Alternatives to RCM Edge
Compare RCM Edge alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to RCM Edge in 2026. Compare features, ratings, user reviews, pricing, and more from RCM Edge competitors and alternatives in order to make an informed decision for your business.
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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. -
2
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. -
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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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PayerLenz
PayerLenz
PayerLenz is a reimbursement benchmarking and eligibility verification platform for behavioral health providers, billing companies and RCM firms. It answers a question standard verification cannot: not whether a patient is covered, but what the payer is likely to allow. The benchmarks are built from more than 500,000 adjudicated claims covering 260+ payer groups across 21 states, and every figure carries its sample size and recency so users can judge how much weight it holds. The platform also provides real-time eligibility checks and full worked verifications, and gives billing teams a live view of accounts receivable. PayerLenz is the first product from Revenue Logic, a behavioral health billing firm. A benchmark is a distribution of what comparable claims have paid; it is not a prediction or guarantee for any individual claim.Starting Price: Free -
6
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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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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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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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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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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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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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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OptiPayRCM
OptiPayRCM
OptiPayRCM’s platform delivers seamless, “last-mile” revenue cycle management automation by integrating with EHRs, clearing houses, payer portals, and other systems via flexible adapters so your billing workflows can be processed end-to-end. Its unified core engine handles eligibility checks, claim submissions, payment postings, denial management, and full accounts receivable workflows using AI and robotic process automation to reduce manual effort and accelerate cash flow. Real-time dashboards and reports provide visibility into key metrics and enable predictive insights, while customizable automation supports exceptions and unique workflows. It reduces first-pass denials by up to 63%, speeds claim status checks up to 50 times faster than human processing, and reduces payment cycle time by up to 35%. It is compatible with more than 200 healthcare systems and supports direct integrations via EHRs, FHIR, EDI, and HL7. -
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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. -
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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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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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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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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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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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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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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. -
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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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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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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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25
Infinx
Infinx Healthcare
Leverage automation and intelligence to overcome patient access and revenue cycle challenges and increase reimbursements for patient care delivered. Despite the progress AI and automation is making in automating patient access and revenue cycle processes, there still remains a need for staff with RCM, clinical and compliance expertise to ensure patients seen were financially cleared and services rendered are accurately billed and reimbursed. We provide our clients with complete technology plus team coverage with deep knowledge of the complicated reimbursement landscape. Our technology and team learn from billions of transactions processed for leading healthcare providers and 1400 payers across the United States. Get quicker financial clearance for patients before care with our patient access plus a platform that provides complete coverage for obtaining eligibility verifications, benefit checks, patient pay estimates, and prior authorization approvals, all in one system. -
26
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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eClaimStatus
eClaimStatus
eClaimStatus provides simple, practical, efficient and cost effective real time Medical Insurance Eligibility Verification system and Claim Status solutions that power value added healthcare environments. At a time when healthcare insurance companies are reducing reimbursement rates, medical practitioners must monitor their revenue closely and eliminate all possible leakages and payment risks. Inaccurate insurance eligibility verification causes more than 75% of claim rejections and denials by payers. Furthermore, refiling rejected claims cost an organization $50,000 to $250,000 in annual net revenue for every 1% of claims rejected (HFMA.org). To overcome the revenue leakages, you need a no-fuss, affordable and effective Health Insurance Verification and Claim Status software. eClaimStatus was designed to solve these specific challenges. -
