Alternatives to OptiPayRCM
Compare OptiPayRCM alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to OptiPayRCM in 2026. Compare features, ratings, user reviews, pricing, and more from OptiPayRCM 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. -
2
XpertCoding
XpertDox
XpertCoding is an AI-powered medical coding software by XpertDox that uses advanced AI, natural language processing (NLP), and machine learning to code medical claims automatically within 24 hours. It automates the coding process, enabling faster and more accurate claims submissions to maximize financial gains for healthcare organizations. Features include minimal human supervision, easy EHR connectivity, flexible cost structure, a significant reduction in denials and coding costs, a HIPAA-compliant business intelligence platform, risk-free implementation with no initial fee and a free first month, and higher coding accuracy. XpertCoding's autonomous coding solution helps healthcare providers and organizations get paid faster, accelerating the revenue cycle and allowing them to focus on patient care. Opt for XpertCoding for a reliable and accurate medical coding software solution for your practice. -
3
Mercury Medical
CrisSoft
Awarded among the Top 10 MPM and RCM solutions, Mercury Medical is a robust medical billing solution. With over 400 customizable reports, built in Scheduler and Patient Portal, Mercury Medical is the perfect solution for major billing, suitable for multiple specialties and RCM processes Mercury Medical is a reliable, proven professional Accounts Receivable solution that will reduce processing times, shorten payment cycles and increase cash flow. Mercury Medical is fully configurable to any vertical or process including: Anesthesiology, University, Physical Therapy, and more. Mercury Products are HIPAA compliant with a guaranteed connection to any clearinghouse or insurance company. Mercury Medical’s automated job system will facilitate a daily system tune-up: housecleaning; folder maintenance; daily backups; 837 exports; 835 imports; HL7. All subscriptions come with the expert help of CrisSoft Support.Starting Price: $440.00 -
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NeuralRev
NeuralRev
NeuralRev is an AI-powered Revenue Cycle Management (RCM) platform that automates and accelerates end-to-end financial workflows in healthcare, reducing manual effort and errors while improving cash flow and operational efficiency. It automates insurance eligibility verification by connecting to clearinghouse networks in real time so patient intake and coverage checks happen instantly, and it handles prior authorization by assembling clinical and payer requirements, submitting requests electronically, and tracking approvals to reduce denials and delays. It also delivers real-time patient cost estimates by combining eligibility data with payer rules to improve transparency and upfront collections, and it streamlines medical coding, claim submission, claims processing, post-claim follow-up, and recovery, so teams spend less time chasing paperwork. -
5
RevCycle Engine
Aptarro
RevCycle Engine applies built‑in, customizable rules and AI‑powered automation to correct coding and charge errors at the source, ensuring billing data is accurate before claims are submitted. By integrating seamlessly with EMRs and practice management systems, it ingests claims data in real time, applies industry‑proven rules tailored to each organization’s needs, and fixes errors automatically, reducing preventable denials and costly rework. Streamlined workflows prioritize and route only complex or exception claims for human review, boosting team efficiency and reducing burnout. With AI‑driven charge accuracy, the platform increases clean claim rates, lowers cost‑to‑collect, and stabilizes cash flow, all visible through clear dashboards and real‑time insights. Scalable automation handles high claim volumes without overtime or late‑night efforts, while features such as charge accuracy validation, denial prevention, coding review optimization, payment collection support, and more. -
6
Altair
Altair Health
Insurance companies run AI to review, adjust, and deny claims. Most practices still work them by hand. Altair closes that gap: an AI-native, done-for-you medical billing service that runs your full revenue cycle, from eligibility and prior authorization to claims, denials, and appeals, backed by a US-based team of expert billers. It is a service that does the work, not software your staff operates. Altair scrubs claims against payer edits and medical-necessity policies, works denials to root cause, files appeals, and learns how each payer behaves. It also runs patient billing and collections for you: statements, payment reminders, payment plans, follow-up on unpaid balances, and aged patient A/R, so the patient share is collected in full. Coding and charge capture stay with your practice; Altair runs everything else. It works with every EHR, and a live view shows what is billed, paid, and at risk. Payers built their AI to pay you less. Altair gets you paid in full.Starting Price: 5% -
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BHRev
BHRev
