10+ Best Medical Claims Processing Software 2023

ABILITY Network provides the most comprehensive claims management software, ABILITY CHOICE, that enables healthcare providers to speed up their revenue cycle while reducing their accounts receivable (A/R) days for any of their payers. The platform offers a highly intuitive claims processing solution that smooths out users’ claims submission and receipt across all major providers including Medicare and Medicard as well as thousands of commercial insurance entities.

nThrive is a fully integrated medical billing platform that improves first-pass payment rates as well as denial management, delivering the highest payer claims acceptance rate of 98.7%. It is built with advanced claims management reporting that gives healthcare providers access to claims, benefit explanations, and denial information with ad-hoc queries that can be defined as distributed and reported as specified by a user. nThrive helps boost the financial strength of clients while significantly enhancing payment accuracy.

Comindware offers a web-based claims management solution that enables faster claims processing and improved productivity as agents can finally give their undivided attention to the people they serve rather than the process. The platform offers rules-driven workflow automation that dramatically improves not only claims operation efficiency but also claims cycle times and customer satisfaction. It is highly customer-centered, cost-effective, and scalable, giving users a definite edge in the market. 

Change Healthcare accelerates medical claim processing through its advanced claiming solution that improves claim auto-adjudication rates while enabling users to effectively identify the most efficient method of processing claims for a much higher first-pass rate at a lower cost. The platform radically improves processing cost-per-claim through effective elimination of manual intervention during the claim repricing and adjudication process. It provides supplemental data and reduces time spent on pended claims.

Experian Health empowers companies with increased claim accuracy and improved cash flow by harnessing the innovative power of its robust medical claims processing solution. The platform proactively automates claims and accelerates reimbursements as it drives financial performance using a data-driven and clean medical claims management tool that automatically checks the integrity of every claim before they are submitted. Experian Health is designed to eliminate the costly and stressful rework that claims management typically surfaces.

DataGenix takes claims and benefits to new heights with its advanced platform designed to give users a clear view of their operations. It consists of sophisticated technology and innovation bound to simplify all claims processing complexities and enhance health care benefits management. The platform offers the best-of-breed claim adjudication framework and instant on-screen reporting with integrated preauthorization and pre-approval.

Hyland transforms customer experience with its best-in-class medical claims processing software that digitizes and automates all key claims processes to foster efficiency and profitability. It elevates first pass claims adjudication through automating the interrogation of each claim field for standard and custom rules compliance while enabling users to not only prioritize staff review but also the correction of erroneous data on claims such as the date of receipt, claim value, and incorrect numbers. 

Exela is a powerful medical claims processing software that automates high-volume routing and data capture, delivering the most efficient processing with multichannel claims ingestion. It is a comprehensive suite of healthcare solutions that streamlines healthcare workflow and unifies data in a robust digital exchange platform designed for the insurance industry. Exela provides a single point of access not only for claims management but also for correspondence and payments.

OSP Labs aspires to help healthcare sector partners use the power of technology to increase operational efficiency by lowering costs, saving time, and transforming every client encounter into a memorable experience, increasing customer loyalty. OSP Labs remains committed to developing high-quality, cost-effective solutions promptly. OSP specializes in creating tailored business-intelligent systems and works with small, medium, and enterprise-level healthcare organizations to tackle technology difficulties.

PLEXIS Healthcare Systems is a global leader in payer technology, providing trusted enterprise claims management and core administration solutions to healthcare payers and delivery systems. PLEXIS Healthcare transforms the healthcare business by sparking growth, innovation, and efficiency across multiple business lines for payer organizations. There are more than 100 companies that rely on PLEXIS core administrative enterprise solutions to govern the lives of over 55 million people in all 50 states and throughout the world.