Alternatives to HEALTHsuite
Compare HEALTHsuite alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to HEALTHsuite in 2026. Compare features, ratings, user reviews, pricing, and more from HEALTHsuite competitors and alternatives in order to make an informed decision for your business.
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1
Service Center
Office Ally
Service Center by Office Ally is a trusted Revenue Cycle Management and patient payments platform used by more than 80,000 healthcare providers and health services organizations, which process more than 950 million transactions annually. Service Center is a cost-effective solution enabling providers to control their revenue cycle. With a user-friendly interface, Service Center helps providers check and verify patients’ eligibility and benefits, submit, correct, and check the status of their claims online, and receive remittance advice. Accepting standard ANSI formats, data entry and pipe-delimited formats, Service Center helps streamline administrative tasks and create more efficient workflows for providers. -
2
Commissionly Tracker
Commissionly
For less than the cost of an employee, our insurance commissions calculation software saves time and recovers profit from missing commissions for Medicare and other lines of insurance. Our insurance commission management software automates the tracking of missing payments and calculates all your commissions, overrides, splits, overrides, bonuses and uplines. Our carrier statement import system matches the headings in your carrier reports to swiftly import commission payments. Multiple carrier reports will be converted into standard formats so that you can extract useful reports from the data. The system will identify any Medicare or other insurance commission payments that do not match the schedule or amount you expect to receive. You can export your discrepancies with all the carrier information attached ready to send to your carrier for correction and payment.Starting Price: $899 per month -
3
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. -
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Virtual Benefits Administrator (VBA)
Virtual Benefits Administrator
Virtual Benefits Administrator (VBA) is the industry's leading cloud-based benefits administration software solution. With a robust functionality and unlimited flexibility, VBA allows users to build and manage medical, vision, dental, disability, Medicaid, Medicare, Medicare Supplement, care management, long-term care health benefits, health savings accounts (HSAs), flexible spending accounts (FSAs), health reimbursement accounts (HRAs), and COBRA. -
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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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PlanXpand
Acero Health Technologies
PlanXpand™ is Acero’s proprietary transaction processing engine, one that powers each of our products for health benefits administrators. Leveraging this engine, clients may choose to implement Acero’s products concurrently or incrementally. In addition to selecting one of our standard products, administrators also may choose to utilize PlanXpand™ to develop a custom solution to extend existing system capabilities. Acero’s unique, integrated solutions feature Service-Oriented Architecture, allowing health benefits administrators and insurers to add features and functions to existing adjudication platforms. At the same time, our sophisticated design and engineering enables real-time adjudication of every type of claim, all in direct interaction with the core claims system, resulting in more accurate processing, more satisfied customers and less need for claims adjustments. -
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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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Hi-Tech Series 3000
Hi-Tech Health
Series 3000 is a cloud-based claims administration solution for businesses within the healthcare industry. No matter what your adjudication, reporting, or plan needs are, this platform reduces time processing claims and increases productivity as it assists with: •Client management •Benefits input •Electronic claim submissions •Claims processing •Real-time status tracking Our built-in database efficiently manages clients and employee benefits. This platform allows users to make real-time updates including: •Claims statuses •Currency conversion •ACH deposits and disbursements •Document printing No matter what happens, our cloud-based software is reliable, and we pride ourselves on 99 percent up time. Series 3000 is HIPAA compliant and ensures secure data management and backup. We upgrade our communications and IBM hardware every two to three years and maintain System Critical Support with all our vendors, keeping our technology up to date.Starting Price: $3500 per month -
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PLEXIS Payer Platforms
PLEXIS Healthcare Systems
PLEXIS’ suite of best-in-class apps has a proven record of giving payers the extended functionality necessary for modern core administrative ecosystems. From real-time benefit administration and adjudication to automatic EDI transmission and self-service customer portals, PLEXIS Business Apps have you covered. Passport provides essential connectivity from the core admin and claims management engines to PLEXIS business apps, your own apps, and existing in-house systems. With its flexible API layer, Passport delivers real-time integration with portals, automated workflow toolsets, and business apps. Connectivity is limitless. Streamline workflows with a centralized, modern core administration & claims management platform. Process claims in a timely and accurate manner, and automate the complexities of benefit administration to capture a quick ROI and deliver superior customer service. -
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William
Certifi