BHRev is a specialized revenue cycle management service and automation platform built for behavioral health providers that helps practices streamline and optimize their entire financial workflow from claims submission to payment collection with AI-powered automation, expert oversight, and industry-specific expertise. It focuses on the unique challenges behavioral health organizations face, including complex payer rules, documentation requirements, high denial rates, and evolving compliance standards, by automating up to 80% of RCM tasks while human experts handle exceptions, compliance checks, and more nuanced billing functions to ensure faster reimbursement and fewer administrative errors. It combines advanced automation with human review to handle critical steps such as insurance eligibility verification, claims processing and scrubbing, denial management and follow-up, and patient payment posting so clinics can reduce operational burden and increase cash flow. -
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InvisaClaim
InvisaClaim, LLC
InvisaClaim AI Revenue Cycle Management that prevents denials and wins the ones that slip through. The most advanced all-in-one platform for billing companies and RCM teams. Before claims go out, Pre-Submission Check and Pre-Check AI scrub them against NCCI edits, coding conflicts, and payer rules stopping denials at the source. When one slips through, upload or live-feed a denial letter or 835 ERA and AI extracts patient data, CARC/RARC, CPT/ICD-10, amounts, and deadlines then drafts a payer-specific appeal in 60 seconds across 30+ payers. Modules: Pre-Submission Check, Denial Workbench, NSA/IDR (eligibility, QPA, GFE & IDR letters), Prior Auth, A/R aging, NPI verification, deadline alerts, full audit trail. Connects to your clearinghouse and EHR: Change Healthcare/Optum, Waystar, Availity, Athenahealth, plus a FHIR R4 layer for EPIC/Cerner. HIPAA Compliant · SOC 2 · 256 EncryptionStarting Price: $399 -
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iMedX
iMedX
iMedX, Inc. provides clinical documentation and revenue-cycle solutions designed to help healthcare providers focus on patient care rather than administrative burdens. The platform supports AI medical coding, standard medical coding, clinical documentation, abstraction of core measures, and revenue-cycle-management workflows. Their AI medical coding offering, part of the ‘RCM Companion Suite’, uses advanced machine-learning to improve accuracy, reduce denials, and accelerate payments by automating case-routing, pre‐populating codes, guiding coders in real time, and surfacing documentation gaps before claims leave the organization. Users gain features such as intelligent case routing to the right coder, autonomous resolution of routine cases, in-moment assistance through an AI assistant, and embedded audit tools that identify missed reimbursement, documentation errors, and compliance risks. -
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Arrow
Arrow
Arrow is a healthcare revenue cycle management platform that modernizes and streamlines healthcare payments by automating billing, claim operations, and predictive analytics to help providers and payers reduce administrative burden, minimize denials, and accelerate collections. It brings workflows, data, and AI together so teams can detect errors in claims before submission, manage denials with root-cause analysis and one-click fixes, and get detailed real-time claim status updates directly from payers. It simplifies the ingestion of Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) data into a centralized, user-friendly format, provides revenue intelligence with actionable insights into the revenue cycle, and monitors payment integrity to highlight underpayments or overpayments according to payer contracts. -
11
QuickIntell
QuickIntell
QuickIntell provides AI agents for healthcare revenue-cycle operations. Its software supports medical coding, eligibility checks, prior authorizations, payer calls, claim-status follow-up, denial prevention and management, appeals, payment-posting exceptions, accounts-receivable follow-up, and patient communication. The platform combines automated workflows with human approvals, audit trails, and writebacks to electronic health record and practice-management systems. It serves hospitals, provider groups, and revenue-cycle management organizations seeking to reduce repetitive administrative work. -
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Axora
Axora.AI
Axora AI is an intelligent, end-to-end claims engine that blends AI-powered automation with billing expertise - managing everything from eligibility to payment posting. But it’s more than automation. Axora AI prevents denials before they happen, adapts to payer rule changes, and prioritizes what matters - so you recover more revenue with less effort. 1. Manages your full claims cycle from start to finish 2. Flags denial risks before submission 3. Prioritizes actions that improve cash flow 4. Seamlessly fits into your EHR, payer, and finance systems 5. No migrations. No disruption. Just faster, cleaner paymentsStarting Price: $30/month -
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Precision Practice Management
Precision Practice Management
Whether you're looking to outsource all of your revenue cycle management functions or just some of them, Precision Practice Management has the experience and expertise to help you stay on top of the constantly changing landscape in this most important area. Precision can successfully address all areas of revenue cycle management, from compliance, credentialing, coding, claims processing, clearinghouse edits and electronic lockbox to claim denial management, reporting, financial analyses and more. Your in-house staff may be doing a tremendous job in managing some or most aspects of your medical billing, but your office staff has many other important clinical functions to perform. Sometimes billing matters receive lower priority and suffer as a result. Precision's medical billing experts are focused entirely on medical billing and nothing else; that's all they do. -
