Alternatives to RevCycle Engine
Compare RevCycle Engine alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to RevCycle Engine in 2026. Compare features, ratings, user reviews, pricing, and more from RevCycle Engine competitors and alternatives in order to make an informed decision for your business.
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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. -
2
Virtual Examiner
PCG Software
Virtual Examiner®, PCG Software’s flagship product, monitors the internal claims process of an organization to trend provider data for fraudulent and abusive billing patterns, and maximizes financial recoveries. PCG Software’s Virtual Examiner® allows healthcare organizations to enhance their current claims adjudication system with more than 31 million edits per claim. The software solution monitors an organization’s internal claims process to identify unclean claims and reduce payment for improper or erroneous coding to conserve premium dollars. Virtual Examiner® is more than a claims review solution with a focus on code combinations. It is a cost containment solution that evaluates the claim not only for abusive billing patterns but also identifies those claims that may involve third-party liability/coordination of benefits, case management opportunities, physician billing education and many other cost recovery reports. -
3
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. -
4
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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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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Artsyl ClaimAction
Artsyl Technologies
Processing high volumes of medical claims through intelligent automation helps businesses deliver higher levels of efficiency that does more than reduce costs. For organizations that rely on manual processes, managing medical claims documents and data is labor-intensive and error-prone, injecting unnecessary risk into the process. With ClaimAction medical claims processing software from Artsyl, your organization can improve margins, minimize touch points and eliminate processing bottlenecks. Capture medical claims data without the need for custom software coding. Route claims data and documents automatically to the right claim examiner, based on your business rules. Configure complex benefits and reimbursement rules to streamline processing and reduce payment delays. Respond quickly to changing government regulations and support data, document and process compliance. -
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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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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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ImagineBilling
ImagineSoftware
The industry’s first intelligent, multi-specialty medical billing software. Streamlining billing and patient collections for over 75,000 physicians across the country. Globalized data eliminates the need for duplicate entry. Visit-driven to allow for large volume and complex information. Flexible data structure accommodates requirements across multiple practices and specialties. Helping you get paid faster. Post payment manually or through electronic remittance. Automatically scrub claims for errors and missing information. Automatically refile insurance claims based on selected criteria. Fast review to evaluate and approve charges. Audit charges by modality, procedure, insurance, user, doctor or date of service. Intuitive reports for tracking the financial health of your front-end and back-end billing. Never lose another charge again. Integrates with your preferred clearinghouse or statement vendor. -
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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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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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Assurance Reimbursement Management
Change Healthcare
An analytics-driven claims and remittance management solution for healthcare providers who want to automate workflows, improve resource utilization, prevent denials, and accelerate cash flow. Increase your first pass claim acceptance rate. Our comprehensive edits package helps you stay current with changing payer rules and regulations. Heighten your staff’s productivity with intuitive, exception-based workflows and automated tasks. Your staff can access our flexible, cloud-based technology from any computer. Manage your secondary claims volume through automatic generation of secondary claims and explanation of benefits (EOB) from the primary remittance advice. Focus on claims that need your attention with predictive artificial intelligence into problem claims. Resolve errors faster, and avoid denials before submittal. Process claims more efficiently. Print and deliver primary paper claims, or add collated claims and EOBs for secondary claims. -
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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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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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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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ARIA Coding Services
CompuGroup Medical US
ARIA Coding Services is designed to assist healthcare providers in navigating the complexities of medical coding, ensuring accurate documentation and timely reimbursements. The service offers three customizable levels to meet varying practice needs. Experts conduct monthly reviews of coding denials and rejections, providing recommendations to improve standard operating procedures and offering optional baseline evaluations of Evaluation and Management (E&M) documentation. Specialists review documentation to confirm coding accuracy, examining superbills, invoices, claims, E&M visits, surgeries, procedures, tests, modifiers, and ICD-10 usage. They deliver regular reports and address discrepancies to enhance coding procedures. A comprehensive service where specialists handle coding directly from provided documentation, ensuring proper entry of charges, thorough documentation in patient notes, and correction of coding rejections or denials as needed. -