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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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PrognoCIS Practice Management
Bizmatics
Seamlessly integrating with, our cloud-based Practice Management solution allows for quick and easy billing management, which enables your practice to quickly identify and confirm patient insurance benefit eligibility level and copay. Work with many different clearinghouses. Efficiently manage your accounting books. Easily reconcile patient accounting and insurance billing. Quick and easy online patient payments and EOB/ERA processing. Our healthcare practice management system has a very robust tasking system. You can quickly find and assign claims to work on using a filter-based search function. You can filter and search outstanding claims by around 100 different parameters, including patient vs. insurance responsibility, primary/secondary/tertiary payer or payer grouping, provider, date of service, aging bucket, and denial reason. Filters can be saved and reused later.Starting Price: $250 per month -
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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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Veradigm Payerpath
Veradigm
Veradigm Payerpath is an end-to-end revenue cycle management suite of solutions built to assist organizations to improve revenue, streamlining communications with payers and patients, and boosting practice profitability for practices of all sizes and specialties. Eliminate missing information, incorrect coding, and data entry error to ensure clean claim submission. Ensure claims pre-submission are correctly coded, have no missing information, and are error-free. Compare performance against peers at the state, national, and specialty levels to optimize productivity and improve financial performance with advanced analytical reporting. Remind patients of their appointments and confirm their insurance coverage and benefits information. Automate the billing and collection of patient responsibility. Veradigm Payerpath’s integrated solutions are practice management (PM) agnostic, interfacing seamlessly with all major PM systems. -
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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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Stedi
Stedi
Stedi is the only programmable healthcare clearinghouse built on modern APIs, while supporting both real-time and batch EDI processes. It enables health techs and incumbents to exchange mission-critical transactions - from eligibility to claims and remits. With a security-first cloud infrastructure, built-in payer redundancy via 3,400+ route connections, and market-leading sub-10-minute support response times, Stedi provides reliability and responsiveness to avoid billing outages and reduce denials. -
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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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Dastify Solutions
Dastify Solutions
Dastify Solutions LLC is a Texas medical billing and revenue cycle management company founded in 2024. We handle coding, charge entry, claim submission, payment posting, denial management, A/R recovery, eligibility checks, prior authorization, and credentialing for U.S. practices, working inside each practice's own EHR, including athenahealth, Tebra (Kareo), eClinicalWorks, AdvancedMD, DrChrono, NextGen and Epic. Most practices are set up in 2 to 3 business days. Pricing starts at 3.99% of collections with no setup fee. Our U.S. team leads client relationships and compliance; our billing team works from our operations office in Lahore, Pakistan, on U.S.-hosted systems under a signed Business Associate Agreement.Starting Price: $3.99 -
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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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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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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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ESO Billing
ESO
Automate your workflow and integrations, and put an end to the repetitive manual work associated with revenue cycle management. ESO Billing frees your team to focus on what they do best. In today’s reimbursement world, efficiency counts. ESO Billing was built to save you time at every possible point in the billing process. Even its interface has been freshly redesigned for the ultimate in speed and ease of use. Customize your workflow based on your business process, task-based workflow moves each claim through its stages with minimal touches. It even alerts you automatically when payments aren’t on time, for the ultimate peace of mind. Our payer-specific proprietary audit process ensures that each claim contains all critical billing information prior to claim submission. The result? The lowest clearinghouse and payer rejection rate in the industry. Pair billing with ESO Health Data Exchange (HDE) and ESO Payer Insights to tap into hospital-generated billing information with one click. -
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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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Optum AI Marketplace
Optum
Optum AI Marketplace is a curated ecosystem of AI-powered solutions designed to transform healthcare by providing payers, providers, and partners with tools to deliver better outcomes efficiently. It offers a diverse range of products and services across categories such as patient & member engagement, eligibility & claims, care operations & management, payment & reimbursement, and analytics & insights. Notable offerings include the prior authorization inquiry API, which enables payers to check a patient's prior authorization status in real-time, and SmartPay Plus, an e-cashiering payment platform that simplifies patient payments and streamlines the collection process. Additionally, Optum Advisory Technology Services provides expert support for digital transformation initiatives, offering system selection, procurement, implementation, and AI tools. It also features partnerships with trusted resellers, such as ServiceNow, to offer cutting-edge healthcare solutions. -