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MDaudit
MDaudit
MDaudit is a cloud-based platform that unifies billing compliance, coding audits, and revenue-integrity workflows for healthcare providers, hospitals, physician networks, ambulatory surgical centers, and the like. It supports all types of audits, scheduled, risk-based, retrospective, and denial-focused. MDaudit automates data ingestion from pre-bill charges, claims, and remittance data; triggers audit workflows; flags anomalies and high-risk patterns; and delivers real-time dashboards and drill-down analytics revealing root causes of billing errors, denials, and revenue leakage. Its modules, including a “Denials Predictor” for pre-submission claim validation and a “Revenue Optimizer” for continuous risk monitoring, help organizations prevent claim denials, reduce recoupments, and capture more legitimate revenue. MDaudit also provides payer-audit management: a secure, centralized workflow to respond to external audit requests and manage documentation exchange. -
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I-Med Claims
I-Med Claims
I-Med Claims provides top-tier medical billing and revenue cycle management (RCM) solutions, trusted by healthcare practices across the U.S. We handle all aspects of RCM, from eligibility verification to denial management, helping practices streamline operations and maximize reimbursements. With billing plans starting at just 2.95% of monthly collections, we offer affordable solutions that enhance financial workflows, maintain compliance, and improve cash flow. By outsourcing billing to us, practices can focus on patient care while benefiting from reduced claim denials and faster payments. -
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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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Experian Health
Experian Health
Patient access is the starting point for your entire revenue cycle process. Ensuring correct patient information on the front end reduces the errors that cause rework in the back office. 10 to 20 percent of a health system's revenue is forced to remediate denied medical claims and 30 to 50 percent of those occur during patient access. By adopting an automated, data-driven workflow—not only are you reducing the errors that lead to claim denials, you’re also improving access to care for your patients through capabilities like online scheduling options that are available 24/7. Access is further improved by reducing the friction around patient billing by leveraging real-time eligibility verification to deliver accurate patient estimates at registration. Increase staff efficiencies by improving registration accuracy. Correct discrepancies and errors in real time to avoid costly denials and rework. -
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Approved Admissions
Approved Admissions
Approved Admissions is a secure platform that automates tracking of coverage changes for Medicare, Medicaid, and commercial payers bundled with real-time eligibility verification and coverage discovery. The platform's primary goal is to help providers minimize the number of claim denials due to a missed insurance coverage change and accelerate the billing cycle. Approved Admissions is using the innovative RPA (Robotic Process Automation) Bridge solution to ensure patient data consistency across multiple systems, and benefit coverage search. Key Features: - Automated eligibility verifications and re-verifications - Email or API notifications if any coverage changes are detected - Real-time verifications - Batch eligibility verification - Seamless integration with RCM, EHR platforms (PointClickCare, MatrixCare, SigmaCare, DKS/Census, FacilitEase, and many others) - RPA-powered cross/platform synchronizationStarting Price: $100 per month -
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Droidal
Droidal LLC
Droidal is an AI-powered revenue cycle management platform that helps healthcare organizations reduce costs, increase revenue, and improve patient experiences. By leveraging Generative AI and large language models (LLMs), Droidal automates complex billing, claims, and payment workflows with precision and speed. The platform processes over 2 million claims monthly across 1,800+ locations while maintaining coverage for 3,500+ payers. Its AI agents streamline operations for hospitals, clinics, and care providers — cutting denials, accelerating payments, and boosting cash flow. Designed for seamless integration, Droidal enhances productivity without replacing existing systems or workflows. With enterprise-grade compliance and a subscription-based model, Droidal delivers measurable ROI while freeing up staff to focus on patient care. -
20
Billient AI
Billient