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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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E-COMB
KBTS Technologies
EDI Compatible Medical Billing (E-COMB) is a web based solution for generating medical claims complying with the HIPAA transaction and code set standards, regulated by the US Government following the recommendations of American National Standards Institute (ANSI). The application is designed to generate, submit and reconcile the claims to the insurance carriers, guarantors and/or patients. This is one of the most important tools for doctors in realizing their revenue by reducing the turnaround time in the claims reimbursement. All the information related to environment of the Doctor’s Office/Hospital is grouped together as Master Data. This information is frequently used for claims processing and is less likely to change quite often. Master Data contains details of the Procedures, Diagnoses, Doctors, Payers, and Billing Providers etc. This data is created as part of the initial set up and can be updated easily at any time. -
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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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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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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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Dastify Solutions
Dastify Solutions
Dastify Solutions is a U.S.-based, AI-powered medical billing company trusted by 1,000+ healthcare providers nationwide. They specialize in high-accuracy RCM, leveraging advanced AI and a team of 500+ AAPC/AHIMA-certified coders to reduce errors by up to 99%. They offer end-to-end services, including coding, AR recovery, credentialing, and denial management, customised for 75+ specialities on a flexible pay-for-paid model. Their platform integrates seamlessly with 600+ EHR / EMR systems.Starting Price: $50 -
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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 (pipeline), plus a FHIR R4 layer for EPIC/Cerner. HIPAA Compliant · SOC 2 · 256 EncryptionStarting Price: $349 -
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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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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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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. -
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Quadax
Quadax
How well you manage the challenges of your revenue cycle has a direct effect on your bottom line and the success of your entire organization. It doesn’t matter how many patients seek your care if it’s taking months to receive the expected payments for the services you provide. And, you shouldn’t have to spend hours each day tracking down the payments you’ve worked hard to earn. There’s a better way to maximize healthcare reimbursement. Let Quadax be your guide to creating a comprehensive, sustainable and orderly strategic plan, and select the right technology solutions and services that best fit your business model. With us as your partner, you can achieve operational efficiency, optimize financial performance and enhance the patient experience. The goal for every claim going out the door is to avoid a denial and get paid as quickly as possible. -
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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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Silna Health
Silna Health
Silna Health’s Care Readiness Platform handles all prior authorizations, benefit checks, and insurance monitoring upfront to make sure patients are clear to receive care while providers gain capacity to focus on treatment. Its AI‑powered engine manages the entire prior authorization workflow, from tracking upcoming authorizations and sending weekly reminders to submissions and follow‑ups, automatically applying industry‑proven rules and escalating exceptions for human review. Specialty‑specific benefit checks verify coverage, accumulations, authorization requirements, and visit limits in real time, delivering accurate quotes at intake. Continuous insurance monitoring flags lost coverage, detects new plans, and safeguards against eligibility lapses. Designed for zero extra headcount, Silna ingests data directly from EMRs and practice management systems, offers configurable rule sets and strategic guidelines, and presents clear dashboards with incremental revenue insights. -
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Billient
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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Alaffia
Alaffia Health
Alaffia’s AI-powered system uncovers fraud, waste, and abuse in the most intricate healthcare claims to prevent and recover overpayments for payers and employers. Alaffia detects and corrects errors in misbilled claims before an improper payment is made. Alaffia empowers you to recover and save on overpayments previously made on misbilled claims. Overpayments on error-filled claims could be costing you hundreds of dollars per employee each year. Work with Alaffia to eliminate overpayments and drive more savings to the bottom line. The Alaffia system detects and corrects inaccurately billed claims, preventing overpayments. We work directly with your health plan or TPA for seamless integration and no disruption to your members. Our services are entirely contingency-based, so you only pay when we deliver savings. We ensure that providers aren’t charging your employees for services not rendered. -
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ImagineMedMC
Imagine Software
