Alternatives to InsightPro.ai
Compare InsightPro.ai alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to InsightPro.ai in 2026. Compare features, ratings, user reviews, pricing, and more from InsightPro.ai competitors and alternatives in order to make an informed decision for your business.
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Service Center
Office Ally
Service Center by Office Ally is a trusted Revenue Cycle Management and patient payments platform used by more than 80,000 healthcare providers and health services organizations, which process more than 950 million transactions annually. Service Center is a cost-effective solution enabling providers to control their revenue cycle. With a user-friendly interface, Service Center helps providers check and verify patients’ eligibility and benefits, submit, correct, and check the status of their claims online, and receive remittance advice. Accepting standard ANSI formats, data entry and pipe-delimited formats, Service Center helps streamline administrative tasks and create more efficient workflows for providers. -
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Tebra
Tebra
Independent practices need complete solutions to maximize patient and provider well-being. While each Tebra product is purpose-built to modernize and optimize every step of the patient-practice journey, the combined platform delivers a complete operating system that provides added value for providers and patients alike. Power your connected practice with everything you need to attract new patients and keep current ones through the power of digital presence. Empower patients through every communication touchpoint and deliver a uniquely frictionless experience and convenient access that builds trust and a healthier practice. A modern, certified EHR solution built for the needs of today’s provider, delivering everything your practice needs. This includes robust charting, streamlined documentation, a comprehensive view of patients and their history, eRx, eLabs, telehealth, and more, allowing providers control of how they deliver care. -
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H1
H1
At H1, our mission is nothing short of creating a healthier future worldwide by unlocking and democratizing global access to critical expertise, HCP information, claims data, ground-breaking research and discoveries, and connected insights for all – doctors, researchers, industry and, ultimately, patients – bringing everyone closer together to advance medicine and clinical outcomes. Insights derived from H1’s solutions help life sciences and other healthcare organizations accelerate the development, launch, and dissemination of life-saving treatments, drive meaningful engagements with key opinion leaders, and help ensure equitable access to healthcare services. -
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TriZetto
TriZetto
Accelerate payment while decreasing administrative burdens. With 8,000+ payer connections and longstanding partnerships with 650+ practice management vendors, our claims management solutions can result in fewer pending claims and less manual intervention. Quickly and accurately transmit professional, institutional, dental, workers compensation claims and more for fast reimbursement. Meet the shift to healthcare consumerism head on by providing a straightforward and seamless financial experience. Our patient engagement solutions empower you to have informed conversations about eligibility and financial responsibility while reducing hurdles that may impact patient outcomes. -
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Inovalon Provider Cloud
Inovalon
Optimize revenue cycle management, care quality management, and workforce management all in one single-sign-on, easy-to-use portal. More than 47,000 provider sites rely on our innovative tools to simplify complicated operations across the patient care journey. Improve the patient financial experience and simplify administrative and clinical complexities with the Inovalon Provider Cloud – all while saying goodbye to siloed workflows. Our SaaS solutions help you strengthen financial and clinical outcomes across the patient journey, from creating front- and back-end revenue cycle processes for better reimbursement to ensuring appropriate staffing levels for optimal care. This is all managed in one comprehensive portal to take your organization to new heights improving revenue, staff equity, and care quality. Enhance your organization’s efficiency, productivity, and overall effectiveness. Discover what the Provider Cloud can do. -
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HealthRules Payer
HealthEdge Software
HealthRules® Payer is a next-generation core administrative processing system that provides transformational capabilities to health plans of all types and sizes. For more than ten years, health plans implementing HealthRules Payer have been able to quickly address market opportunities and stay in front of their competition. HealthRules Payer is unlike any other core administrative solution because of its use of the patented HealthRules Language™, an English-like vernacular that delivers a revolutionary new approach to configuration, claims processing and transparency of information. HealthRules Payer helps transform health plans looking to grow, innovate and compete beyond any other core system today. -
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Availity
Availity