Billient is an AI-powered medical coding platform built for unmatched coding speed, accuracy, compliance, and revenue cycle performance. Designed as an AI medical coder that never misses, never slows, and never breaks, Billient helps healthcare organizations move from clinical documentation to validated coding recommendations with fewer bottlenecks, cleaner claims, faster reimbursement, and improved cash flow. It reads medical notes directly from EHR systems through compliant HL7/FHIR integration, CCDA parsing, automation workflows, or file uploads, then runs each encounter through a context-aware AI engine that detects diagnoses, procedures, documentation context, and medical decision-making complexity. Billient automatically recommends ICD-10, CPT, HCC, DRG, modifiers, and related codes, with confidence scoring and validation to prioritize high-risk encounters for manual review. -
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Amy by CombineHealth
CombineHealth
Amy by CombineHealth is an AI medical coding automation solution that helps mid-sized hospitals and multi-specialty physician groups automate complex coding workflows with confidence. Amy supports CPT, ICD-10, HCPCS, E/M, modifiers, and specialty-specific coding requirements. Amy analyzes clinical documentation, coding guidelines, payer logic, and specialty-specific rules to generate accurate, explainable coding recommendations. It helps identify missed services, documentation gaps, undercoding opportunities, and coding exceptions, with evidence for each suggested code. A key differentiator is Amy’s feedback loop: for every chart it codes, downstream claim outcomes such as denials, payer responses, and reimbursement results are used to improve future coding performance and reduce repeat errors. In production, Amy has delivered 98%+ coding accuracy, up to 85% coding automation, and a 75% reduction in coding-related denials. -
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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. -
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Adonis
Adonis
Adonis is an AI-powered platform designed to revolutionize revenue cycle management by providing monitoring, alerting, and dynamic issue resolution capabilities. It enhances task prioritization across RCM organizations through insights into denial trends, underpayments, and performance metrics. By leveraging AI-driven insights, Adonis aims to increase first-pass acceptance rates and minimize human errors, going beyond basic automation. The platform proactively prevents denials, automating routine tasks to allow teams to focus on patient care and experience. Adonis seamlessly integrates with existing electronic health records, practice management, billing systems, and patient portals in real time, eliminating data silos and ensuring a cohesive workflow. Its solutions are tailored for various healthcare organizations, including physician group practices, hospitals, healthcare systems, digital health providers, and practice management services. -
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CureAR
TechMatter
CureAR is an AI-powered medical billing and revenue cycle management software designed for in-house billers, billing companies managed-service providers and DME companies. The software consolidates eligibility verification, charge capture, AI-assisted coding suggestions, claim scrubbing, electronic claim submission, ERA ingestion, and automated payment posting into a single cloud-hosted system. It is configurable for specialty billing rules and supports multi-tenant operations for practices that handle multiple client accounts. Key Features: AI-assisted coding and claim scrubbing: Machine learning highlights likely coding errors and applies payer-specific validation rules before submission. Real-time claim status and alerts: Tracks claims from submission to adjudication and surfaces exceptions for prioritized follow-up. ERA ingestion and automated posting: Electronic remittance advice handling with configurable reconciliation workflows reduces manual posting effort.Starting Price: $129/month/user -
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AltuMED PracticeFit
AltuMED
Conducting thorough checks on the financial eligibility of the patients, running their insurance’s analysis and monitoring discrepancies, the eligibility checker covers all. If however any error does creeps in the data submitted, our scrubber working on deep AI&ML algorithms is capable of scrubbing errors be it coding errors, incomplete or wrong patient financial information. The software, at present, has 3.5 Million edits pre-loaded in its memory. To further streamline the process, automatic updates are issued by the clearing house to inform about the status of in-process claims. Covering the entire billing spectrum from verifying the patient financials to working on denied or lost claims and also has a through follow-up feature for appeals. Our intuitive systems warns if a claim could be denied, taking corrective actions to prevent it but also is capable of tracking and appealing for lost or denied claims. -
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Athelas
Athelas
Athelas is an AI-driven RCM, EHR, and ambient AI platform built to grow modern healthcare organizations. It brings revenue cycle management, clinical documentation, EHR workflows, and healthcare AI agents into one practice platform designed to accelerate payments, reduce administrative work, and help providers focus on patients. Athelas RCM transforms claim management, denial defense, remittance reconciliation, and reimbursement tracking with AI-powered tools that identify the right approach for each claim, automate portal information retrieval, extract payer decisions from the web or phone calls, and surface insights into practice financial health. Ambient AI works as more than a scribe, adapting to each clinician’s documentation style, automatically syncing chart notes to the EMR, generating CPT and ICD-10 codes, supporting parallel scribing, answering questions, retrieving data, running tasks, and providing compliance nudges during encounters.Starting Price: Free -