42
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. -
43
Rhyme
Rhyme
Rhyme connects payers and providers intelligently inside the prior authorization workflow, reclaiming the time lost on back-and-forth efforts and returning it to the patient. Automating manual tasks is critical (that’s why we do it), but it isn’t enough. When the nuances of clinical decision-making require collaboration between payers and providers, Rhyme keeps your workflow clear, agile, and fluid. We created the largest integrated prior authorization network, to leave a disjointed system behind and replace it with intelligent collaboration. Deep relationships and connections to EHRs, payers, and benefits managers, all on one platform. No scrambling, no screen-scraping, no secondhand info. We meet providers and payers right where you are, in your existing systems and workflows. Connections are easy so we can adjust to you, not the other way around. Prior authorizations aren’t an add-on to our platform, they’re all we do. -
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Anomaly
Anomaly
Anomaly is an AI-powered payer management platform built for healthcare revenue teams to “know your payers as well as they know you.” It surfaces hidden payer behaviors by decoding complex rules and detecting payment patterns across hundreds of millions of healthcare encounters. The core engine, Smart Response, continuously analyzes payer logic, adapts to shifting policies, and embeds learnings directly into existing revenue cycle workflows to provide real-time denial prediction, assisted claims correction, and alerts to revenue risks. By integrating payer-specific insights into existing systems, users can anticipate revenue loss, negotiate payer contracts from a stronger position, and proactively correct or reverse denials before they impact cash flow. The system helps level the playing field between providers and payers by turning opaque billing logic into actionable intelligence and embedding it into day-to-day financial operations. -
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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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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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Inovalon Eligibility Verification
Inovalon
Eligibility Verification Standard streamlines patient access and billing workflows by enabling staff to assign and prioritize patients/residents, payers, and tasks during eligibility verification. This technology goes beyond basic eligibility needs, providing a dashboard to confirm, manage, and store every inquiry. Speed up eligibility verification processes with automated enrichment of incomplete or incorrectly formatted transactions from the payer. Perform multiple eligibility inquiries at once with batch file uploads that verify Medicaid, Medicare, and commercial coverage quickly and efficiently. Easily assign tasks to team members, apply follow-up flags, and create eligibility documentation for future reference. Manage patients between batches and resolve issues with just a few clicks. Save time and ensure coverage accuracy with one cloud-based, all-payer health insurance eligibility verification software that empowers staff to manage benefit inquiries however, works best for them. -
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MedClarity
Medusind
MedClarity is Medusind's turnkey RCM technology. MedClarity is a robust, web-based medical billing and practice-management software. The solution comes with a range of tools to enable medical practices of all sizes to take full control of their front-office and revenue operations. In addition to offering intuitive navigation and workflows, MedClarity boasts an advanced rules engine for clean claim submission, smart scheduler, comprehensive reporting and business analytics, real-time insurance eligibility verification, denial management and claim status lookup, and integration more than 30 EMR platforms. -
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Myndshft
Myndshft
Experience a seamless workflow by having real-time transactions driven within existing technology platforms. Providers and Payers reduce time and effort by up to 90% for benefits and utilization management. Eliminate the current benefits and utilization management black box – eliminating confusion for patients, providers and payers. Self-learning automation and fewer clicks mean more time for patients, providers and payers to focus on care. Myndshft eliminates the quagmire of point solutions by providing a unified, end-to-end platform for in the moment payer-provider-patient interactions. Myndshft dynamically updates automated workflow and rules engines based on the actual responses and results from provider-payer interactions. Our technology continuously adapts to the rules in use by payers. The more you use it, the smarter it gets. A library of continuously-updated thousands of rules for national, state and regional payers. -
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Axxess Home Health
Axxess
Increase your organization’s cash flow by processing claims from Medicare, Medicaid and all other commercial payers. Automated processing of all payer claims in real time from anywhere at anytime ensures your claims get processed and get paid faster. Automatically submit and track your claims from anywhere at any time with real-time claims status updates. You are assigned a dedicated account manager that is a certified health care claims manager. You even have their mobile phone number. Diversify your revenue sources and improve your cash flow with our automated, anytime, anywhere claims processing with complete visibility to all your electronic funds transfers (EFT) and payment projections. Process, track and fix claims in real-time to capture all your revenue while eliminating costly time-consuming processes. Automate Medicare eligibility verification and claims processing.
