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10+ Best Medical Claims Processing Software 2022

A medical claim billing software needs proficient claims review management to support the accurate coding of claims that result in fair, and transparent payment policies. An ICD-10-compliant medical claims management software that evaluates claims information helps providers in the USA to decrease the rate of denials.

Alternatives

Logo Name Rating CEO Pricing Founded Revenue Employees Location Reviews Customers
AbilityNetwork 3.7 Bud Meadows Custom 2000 $73.7M 242 + Minneapolis 1693+ Reviews 1000000+
nThrive 3.8 Hemant Goel Custom 2016 $952.3 M 6000+ Alpharetta 1325+ Reviews N/A
Comindware 4.6 Max Tsypliaev Custom 2010 $4.5 M 31+ Foxboro 1888+ Reviews N/A
Change Healthcare 3.8 Neil E. de Crescenzo Custom 2007 $3 B 15,000+ Nashville 1654+ Reviews N/A
Experian Health 4.8 Brian Cassin Custom 1994 $134.16 M 700 + Franklin 1745+ Reviews N/A
Datagenix 5 Mark Oja Custom 2000 $1 M 10+ California 1852+ Reviews N/A
Hyland Medical Claims Processing 4.3 Bill Priemer Custom 1991 $630 M 3500+ Westlake 1987+ Reviews 4000+
Exela 3.8 Ron Cogburn Custom 2017 $1 B 17500+ Texas 1753+ Reviews N/A
OSP Labs 4.4 Riken Shah Custom 2009 $19 M 131+ Maryland 1852+ Reviews N/A
PLEXIS Healthcare 4.8 Jorge Yant Custom 1996 $11.43 75+ Medford 1789+ Reviews N/A

AbilityNetwork

3.7 User Rating
Custom Price
Security, Achieve ROI, Accurate data Features
Overview
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

3.8 User Rating
Custom Price
Web-based analytics platform, Integrated billing solution, Faster reimbursements Features
Overview
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

4.6 User Rating
Custom Price
Full automation, SLA tracking, API and Integrations Features
Overview
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

3.8 User Rating
Custom Price
Direct pre-adjudicated claims, Enhance Claims Processing, Advanced Claim Management Features
Overview
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

4.8 User Rating
Custom Price
Automatic alerts, Claim is coded properly, Reimbursement Features
Overview
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

5 User Rating
Custom Price
Advanced Ad Hoc Reporting, Integrated Solutions, Rapid Deployment Features
Overview
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 Medical Claims Processing

4.3 User Rating
Custom Price
Increase efficiency, Improve clinical decision making, Reduce operational costs Features
Overview
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

3.8 User Rating
Custom Price
Digital Mailroom, Automated Processing, Intelligent Decisioning Features
Overview
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

4.4 User Rating
Custom Price
Dedicated Quality Assurance, Claims integration, Remittance Management Features
Overview
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

4.8 User Rating
Custom Price
Flexible, Rapidly Scalable, Claims Management Engines Features
Overview
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.