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Dastify Solutions
Dastify Solutions
Dastify Solutions is an Austin, Texas-based revenue cycle management (RCM) firm specializing in AI-driven medical billing, credentialing, and accounts receivable (AR) recovery, also offering services in California. Powered by a team of over 500 certified billing specialists, the company supports more than 50+ medical specialties and expertise on 50+ major Electronic Health Record (EHR) systems to optimize clean claim rates and reduce billing errors.Starting Price: $50 -
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Encipher Health
Encipher Health
Encipher Health is a comprehensive AI-powered healthcare technology platform that automates medical coding, risk adjustment, and revenue-cycle processes across specialties. Using Neuro-Symbolic AI, OCR, ML, and knowledge-graph logic, it converts unstructured clinical documentation into accurate, audit-ready codes (CPT, ICD-10, HCC, HCPCS) while enforcing payer, CMS and compliance rules. Its products — including GI coding automation, radiology coding (Conrad AI), anesthesia coding (Sedate AI), HCC/risk adjustment (Cogent AI / RiskGen‑Core / RAF Totalizer), E/M coding, home-health coding, ICD-10-AM support, AR follow-up and denial resolution — streamline workflows, reduce manual effort, minimize denial risk, and accelerate reimbursements. Real-time and retrospective workflows, seamless EHR integration, MEAT-criteria validation, modifier logic, and compliance guardrails ensure high accuracy, regulatory alignment and audit readiness. -
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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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VoiceCare AI
VoiceCare AI
VoiceCare AI is an agentic AI platform that automates the entire healthcare revenue cycle (RCM) from patient intake to claims across payer portals, voice, SMS, web chat, and legacy systems, with native EHR integration. One AI agent, Joy, orchestrates benefit verification, prior authorization, and claims & denials management by talking to patients and payers directly and navigating payer portals autonomously. The platform is built for specialist medical practices, dental groups and DSOs, RCM enterprises, and integrated delivery networks (IDNs) and health systems. Every agent action is logged, audit-ready, and transparent, with a human-in-the-loop safety net for complex clinical exceptions. VoiceCare AI is HIPAA-compliant and SOC 2 Type II attested.Starting Price: $30000 -
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Paradigm
Paradigm
Paradigm Senior Services offers a full-service, AI-powered revenue cycle management platform specifically tailored to home-care agencies that bill third-party payers such as the U.S. Department of Veterans Affairs (VA), Medicaid, and other managed-care payers. It automates and streamlines every step of the billing and claims process: from eligibility/authorization verification, state- or payer-specific enrollment and credentialing, to submission of clean claims, denial handling, and payment reconciliation. It integrates with common agency management software and electronic visit verification tools to scrub shifts, verify authorizations weekly, and reconcile payments, reducing denials and minimizing administrative burden. Paradigm also supports “back-office as a service” for providers; even if they already have internal billing staff or scheduling software, Paradigm can take over claims processing as a specialized, expert billing department. -
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Smarter Technologies
Smarter Technologies
Smarter Technologies is an AI-powered automation and insights platform focused on healthcare revenue cycle management that helps hospitals, health systems, and provider organizations optimize administrative and financial workflows to increase efficiency, reduce costs, and improve cash flow while letting clinical teams focus more on patient care. It combines proprietary clinical and agentic AI, human-in-the-loop virtual agents, advanced clinical ontology, and structured AI insights to automate up to 80% of revenue cycle tasks such as eligibility verification, documentation integrity, coding accuracy, claims processing, and denial management without replacing existing systems. Its solutions include modular RCM automation blended with skilled operational support, clinical AI tools like SmarterDx that understand tens of thousands of diagnoses and procedures to improve reimbursement and prevent errors, and SmarterNotes. -
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elsai RCM analytics intelligence transforms fragmented revenue cycle data into actionable operational intelligence. By connecting claim, payer, authorization, charge, and financial data, it helps teams prevent denials, identify revenue leakage, prioritize recovery, and make faster revenue decisions with explainability, governance, and human oversight built in.