Collaborating for patient care requires constant connectivity and up-to-date information. Simplifying how you exchange that information with your payers is more important than ever. Availity makes it easy to work with payers, from the first check of a patient’s eligibility through final resolution of your reimbursement. You want fast, easy access to health plan information. With Availity Essentials, a free, health-plan-sponsored solution, providers can enjoy real-time information exchange with many of the payers they work with every day. Availity also offers providers a premium, all-payer solution called Availity Essentials Pro. Essentials Pro can help enhance revenue cycle performance, reduce claim denials, and capture patient payments. Availity remains your trusted source of payer information, so you can focus on patient care. Our electronic data interchange (EDI) clearinghouse and API products allow providers to integrate HIPAA transactions and other features into their PMS. -
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EbixEnterprise
Ebix
EbixEnterprise is a comprehensive insurance management solution that streamlines policy management throughout its lifecycle. EbixEnterprise contains six components, Customer Relationship Management (CRM), health insurance exchange, policy administration, claims administration, data analysis, and consumer web portal. Each of the components is seamlessly integrated with one another, which allows data to flow between each other as dictated by the business need. SmartOffice CRM provides organizations with the ability to maintain agent/broker information, commission rates, manage sales pipeline, state license information. EbixEnterprise's Online Quoting Portal, HealthConnect, is the leading health insurance exchange for buyers and sellers of health insurance and employee benefits. EbixEnterprise Administration is a fully functional policy administration system that provides all of the tools that are necessary to manage policies, define plans, maintain plan rate information, etc. -
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Inovalon Insurance Discovery
Inovalon
Insurance Discovery reduces uncompensated care and underpayments by identifying active billable coverage previously unknown to the provider. Using sophisticated search capabilities, this solution identifies if patients have multiple active payers to help boost reimbursement opportunities. Prevent reimbursement delays and increase the speed of revenue capture by sending claims to the right payers on the first submission, enabled by more accurate coverage information. Run Insurance Discovery with verified patient demographic data to get accurate coverage and eligibility information. Replace manual insurance discovery methods with one quick, comprehensive search that inquires numerous databases in seconds to deliver detailed, accurate coverage information. Improve the patient/resident experience and estimate accurate out-of-pocket costs to improve their financial experience. -
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FINEOS
FINEOS
The FINEOS Platform provides clients the only complete end-to-end SaaS core product suite that includes FINEOS AdminSuite enabling quote to claim administration as well as add-on products, FINEOS Engage to support digital engagement and FINEOS Insight for analytics and reporting. The foundation of your digital insurance strategy. The FINEOS Platform seamlessly blends FINEOS AdminSuite + FINEOS Engage + FINEOS Insight + Platform Capabilities to create the most modern single core insurance platform for Life, Accident and Health. Legacy core systems utilized a ‘one size fits all’ business technology approach that no longer fits the needs of an agile business. Today, consumers, employers and brokers have access to powerful SaaS computing platforms and software tools that set a much higher bar for an insurer’s digital strategy. Monolithic insurance software models of the past focused solely on details of the insurance contract. -
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HealthEC
HealthEC
HealthEC’s best population health management platform, comprising our care management module CareConnect™ and our analytics module 3D Analytics™ - is designed to elevate quality of care and patient experience by overcoming the healthcare industry's toughest data challenges. Conquer system chaos with a universal data warehouse of normalized claims, clinical, and SDoH data, from any source. CMS certified for reuse. Eliminate workflow disruption with integrated, customizable care plans, decision-support tools and robust care management support. Deliver patient-centric care by seamlessly coordinating with community resources and addressing social determinants of health. Inform strategies with actionable insights at the diagnosis, provider, practice, and organizational levels, presented in clear dashboards or at the point of care. Enhanced MCO performance reviews and CMS interoperability rule compliance. -
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ENTER
ENTER Health
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 -
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CareCloud
CareCloud
Grow your practice with the number one cloud-based EHR and practice management software, CareCloud. CareCloud offers a complete suite of tools for healthcare professionals and providers of all sizes and practices. These include Concierge, a comprehensive revenue cycle management solution; Central, a user-friendly practice management tool; Charts, an easy-to-use electronic health records solution; Community, patient engagement and social tools; and Companion, a clinical and administrative mobile app. -
