exchange for all insurance claims handling process participants. If you develop any solutions related to claims management, let's talk and find the ways how we could help you to exchange the data with other systems or how we can provide your solution to our users.Starting Price: $400 per year -
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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. -
34
Majesco ClaimVantage
Majesco
Digital technologies are having a significant impact on insurance, and those keeping pace with this evolution are on track to maintain a competitive advantage. Traditional claim management tools, involving multiple systems, paper files and manual processes, are being replaced with cloud-native enterprise claim management platforms. The Majesco ClaimVantage Claims Management Software for L&H platform streamlines the claims process through the full life cycle of a claim, from intake through payment calculation, integrating multiple systems to improve the flow of information across your business. Improve the customer experience and drive operational effectiveness with accurate and timely claim decisions. Built on the Salesforce Lightning Platform, Majesco ClaimVantage Claims Management Software for L&H enables insurance companies and TPAs to modernize and optimize their claims operations today and into the future. -
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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. -
36
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. -
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TotalEclipse
Startech Software
Startech Software’s TotalEclipse™ product is a fully featured single-database Claims Management & Medical Bill Review Software application. Representing the culmination of over three years of development and testing, TotalEclipse™ is designed by real claims adjusters, bill reviewers, and administration managers who use this mission-critical software to do their jobs every day. Many companies develop their software with the user in mind. TotalEclipse is developed with our users involved. The result is an application designed around real-world workflow with a strong focus on making easily available the information most often needed on the job. Eclipse offers the specific processing power, functionality and reporting capabilities you need to maximize productivity while controlling costs. The single-database backend is scalable for use with either the Microsoft SQL Server™ or Oracle™ platform. -
38
ClaimBook
Attune Technologies
ClaimBook enables faster settlement of insurance claims, improved accountability and fewer rejections. It is well equipped with the features to address every part of the claims and evidence submission. ClaimBook supports international patient treatment with dedicated workflows, therefore enabling medical tourism. A built-in Rules Engine that disallows incomplete submissions, and knows what information and documents need to be submitted. This results in error-free submissions that are complete and guarantees that it is pre-authorized. ClaimBook's Smart Data Extraction can read documents uploaded to extract relevant data from the Hospital's Information System (if integrated with ClaimBook) to prevent the need for manual entries. ClaimBook also features Integrated Emailing by creating a virtual inbox in your dashboard. Withing the dashboard, emails can be composed, the design feature is similar to Microsoft Outlook. -
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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
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. -
41
Terra
Terra
Antiquated on-premise systems are a liability. Streamline your claims operations and improve efficiency with Terra's Automation, Integration, and Intelligence. Terra's products include Claims Management, Policy Management, Benchmark, and an Ancillary Services Marketplace. Manage risk with Automation, Cloud-Native, Integration, and Intelligence! Terra is a Cloud-Native Risk Management Information System for Property & Casualty Insurance. -
42
TrackAbility
Recordables
Liability claims management software solutions from Recordables. Software solutions to improve claims management including General Liability, Auto, Property, Incidents, and more. Recordables Liability insurance tracking software organizes incidents and claims that include auto, property, and general liability policies. Tracking all liability and risk incidents and claims, TrackAbility provides comprehensive liability claims tracking software solutions Benefits of TrackAbility liability claims management include start to finish injury liability claims management from incident through completion. Create customizable liability claim types with user-selectable criteria. Safety professionals and field users can collaborate on claims and reports, continuing to add pictures and videos for incidents or claims. Receive a holistic view of financial data necessary for claims management, such as payments and losses based upon individuals, locations, policy specifications, and other data. -
43
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. -
44
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. -
45
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. -
46
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. -
47
teamthink
Athenium Analytics
Optimize your claims and underwriting QA review processes. Quality assurance drives quality results. teamthink® is a powerful SaaS insurance audit suite for claims and underwriting reviews. It replaces spreadsheets, databases and legacy audit systems forever. The teamthink QA software helps quality assurance teams manage audit reviews with greater speed, volume and accuracy. Its comprehensive measurement, analysis and reporting tools deliver actionable information that benefits QA, business managers and company-wide performance. Measure performance and analyze results against your best practices, KPIs and compliance requirements. Develop reviewer questionnaires and audit forms that fully support your specific quality assurance goals. Visualize results using standard reports and dashboards to quickly understand key metrics. Increase productivity with questionnaires that display only pertinent information based on the facts of the file. -
48
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. -
49
COBRAGuard
COBRAGuard
They leave COBRA to expert COBRA administrators, so they can focus on building their bottom lines. If you’re short on time, manpower or expertise, count on COBRAGuard to simply, efficiently and cost-effectively manage your COBRA administration. When you use COBRATrak, our proprietary Web-based COBRA administration system, you'll have real-time information at your fingertips - 24/7. No more searching. No more wondering. No more system maintenance! Instead, you’ll enjoy the peace-of-mind and reduced stress of effortless COBRA administration. Those who try COBRATrak never go back - In fact, our customer retention rate is more than 98 percent!Starting Price: $29.95 per month -
50
CoreLogic Claims Connect
CoreLogic Australia
CoreLogic’s Claims Connect is a powerful solution designed for the insurance industry to streamline and manage claims processes efficiently. The platform allows insurance companies to quickly assess property damage, automate claims handling, and access real-time property data, helping to accelerate claims resolution. By integrating advanced property data analytics, Claims Connect helps insurers improve decision-making, reduce processing times, and enhance customer satisfaction. With features such as automated workflows, reporting tools, and access to accurate property information, this platform optimizes the claims lifecycle from start to finish.