Manage your members' healthcare and networks with a cloud-based healthcare delivery system. Automate claims processing for managed care organizations. Includes eligibility, referral and authorization processing, provider contracting, benefit administration, auto claims adjudication, capitation (PCP and Specialty), EOB/EFT check processing, and EDI transfers and reporting. Deploy as a cloud solution or an in-house system. Ideal for managed care organizations (MCOs), independent physician organizations (IPAs), third-party administrators (TPAs), preferred provider organizations (PPOs), and self-insured groups. Streamline the complexities of administrating eligibility, referral authorization and claims processing. Features and functions maximize data integrity while reducing data entry. -
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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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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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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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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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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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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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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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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. -
42
iVEcoder
PCG Software
iVECoder, the decisive code tool with payor intellect, was built on the same intelligence of PCG's Virtual Examiner® claims review engine that healthcare payors worldwide have been using for 25 years. Users can enter multiple codes, and in just a single click, receive multiple answers on a single page. Ramp up coding accuracy and boost your bottom line by using the same billing and coding intelligence platform the payors use. iVECoder is PCG's Virtual Examiner® (VE) claims review engine. This advanced rules based engine —with 45 million edits— is used by healthcare payors throughout the USA and abroad. VE tells payors what to deny or pend for review. -
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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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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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ZOLL Billing
ZOLL Data Systems
Progressive revenue cycle management is, in many ways, the backbone of a thriving medical services operation. Controlling costs, increasing productivity, and accelerating reimbursements are essential activities that keep EMS agencies rolling. Yet efficiently progressing a claim through its lifecycle has traditionally been labor-intensive and prone to delays caused by documentation and coding inaccuracies. ZOLL® Billing is a cloud-based solution that enables revenue cycle professionals to turbo-charge billing performance and deliver more revenue. By automating workflows and eliminating billing errors, ZOLL Billing helps you process more claims with fewer resources and address compliance risk at the same time. Increase productivity and revenue with automated workflows that enable you to process more claims. -
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HCC Coding Engine
Aptarro
Aptarro’s HCC Coding Engine is an AI‑powered solution that integrates seamlessly with electronic medical records and practice management systems to scan every patient encounter in real time, automatically identifying and closing coding gaps to ensure all Hierarchical Condition Category (HCC) diagnoses are accurately captured for optimal risk adjustment and revenue. By applying industry‑proven rules and machine learning models, it prioritizes high‑value encounters for coder review, boosts productivity up to 300% per coder without adding provider workload, and reduces denials through real‑time validation and compliance updates. With exception‑based workflows, clear dashboards for RAF score trends, built‑in audit trails and logging, and fast implementation within existing workflows, organizations see immediate ROI in their first billing cycle and unlock millions in missed revenue while maintaining clinical focus and documentation integrity. -
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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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ediLive!
Texas Medical Systems
ediLive! claims processing software works with any NSF, ANSI, or print file claim image, allowing the HIPAA complaint transmittal of any practice management software's claim file. Additionally, ediLive! customers benefit from real-time connectivity and claim collections workflow management. ediLive! attaches all claim status messaging from payers directly back to the claim for easy follow-up and correction, taking all incomplete claims and compiling them into a single on-screen worksheet for fast corrections and resubmittal. If you use ediLive!, we have a wonderful product call claims scrubber that can help you to get your claims paid – not only faster, but better! Call our office to schedule a free on-line demonstration. We can scrub the first 100 claims for you as a free trial. Every coding error you make costs your practice money. -
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AGS Computer-Assisted Coding
AGS Health
AGS Health's Computer-Assisted Coding (CAC) software helps hospitals and physicians simplify the ICD-10, CPT, HCPCS, and E/M coding process; increases your coder productivity while cutting denials, missed charges, and low-risk scores. Computer-Assisted Coding also known as medical coding software helps to boost productivity and make critical decisions faster while reducing denials, missed charges, and low-risk scores. The AGS Computer-Assisted Coding (CAC) module enables flexible and scalable coding of professional and facility operations to increase accuracy, productivity, and flexibility. Features:- - NLP-Based ICD-10-CM, PCS, CPT, and E&M Code Automation: Leverages NLP to automatically suggest billable codes from different types of clinical documents. - One-Click Coder Validation & Acceptance: Automatically identify charts that have potential queries for seamless validation and acceptance. - Always Up to Date: Our Clinical NLP engine is always learning and improving base. -
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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.