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Change Healthcare
Change Healthcare
Our platform builds consistency, continuity, and scalability across our integrated portfolio, enabling our customers to improve operational efficiency, decision-making, and patient outcomes—and enabling innovation as our healthcare system evolves. With innovative data and analytics, plus patient engagement and collaboration tools, the Change Healthcare platform helps providers and payers optimize workflows, access the right information at the right time, and support the safest and most clinically appropriate care. We enable access to data and facilitate the interoperability of data between sources to support CMS patient access and interoperability rules, as well as enable real-time access to clinical documents to help better manage risk adjustment, improve HEDIS scores, and support accurate payments with faster adjudication. -
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Madaket
Madaket Health
Get hours back in your day and millions back in your pocket with our automated solutions. Access the key players—providers, payers, and partners—and the real-time, accurate data you need to never miss a beat in care delivery. We handle all the complex connections across thousands of payers. All you need to know is fast and easy enrollments to any payer starts here. The cloud has never looked this good. Central command to manage, store, and share provider data in real-time—connected everywhere it needs to be. Provider verification made simple. You request it, our platform processes it fast. -
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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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symplr Provider
symplr
symplr Provider credentialing software helps create a single source of provider data, shrinks turnaround times, and shortens revenue cycles, all while prioritizing patient safety. symplr Provider credentialing software makes data gathering, secure access, reporting, and ongoing compliance less burdensome for providers, credentialing staff, and internal approval committees. Our customers report a 20% reduction in credentialing timelines, including a 50% reduction in committee review meetings. Collect, verify, store, and share provider lifecycle data and documents in one automated, user-friendly hub, resulting in time savings and cost containment. With a built-in payer enrollment module, you can enroll providers with payers and easily track applications step-by-step, to get reimbursed faster. Leverage automation to gather data from hundreds of primary sources and auto-check for expired/suspended licenses, NPDB, DEA, SAM, and more. -
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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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Silna Health
Silna Health
Silna Health’s Care Readiness Platform handles all prior authorizations, benefit checks, and insurance monitoring upfront to make sure patients are clear to receive care while providers gain capacity to focus on treatment. Its AI‑powered engine manages the entire prior authorization workflow, from tracking upcoming authorizations and sending weekly reminders to submissions and follow‑ups, automatically applying industry‑proven rules and escalating exceptions for human review. Specialty‑specific benefit checks verify coverage, accumulations, authorization requirements, and visit limits in real time, delivering accurate quotes at intake. Continuous insurance monitoring flags lost coverage, detects new plans, and safeguards against eligibility lapses. Designed for zero extra headcount, Silna ingests data directly from EMRs and practice management systems, offers configurable rule sets and strategic guidelines, and presents clear dashboards with incremental revenue insights. -
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XSOLIS CORTEX
XSOLIS
A new category of utilization management software, CORTEX provides a 360° approach to addressing the intricacies of utilization management and revenue cycle processes. Powered by real-time predictive analytics and machine learning engine, CORTEX ensures that the right cases are handled at the right time, by the right staff or by exception. CORTEX incorporates precision medicine upon a foundation of evidence-based medicine. Machine learning models operate in real-time to better assess your patient population. Our analytics have been deployed in hospitals and health plans across the nation. With clear inpatient cases, CORTEX does the heavy lifting by automating inpatient determinations on cases that meet your unique threshold. For difficult cases, CORTEX offers your staff the insight they need to make a strong determination. This approach offers incredible value to payers and providers alike. -
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Inovalon Claims Management Pro
Inovalon