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Centauri Health Solutions
Centauri Health Solutions
Centauri Health Solutions is a healthcare technology and services company driven by our desire to make the healthcare system work better for our clients and to provide compassionate support for individuals in need. Our analytics-powered software enables hospitals and health plans (Medicare, Medicaid, Exchange and Commercial) to manage their variable revenue through a custom-built workflow platform. While our tailored support of their patients and members provides them with access to life-enhancing benefits. Our solutions include Risk Adjustment (Medical Record Retrieval, Medical Record Coding, Analytics and RAPS/EDPS Submissions), HEDIS® and Stars Quality Program Management, Clinical Data Exchange, Eligibility and Enrollment, Out-of-State Medicaid Account Management, Revenue Cycle Analytics, Referral Management & Analytics, and Social Determinants of Health. -
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Kovo RCM
Kovo RCM
Kovo RCM is a revenue cycle management and medical billing service platform that helps healthcare providers streamline billing processes, optimize reimbursements, and reduce administrative burden so clinicians can focus more on patient care. It delivers end-to-end RCM services that include insurance eligibility verification, claims submission and tracking, denial management and appeals, coding support, credentialing, patient billing and collections, and custom reporting and analytics to provide clear financial insights and improve cash flow. Kovo RCM supports a wide range of medical specialties, including cardiology, anesthesiology, radiology, mental and behavioral health, internal medicine, surgery, EMS and ambulance services, wound care, and more, offering tailored billing expertise for the unique coding and reimbursement challenges each field faces. -
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Remittance360
GAFFEY Healthcare
All organizations across the healthcare revenue cycle sector can utilize Remittance360. If an entity receives standard 835, business office staff of all levels will find this tool useful in making actionable decisions regarding cash and accounts receivable workflow. Remittance360 is simple and easy to use, start-up time is minimal, and the uploading process of 835 data takes seconds. Utilizing the standard 835 data set, information upload is obtainable for all organizations, with minimal IT involvement. Remittance360 takes advantage of the data organizations have, but delivers relevant reporting of denials, trends, and individual payer activities. Gaining insights into this information can determine specific workflow needs. The ability to query data is simple in Remittance360, and common queries can be saved for easy user functionality. Querying denials by remark code and by department can assist in identifying and fixing root cause issues. -
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RevvPro
RevvPro
Medical billing for healthcare providers is complex, and the old billing methods are now obsolete, with increased demands around documentation, compliance, and reduced reimbursements. Powered by ai, machine learning, and robotic process automation, RevvPro has addressed the severe shortage of certified medical billing staff and provides the missing transparency into real-time data such as claim status, denials using automation. All from a smartphone or desktop. The future of RCM, with RevvPro, answer your issues for proper reimbursement. Facilities are currently using different systems for practice management and EMR/EHR. They can continue to do so if they are comfortable using their current software systems. RevvPro sits like a blanket on top of their existing systems and extracts the needed information to provide transparency to the providers. RevvPro can be accessed by different functions with your revenue cycle team to seamlessly manage their respective workflows and processes.Starting Price: $199 per month -
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ARIA RCM Services
CompuGroup Medical US
ARIA RCM Services is an end-to-end medical billing and revenue cycle management solution designed to enhance financial operations for practices, hospitals, and laboratories. The service offers flexibility by allowing clients to leverage their existing billing technology or utilize ARIA's systems, ensuring full transparency through a dedicated RCM team. Services are tailored to address specific needs, ranging from comprehensive revenue cycle management to focused areas such as aging accounts receivable and coding oversight. ARIA's team of regulatory and payment experts assists clients in navigating the latest CMS and payer requirements, aiming to minimize denials, reduce AR, and accelerate payment processes. The service emphasizes operational efficiency by combining industry best practices with proprietary workflow technology, delivering optimal results at a lower cost. -
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CombineHealth AI
CombineHealth AI