Certifi's William is an intelligent automated premium billing and payments platform that performs all the functions of membership accounting, payment management, collections, and remittance for digital benefits-based billing. William enables 100% electronic billing transactions in complex billing scenarios, including payer-sponsored marketplaces for group and individual populations, as well as unique populations like Medicare Advantage and Medicaid. As a true enterprise-class accounting system, William offers GAAP-compliant reporting with clear audit trails for general ledger management. All customer-facing bills, reports, portals, and tools are branded to be consistent with your organization's brand. The platform delivers rules-based delinquency and termination communications, from notification to policy suspension and termination. Consumers and employers can set up individual or recurring payments using their preferred payment methods. -
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Context 4 Health Plans Suite
Context4 Healthcare
Protect the integrity of your health plan and determine accurate pricing with the Context4 Health Plans Suite, our modular, cloud‑based technology platform. Immediate, actionable, and defensible Fraud, Waste, and Abuse (FWA) detection built by our team of certified clinical, dental, and health benefits experts. Accurate data and cutting-edge cloud technology combine to create a proven and defensible medicare reference-based pricing (RBP) solution. More than 100 healthcare data sets, with professional support to optimize efficiency and compliance. Advanced medical coding software designed to expedite claim submission and minimize denials. Our cloud based Payment Integrity Platform utilizes our proprietary analytics engine to identify coding errors, medical necessity, unbundling, fraud-waste-abuse, audit risks, pricing and other aberrations that can impact your business. -
12
CareJourney
Arcadia
CareJourney is a cloud-based healthcare analytics platform offering deeply comprehensive, clinically-relevant intelligence derived from one of the largest longitudinal claims datasets in the U.S., covering hundreds of millions of beneficiaries across Medicare, Medicaid, Medicare Advantage, and commercial populations and profiling more than 2 million providers. It empowers organizations to assess markets and patient cohorts to uncover opportunities for cost savings and better outcomes, build and grow high-performing networks, make smarter contracting decisions, identify referral patterns and leakage, and benchmark provider performance against peers. It also supports management of at-risk populations through segmentation models, helping organizations understand chronic condition prevalence, care utilization, and cost drivers. -
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ClaimAdept
Isoft
This product is an end to end claims system. The primary functions are claims adjudication, claim workflow and payment disbursement. The flexible design allows the addition of adjudication modules on a line of business basis. Each new line of business added reuses the core functionality of the system. This system takes advantage of the user friendly windows screen design and makes use of a relational database to store information within the system. The software platform is Powerbuilder with an SQL database such as Oracle or Sybase. This combination of software supports a client server based environment that is capable of processing large volumes of claims. Installation and training are available and source code is included as part of the licence fee. Expert staff is available for customizations and tailoring of the system to meet any special requirements identified by the client. All modifications are available with detail design and support for acceptance testing. -
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Majesco ClaimVantage
Majesco
Digital technologies are having a significant impact on insurance, and those keeping pace with this evolution are on track to maintain a competitive advantage. Traditional claim management tools, involving multiple systems, paper files and manual processes, are being replaced with cloud-native enterprise claim management platforms. The Majesco ClaimVantage Claims Management Software for L&H platform streamlines the claims process through the full life cycle of a claim, from intake through payment calculation, integrating multiple systems to improve the flow of information across your business. Improve the customer experience and drive operational effectiveness with accurate and timely claim decisions. Built on the Salesforce Lightning Platform, Majesco ClaimVantage Claims Management Software for L&H enables insurance companies and TPAs to modernize and optimize their claims operations today and into the future. -
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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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SpyGlass
Beacon Technologies
SpyGlass, our enterprise-class health claims management software, offers a powerful, flexible solution for precise and timely claims processing. SpyGlass makes benefit and plan setup remarkably straightforward. BenefitDriven, fully-integrated with SpyGlass, delivers eligibility, contribution accounting, and pension management to the Taft-Hartley industry with the full range of data and processes for Participants and Employers. HIPAA Director, our all-in-one EDI gateway & scheduler, works as a hub by allowing you to directly connect with vendor partners to help avoid transaction costs, manage batch transfers, and automate transfers. SpyGlass provides a deep, landscape view of your population, with the ability to easily drill down to the higher resolution details. Hundreds of unique reports, fully customizable dashboards, and total control over your system are at your fingertips. -
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Complete Claims
Complete Health Systems