Keep revenue flowing with a powerful tool that speeds up reimbursements with eligibility checks, claims status tracking, audits and appeals, and remittance management for government and commercial claims, all in a single system. Leverage an advanced rules engine that immediately scrubs claims against the most up-to-date CMS and commercial payer rules, allowing you to correct errors before claims go out the door. Verify eligibility across all payers during claim upload and see flagged errors so claims can be edited before submission. Decrease days in A/R with automated workflows for audit responses, appeal submissions, and ADR tracking. Customize staff workflow assignments based on the type of claim and action needed. Automate secondary claims submissions to stop timely filing write-offs. Increase claims revenue with automated workflows for faster, more successful audits and appeals. -
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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). -
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symplr Payer
symplr
Save on costs, eliminate data silos, and deliver better outcomes for your members with a unified, automated provider data solution. symplr Payer provides a single source of truth for provider data that is consistently reconciled and validated against primary sources. It improves data quality, access, and transparency. Further, it eliminates duplicate requests for information, reducing provider frustration. Using symplr Payer as the enterprise-wide hub for provider data, payers can feed timely, accurate information to other downstream systems. Our highly configurable, end-to-end provider data management solution manages all pre-contract and renewal contract negotiations. Standardize and streamline your contracting processes, while capturing contract details such as sentinel events, trigger dates, configuration efforts, process steps, fee schedule info, and more. symplr Payer’s unique design allows your organization to consolidate contracting and credentialing. -
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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. -
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Assurance Reimbursement Management
Change Healthcare
An analytics-driven claims and remittance management solution for healthcare providers who want to automate workflows, improve resource utilization, prevent denials, and accelerate cash flow. Increase your first pass claim acceptance rate. Our comprehensive edits package helps you stay current with changing payer rules and regulations. Heighten your staff’s productivity with intuitive, exception-based workflows and automated tasks. Your staff can access our flexible, cloud-based technology from any computer. Manage your secondary claims volume through automatic generation of secondary claims and explanation of benefits (EOB) from the primary remittance advice. Focus on claims that need your attention with predictive artificial intelligence into problem claims. Resolve errors faster, and avoid denials before submittal. Process claims more efficiently. Print and deliver primary paper claims, or add collated claims and EOBs for secondary claims. -
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CAQH
CAQH
CORE brings the industry together to accelerate automation and develop business processes that streamline healthcare for patients, providers and health plans. Drawing on the industry's most trusted source of provider and member data, CAQH enables healthcare organizations to reduce costs, improve payment integrity and transform business processes. In the ever-evolving landscape of healthcare, continuous improvements in payment and claims processing systems are vital. The nation’s providers and health plans trust CAQH to collect and manage professional information, verify primary sources, and monitor for sanctions. The result, is streamlined administration, greater regulatory compliance, and better provider data management. -
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LexisNexis MarketView
LexisNexis
LexisNexis® MarketView™ delivers medical claims-based intelligence to healthcare payers, providers, life sciences companies and health IT organizations across the United States. MarketView delivers actionable insights to remain competitive, allowing businesses to see valuable insights, and visualize ways to transform business. Whether you are a life sciences company, a health plan, a health system, or a health IT vendor, MarketView can help transform key business work streams including marketing, sales, strategic planning, physician relations and outreach, market research, network optimization, recruitment, pricing, contracting, clinical teams and more. Your business needs the most actionable insights to remain competitive. But it’s hard to diagnose the right areas of focus when the picture is unclear. MarketView delivers insights into areas including referral patterns, physician alignment strategies, the quality of clinically integrated networks, patient volumes, etc. -
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Valenz Health
Valenz Health
Our single end-to-end platform of fully integrated health plan solutions delivers value and simplifies the complexity of healthcare for employers, members, providers, and payers. Valenz integrates member-centric services with data-driven insights, connecting the dots with personalized service and guidance for high-quality care and improved outcomes. We engage early and often with results-driven education, support, and services to avoid more serious and costly health events. With Valenz, you can have a healthier member population while also achieving plan and member cost savings, year after year. For the tools and transparency you need to make cost-effective, quality-first decisions, let’s find your path to smarter, better, faster healthcare today. With a suite of fully configurable solutions integrated into one ecosystem strategy, the Valenz healthcare ecosystem optimization platform offers extensive visualization of cost, quality, and utilization opportunities. -