CombineHealth AI is the creator of Amy, Marc, Emily, and Diana — an advanced AI workforce designed to power end-to-end Revenue Cycle and Practice Management services for healthcare groups nationwide. These solutions are built on a proprietary foundational model that delivers 99.2% accuracy and ensures 100% compliance with coding and billing guidelines. The AI workforce helps reduce coding errors, enhance coder productivity, and address physician documentation challenges. Organizations using these solutions have seen a 35% increase in clean claim submissions and a significant reduction in denial rates. The AI employees work seamlessly alongside human teams, performing key functions such as medical coding, billing, data entry, A/R follow-up, and denial management — while providing detailed, auditable reasoning for every action taken.Starting Price: $1000/month -
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RCM Cloud
Medsphere Systems Corporation
The RCM Cloud® “software as a service” (SaaS) model strives to replace resource-intensive medical billing processes with digital solutions that reduce manual processes and optimize workflow thru automation. This approach significantly improves operational efficiency and further allows the business to expand service delivery capacity with only minor increases in administrative staff. Leverage your investment in technology to grow and sustain your business as opposed to increasing the headcount necessary to expand. On the administrative side, RCM Cloud® and associated services are delivered via the powerful, proven and secure medsphere cloud services platform. RCM Cloud® modules include patient/resource scheduling, enterprise registration, in-stream payer eligibility checking, contract management, medical records, billing, claims, payer and self-pay collections, POS payment posting and bad debt which enable all types of healthcare entities to truly transform their revenue cycles. -
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LigoLab LIS & RCM
LigoLab
As a comprehensive enterprise-grade solution, the LigoLab LIS & RCM Laboratory Operating Platform™ includes modules for AP, CP, MDx, RCM, and Direct-to-Consumer, all on one integrated platform that supports the entire lifecycle of all cases, enabling laboratories to differentiate themselves in the marketplace, scale their operations, and become more profitable. The RCM module is deeply integrated with the LIS and automates ICD and CPT coding. Billing processes start at order inception with verification, eligibility, and scrubbing components that increase clean claim submissions and revenue, and decrease claim denials and compliance risk. TestDirectly is a patient engagement portal that enables labs and collection facilities to scale collection, testing, and reporting workflows that produce fast and accurate results, minus the friction and the errors that come with paper forms and manual labor. -
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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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RapidClaims
RapidClaims
Reduce administrative costs and improve reimbursements, all while maintaining compliance. Supercharge your RCM process with RapidClaims AI-driven magic. Slash admin costs, boost reimbursements, and stay compliant effortlessly. Streamline your coding process, and automate or empower your coders with our personalized solutions. Code thousands of charts with speed and precision while catering to unique client requirements. Our Large language model can interpret unstructured data, creating a longitudinal patient record by converting notes into structured codes and disease patterns. Never make the same mistakes twice. Create mass-level coding-related rules with plain English and easily apply them to your charts at scale, segregated by specialty, code type, and coders. Gain a deeper understanding of code-level trends for different sites and take action to improve the revenue cycle. Our platform analyzes charts to identify claim denial patterns and helps you capture them. -
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DoctorMGT
Doctor Management Services
DoctorMGT is a healthcare revenue cycle and practice support company that helps medical providers improve billing performance, reduce denials, and accelerate payments. The company supports solo providers, specialty clinics, hospitals, and medical groups with services such as medical billing, coding, claims management, AR follow-up, and compliance-focused revenue support. DoctorMGT works with complex claims across areas such as pain management, orthopedics, surgery, chiropractic care, durable medical equipment, personal injury, and lien-based billing. Its services are designed to reduce administrative workload while helping providers keep cash flow steady and claims moving efficiently. DoctorMGT also offers virtual medical assistants, virtual medical scribes, appointment scheduling, credentialing, medlegal support, and lien negotiation services. -
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TELCOR RCM
Telcor
Whether you are an independent reference lab, a pathology practice, an outreach lab or a public health lab, TELCOR RCM billing software provides the tools to overcome tough billing challenges and improve profitability. Perform claim submission, claim monitoring, remittance processes, AR management, client and patient billing, and much more for multiple NPIs all in a single revenue cycle management solution. Minimize billing staffing needs and maximize revenue cycle productivity by using the right tools to automate daily billing functions such as claims submission, collecting patient information, as well as generating revenue cycle management financial reports. Eliminate labor-intensive manual adjudication processes by processing electronic payments received from your payers via 835 ERAs or from your bank via lockbox payment files. Send quick and easy-to-understand billing communication to patients, simplify your patient billing process, and make it easier for patients to pay. -