Claims Adjudication for medical, dental, vision, prescription, short and long-term disability claims. Available for on-site license or as a hosted application (ASP). Microsoft technology: SQLServer database with a Windows front end. Acclaimed Customer service staffed by health care claims experts with a minimum of 12 years’ experience in the field. Support calls are logged with status available via the internet. Plan copy and modification feature enable quick setup of plans. Auto-adjudication using benefit codes built using business rules based on over 25 variables from both the claim and the claimant records made available to the adjudication engine. Inbound claims can be scanned images, EDI or paper. HIPAA EDI 5010 transaction sets. Re-pricing fee and UCR Schedules can be loaded on the system in advance of the effective date. The date-driven logic will re-price based on the date of service. -
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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. -
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Smart Data Solutions
Smart Data Solutions
Streamline Your Complete Healthcare Data Workflow. Smart Data Solutions has the tools and experience needed to streamline both your paper and electronic workflows. Our integrated validation, matching, and normalization tools ensure the highest quality data possible, increasing auto-adjudication and reducing manual processing. Whether you’re new to Smart Data Solutions or a long time partner, our development process helps guide you through projects to ensure the best possible position for overall success. Whether your needs are basic or complex, our staff will work with you to understand your needs and the impacts of your workflows. We believe in focusing on your goals, what you want to accomplish, and from that, identifying the best way to get there. Smart Data Solutions provides complete front-end pre-adjudication solutions for hundreds of Payers nationwide. Whether you need basic services or a completely custom workflow, Smart Data Solutions offers a variety of solutions. -
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PBM Express
Laker Software
The core of PBM Express is the adjudication program. Claims undergo hundreds of edits to achieve accurate processing results, regardless of the difficulty of the plan design. The parameter drive program provides for an extremely flexible architecture that allows for client customization as needed. Laker's advanced software solution provides clients with superior performance and industry-leading uptime. As a technology leader, Laker continually updates and enhances our systems to meet the growing needs of our customers. Laker customers have the marketplace advantage of the fastest, most flexible and most durable system available. What’s more, Laker works closely with our customers to develop, test, and implement new products which allow them to better compete and win new business. Laker grows as our customer's claim volume grows. It is in the best interest of both Laker and our customer’s to provide changes to the software in a timely and efficient manner to allow for that growth. -
21
AgentExpress
AgentExpress
AgentExpress is not your typical quoting and enrollment platform. We've modernized the traditional CMS experience to set brokers up for success in the ever-changing landscape of insurance professionals. A foundation of technology, training, and support differentiates our agents allowing them to create truly incredible experiences for their clients. Built with decades of experience in the insurance and technology space. The AgentExpress platform is the industry leader in Medicare Advantage, MAPD, PDP, Medigap, ACA, Ancillary, and Final Expense Life quoting and enrollment broker technology solutions. Working with AgentExpress, you'll have a team dedicated to your success. Grow your business with in-depth product, technology and sales training. Train with our team, attend our weekly webinars, or learn at your own pace with our industry-first micro learning platform for insurance agents. -
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EzyMed Online 4
Top Tech Computing Systems
EzyMed Online 4 is a fully integrated Medical Practice Management software for General Practices, Radiology and Specialists Centres. Developed for the Australian medical practice environment, EzyMed Online 4 encompasses all functions required for the Medicare Australia's Online Claiming Online process, Department of Veterans Affairs (DVA) Claims and Australian Childhood Immunisation Register (ACIR) claims. EzyMed Online is a comprehensive system designed to manage your practice efficiently with just a few clicks of the mouse. A secure database management ensures your system consistently maintains its performance even with a million or more records. From the time a patient is registered at the reception, the consultation is tracked by EzyMed Online 4 and stored in the patient’s database as paperless recording. The patient’s medical history can be retrieved at anytime even to all appointments ever recorded. -
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Oracle's Digital Insurance Platform empowers insurance providers to deliver innovative solutions and exceptional digital customer experiences. This comprehensive insurance management system streamlines operations from sales channels to back-office processes, enabling rapid deployment of new offerings and seamless implementation of necessary changes. With real-time analytics, insurers gain valuable insights into their business, facilitating informed decision-making. The platform supports both individual and group life and annuity insurance, consolidating underwriting, policy processing, billing, and claims into a single, efficient system. Health insurers benefit from simplified enrollments, premium billing, and claims adjudication, enhancing member satisfaction through transparent and personalized services. Additionally, the platform accelerates the bancassurance lifecycle by providing real-time connectivity between banks and insurers, ensuring speed, consistency, and reliability.