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Inovalon Payer Cloud
Inovalon
Improve clinical quality metrics, risk score accuracy, patient and provider engagement, patient outcomes, operational transparency, and economic performance, all with one comprehensive suite of software solutions. The Inovalon Payer Cloud transforms traditional workflows into data-driven processes that support your health plan’s key objectives. Backed by industry-leading analytics capabilities, our converged SaaS solutions deliver the member-centric insights and speed, accuracy, and flexibility you need to stay ahead in this diverse, ever-changing marketplace. Inovalon's SaaS suite of healthcare payer solutions delivers member-centric insights and actions to help health plans measure, manage, and improve healthcare outcomes, economics, and quality of care. Payer solutions to improve member care and outcomes while achieving greater operational performance and efficiency with sophisticated analytics and dynamic business intelligence. -
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Talix
Talix
The Talix platform powers intelligent workflow applications that enable risk-bearing healthcare organizations to succeed in the age of value-based care. Our workflow solutions for payers and providers require intelligent underlying technologies to work in unison and at scale. We’ve engineered the Talix Platform to support the needs of thousands of end-users, anywhere in the world simultaneously. Moreover, our platform architecture enables multiple SaaS application solutions in order to harness the efficiencies derived from being able to process millions of patient charts and encounter data. The Talix Platform is comprised of several technology components, intricately linked, to power software applications at scale for healthcare payers and providers. These components form the building blocks of artificial intelligence (AI). -
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InsureEdge
Damco Solutions
InsureEdge is an end-to-end Insurance Software designed to help insurance businesses gain maximum value through its comprehensive modules. The highly customizable and configurable solution boasts of the industry’s best insurance processing functionalities. Suitable for multiple lines of insurance businesses, InsureEdge can effectively and efficiently manage and streamline workflows to boost performance, profitability, and accuracy. It supports a variety of everyday operations through back office automation and other modules including customer relationship management, policy administration, claims processing, and more. As a flexible and scalable insurance software, InsureEdge is the key to future proofing your business. -
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Collective Health
Collective Health
Collective Health is the first integrated solution that allows self-funded employers to administer plans, control costs, and take care of their people, all in one place. Let us show you how we deliver better benefits with curated programs, connected administration, and smart member experience. From scientists to truck drivers to musicians, we’re proud to serve the happiest clients and members in the health insurance industry. See why leading self-funded employers across the nation choose Collective Health. Are you a broker or consultant working to drive your clients’ healthcare strategy forward? Collective Health simplifies employee healthcare with an integrated technology solution that makes health insurance work for everyone. With nearly a quarter of a million members and over 50 clients, including Driscoll’s, Pinterest, Red Bull, Restoration Hardware (RH), Zendesk, and more, Collective Health is reinventing the healthcare experience for forward-thinking organizations. -
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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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Medallion
Medallion
Medallion is the first solution for healthcare companies to fully offload their clinician operations—state license management, payor enrollment, credentialing, and more—in one modern management platform. By empowering digital health companies, hospitals, payers, and other organizations to credential, license, and monitor their providers with ease from one modern platform, they eliminate time-consuming and laborious tasks that ultimately increases accessibility of care to millions of patients nationwide. Since inception in 2020, Medallion has saved over 100,000 administrative hours for leading healthcare companies like Cerebral, Ginger, MedExpress, Oak Street Health, and hundreds more, and has raised $50M from leading investors like Sequoia Capital, Spark Capital, Optum Ventures, Elad Gil, and Peter Reinhardt. -
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Garner
Garner