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Nextech
Nextech Systems
Revenue cycle management platform with payment processing, claims management, patient access, and denials management. Nextech’s specialty-focused technology solutions are personalized to meet the unique workflow requirements of specialty providers, helping practices increase efficiencies across their clinical, administrative, financial and marketing functions using a single platform. Offering all-in-one, ONC-certified electronic medical records (EMR/EHR), practice management, revenue management, and patient engagement software and services, Nextech is recognized as the top single solution provider for ophthalmology, plastic surgery and dermatology, serving a client base of more than 9,000 providers and 50,000 office staff members. Offering physicians intelligent healthcare technology, Nextech focuses on the success of its specialty practices through consultative guidance and implementation of solutions tailored to the speed and workflows of individual providers. -
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Aria RCM
eMDs
Every practice’s revenue cycle is the same. It starts when a patient sets an appointment and it ends when the practice receives payment. It sounds simple enough, but the reality is there are lots of opportunities along the way where simple mistakes can cost your practice money. At eMDs, we don’t simply process claims. That’s the easy part. Instead, we help our customers navigate the entire revenue lifecycle with our expertise understanding payer billing rules, audits, recoupments, appeals and denials, and much more. Why is this important? Your revenue cycle is like a production line. Each step has to be perfectly executed so the next one can be. One little hiccup and the production line (your revenue) comes to a screeching halt. By leveraging best practices developed over our 20+ years in business, our team of industry experts, and our proprietary technology, Aria RCM ensure your billing lifecycle is set up for maximum revenue collection. -
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Optimus Suite
EqualizeRCM Services
Innovative and industry-defining software solutions are at the heart of EqualizeRCM’s healthcare revenue cycle management strategy. Our RCM automation platform, Optimus Suite, seamlessly coexists with clients’ existing infrastructure (EMR, PM, Clearing House, Payer, and other systems). This platform, along with its set of intelligent applications, empowers facilities and practices to have efficient revenue cycle processes while reducing operational costs. Optimus can be tailored to integrate with your system and help bring your RCM performance to the next level. Denials and AR management system, enabling easy claim status, dashboard analytics, and root cause analysis of denials and AR. Platform to integrate 835 and 837 data into the denials and AR management process, enabling rapid claims analysis. A hosted, inexpensive, customizable contract payment calculator enabling calculation of expected payments per provider’s contracts and comparison to payments received. -
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Benchmark PM
Benchmark Solutions
Benchmark PM enhances patient engagement from initial intake through final encounter with features such as patient onboarding, easy appointment scheduling, customizable reminders, robust reporting, and user-friendly dashboards. For billing, Benchmark PM simplifies filing, processing, and follow-up with integrated claims management, an integrated clearinghouse, electronic billing, insurance verification, and a versatile payment portal. Benchmark Solutions operates as healthcare practices’ one-stop management solution, comprising of Benchmark EHR software, Benchmark PM software, and Benchmark RCM services. Benchmark Solutions' offerings come together to form a comprehensive electronic toolset that can streamline daily internal operations and increase revenue earned all while improving the overall patient experience. Each piece of the Benchmark Solutions suite is modular so it can easily integrate with other technologies already in place. -
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Rivet
Rivet Health
Patient cost estimates and upfront collection. Understand patient responsibility instantly with automatic eligibility and benefit verification checks. Hyper-accurate estimates based on your own practice data, creating better care and a healthier business. Send estimates via HIPAA-compliant text or email. It's time to treat 2020 like 2020. Collect more than ever with upfront mobile patient payments. Ditch the write offs and decrease patient AR. Run eligibility checks and provide accurate cost estimates, even for multiple payers, treatments, facilities or providers. Collect payment up front via HIPAA-compliant text or email. Reduce A/R days, collect more revenue and increase patient satisfaction all at once. Identify, analyze and resolve denials, as well as track ROI from reworked claims. Automate denial assignments to team members via Rivet, and leave notes and links along the way to resolve future denials even faster.