Garner delivers a data-driven platform that enables individuals, employers, and health plans to identify top-performing medical providers by leveraging one of the largest claims databases in the U.S., over 60 billion records covering more than 320 million patients. It uses more than 500 specialty-specific quality and efficiency metrics to analyze provider performance and diagnose outcomes, and a verified directory powered by AI that achieves approximately 92% accuracy for provider phone, address, and appointment-availability information. Providers flagged as “Top Providers” meet rigorous criteria, including evidence-based treatment, minimized unnecessary procedures, and efficient cost structures. Members can use a mobile app and concierge service to locate in-network Top Providers with available appointments, and when eligible, have certain out-of-pocket costs reimbursed for services rendered by these providers.Starting Price: Free -
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SKYGEN’s Provider Data Management (PDM) is an on-demand solution that helps healthcare payers strengthen provider network management and provider relationships. PDM also strengthens payers’ ability to effectively build provider networks, improves provider and member satisfaction, and lowers administrative costs. It’s a smart solution that helps payers and providers meet the needs of today’s technology-savvy healthcare constituents. Lower contract acquisition costs via fast, efficient, paperless provider recruitment and supplemental network rental. Lower credentialing costs and improved provider satisfaction through online credentialing. Eliminating expensive outreach by automating provider self-verification and ensuring accurate and verified provider data for online directories. SKYGEN powers dental and vision connectivity solutions that inspire clients to move confidently into the future by employing technology that creates unparalleled efficiencies.
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Amazing Charts Practice Management
Amazing Charts
Amazing Charts Practice Management is a comprehensive solution designed to streamline administrative tasks and enhance the efficiency of independent medical practices. Developed by a practicing physician, this system automates processes such as capturing patient demographics, scheduling appointments, pre-registering patients with insurance eligibility checks, and generating analytical reports. It also determines patient financial responsibilities at the point of care, maintains insurance payer lists, and ensures prompt and accurate billing to assist in payment collection efforts. Key features include the ability to view unpaid claims to ensure timely resolution, a claims manager who reviews submissions to reduce denials, and an integrated secure connect clearinghouse for high-level support and quick responses to payer changes. The system offers intelligent, interactive role-based dashboards that automatically prioritize work lists across all office areas.Starting Price: $229 per month -
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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. -
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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. -
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Veritable
314e Corporation
Veritable accelerates patient insurance eligibility verification and claims-status checks by providing instantaneous results in a clean, intuitive interface. It supports real-time, batch uploading of patient lists to verify eligibility across more than 1,000 payers (including national Medicare and all state Medicaid) and multiple service types. It also enables tracking of claims status, from submission through reimbursement, so practices and billing companies can proactively identify issues to reduce payment delays and denials. Key benefits include automating eligibility and claims workflows to reduce manual entry and phone calls, improving front-desk patient experience by validating coverage and copayments at check-in, and offering seamless integration for both technical and non-technical users with strong data-security controls. It includes a “Code Explorer” for instant lookup of ICD-10-CM, ICD-10-PCS, HCPCS Level II, and CPT codes.Starting Price: $50 per month -
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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. -
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SOLIFE
Vermeg
SOLIFE is a comprehensive policy administration system developed by VERMEG, tailored for life and health insurance companies. It facilitates end-to-end management of new business processes, policies, and claims, encompassing features such as cash and events management, accounting integration, distribution and fees management, reinsurance, tax and legal compliance, dedicated reporting, and claims handling. Designed with over 20 years of industry expertise, SOLIFE offers a client-oriented approach, continuous updates to meet regulatory changes like MiFID and PRIIPs, and a robust platform supporting digital processing through APIs and responsive design. Its high level of automation significantly reduces administrative costs, while a flexible product-design workbench accelerates time-to-market delivery. The system also supports multi-distribution models, catering to diverse business needs. -
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Model N
Model N
Model N delivers an end-to-end platform empowering companies to maximize revenue as they transform Sales, Marketing, Channels, Finance, and Legal processes. Model N’s revenue management solutions help you maximize revenue by transforming siloed, tactical activities into strategic end-to-end revenue processes through automation and intelligence. Revenue Cloud bridges the gap between front-office and back-office activities providing a unified system of record for all revenue execution. Model N allows customers to easily configure and quote complex products, quickly come to terms on complicated contracts, have more accurate and timely channel data ensuring visibility into channels, and efficiently manage incentive programs avoiding overpayments. Model N Rebate Management helps you better engage your channels to improve and optimize revenue. -
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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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Alaffia
Alaffia Health
Alaffia’s AI-powered system uncovers fraud, waste, and abuse in the most intricate healthcare claims to prevent and recover overpayments for payers and employers. Alaffia detects and corrects errors in misbilled claims before an improper payment is made. Alaffia empowers you to recover and save on overpayments previously made on misbilled claims. Overpayments on error-filled claims could be costing you hundreds of dollars per employee each year. Work with Alaffia to eliminate overpayments and drive more savings to the bottom line. The Alaffia system detects and corrects inaccurately billed claims, preventing overpayments. We work directly with your health plan or TPA for seamless integration and no disruption to your members. Our services are entirely contingency-based, so you only pay when we deliver savings. We ensure that providers aren’t charging your employees for services not rendered. -
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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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Reimbursify
Reimbursify
Reimbursify is the first and only mobile-enabled, software platform delivering a truly innovative solution empowering patients, serving practitioners, and enabling digital partners to easily file out-of-network reimbursement claims for medical and mental health services. Reimbursify is the fast, easy way to file out-of-network (OON) reimbursement claims from your health insurance company! Our intelligent app takes the pain and trouble out of claim filing to make sure you get all the money coming to you. Fast, streamlined registration for primary insured, spouse & dependents. Smart dashboard manages all your claims and keeps track of money you’re on track to collect. Proprietary Rejection Resolution Pathway to help resolve rejected claims fast. Provider search function that auto-populates provider information.Starting Price: Free -
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Oracle's Digital Insurance Platform empowers insurance providers to deliver innovative solutions and exceptional digital customer experiences. This comprehensive insurance management system streamlines operations from sales channels to back-office processes, enabling rapid deployment of new offerings and seamless implementation of necessary changes. With real-time analytics, insurers gain valuable insights into their business, facilitating informed decision-making. The platform supports both individual and group life and annuity insurance, consolidating underwriting, policy processing, billing, and claims into a single, efficient system. Health insurers benefit from simplified enrollments, premium billing, and claims adjudication, enhancing member satisfaction through transparent and personalized services. Additionally, the platform accelerates the bancassurance lifecycle by providing real-time connectivity between banks and insurers, ensuring speed, consistency, and reliability.
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Health Catalyst
Health Catalyst
Health Catalyst is a leading provider of data and analytics technology and services to healthcare organizations, committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Climb out of the data void and pursue innovation. Only a healthcare-exclusive approach to data and analytics will empower you on your journey to massive, measurable improvements. Health Catalyst will help you elevate your organization to peak performance. Don’t rely on isolated analytic attempts to improve performance with no impact. Take revenue, cost, and quality to the next level with AI and data science at the core of your strategy and operations. Apply AI on the front end to help analysts and leaders achieve the measurable transformation that is spread, scaled, and sustained. Expand the use of self-service AI into your mainstream analytics. With one click, Healthcare.AI is up and running in your existing business intelligence tools and applications. -
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Take Command
Take Command
Powerful new HRAs simplify the process of providing health insurance and provide you with peace of mind. Say goodbye to complicated group plans. Get started by answering a few questions about how you'd like your HRA to work. Don't worry, our platform will guide you through the process and put you in control as you craft your plan. Once you are done designing your HRA, we'll get busy taking care of the legal requirements and getting your employees setup on our platform. Once your HRA is established and your employees are setup on our platform, we will begin helping you manage the claims process. Each day we work to bring about a healthcare system that gives you peace of mind because we believe people deserve a clearer path to health insurance.Starting Price: $15 per user per month