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24
SmartEMR
SmartEMR Solutions
SmartEMR is a Web-based electronic medical records solution that enables physicians to record patient encounters and test interpretations quickly and easily. It's tailored to the physician's workflow to ensure a smooth, natural interaction while creating reports that are compliant with the Centers for Medicare and Medicaid Services (CMS)* for coding and reimbursements. SmartEMR also works as a medical billing software, facilitating reimbursement by using our CMS-compliant Superbill generation module. Your electronically submitted claims will be processed with a higher priority ensuring faster turnaround time for reimbursement. SmartEMR will improve your cash flow, by reducing costs and streamlining the entire process for reimbursement.4 -
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Edifecs
Edifecs
Whether it’s understanding the nuances of the CMS and ONC final rules, developing a roadmap to meet the deadlines, or implementing a solution, we’ve got you covered. As the leader in interoperability, Edifecs has the expertise to help you achieve compliance with the new mandates and unleash the power of secure, reliable electronic health data exchange. Edifecs offers best-in-class Smart Trading and Encounter Management tailored specifically for small and medium-size health plans. Harness financial, clinical, and administrative data to drive business initiatives and enable administrative automation. Streamline encounter management operations and improve first-pass rates for managed Medicaid and Medicare Advantage through a hosted solution model. Edifecs offers COTS-based modular solutions to maximize data quality and drive payment reform initiatives. Harness financial, clinical, and administrative data to drive business initiatives and enable administrative automation. -
26
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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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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BrokerEngage
Benefitalign
Avoid double re-directs - Experience a streamlined enrollment experience on a single platform while completing Special Enrollment Period (SEP) verifications, complex eligibility situations and reporting life changes, without visiting ‘healthcare.gov’. Efficient APIs - Application-programming Interfaces (APIs) in our EDE platform transfer data between the Federally-Facilitated Exchange for faster submissions, eligibility checks and renewals. APIs quickly calculate the appropriate cost sharing reductions and premium tax credits. Medigap Filters - This Medicare feature is designed to meet regulations. You can now quote, compare and add the optional riders for Medigap plans in BrokerEngage, without scouting through carrier portals. Healthcare Providers & Drugs - Find plans for your clients that include the prescription drugs & healthcare providers they need. -
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Direct Care Innovations
Direct Care Innovations
DCI focuses on providers and Government Agencies in the Medicaid, Medicare, and Managed Care Markets. Our software solutions streamline processes, allowing you to serve the direct care industry with coverage in all locations - from cities to rural areas. Our team can have you live in under 90 days. Are you looking to improve authorization management of your healthcare agency? At Direct Care Innovations (DCI), we offer our Real-Time Authorization Management Module as part of our business management platform. We designed the authorization module to serve as a real-time data management and reconciliation system for Medicaid, Medicare, Managed Care, and other service code-based insurance authorizations.Serves as the system of record for agencies to access and maintain service authorizations. -
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CyberSource Medical
ComCom Systems
The market's most powerful and accurate solution for claims processing. CyberSource Medical Claims Scanning Solution, a complete turn key system for HMO, PPO, TPA, or Self Funded Organization, is installed at your location for automated data entry of CMS-1500, ADA-2006 UB-04 and enrollment forms. Using advanced "intelligent" features combined with your business rules, CyberSource recognizes, validates and formats the data from medical claim forms. Fuzzy Matching performs an intelligent search of your member and provider database correctly identifying the exact match. The matched data is then utilized to verify and correct data on the medical claim before being passed through to adjudication. The combination of industry-leading OCR efficiency, your business rules and “Fuzzy Matching” results in exceptional accuracy of the data from your medical claims forms. -
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ClaimScape
DataGenix
Emerged in the year 2000, DataGenix is strongly resolved to provide TPAs, adjusters, and insurance companies with modern claims processing solutions. We understand that claims processing and health benefits management can include several complications. So that your business does not suffer any losses, our experts have created the advanced ClaimScape software that can automate the entire adjudication process. The goal of our business and the Claims software is to resolve the perplexities that hinder the reach of unmatched customer experience for your clientele network. Keeping in mind the modern trends and requirements, we can assure your business's optimum growth with our software products. We have won the trust of top TPAs of the nation and are willing to serve more. -
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Anagram
Anagram
Anagram Prosper puts money back in the hands of your patients — at no cost to your practice. Increase your margins, delight your patients, and forget courtesy discounts. We partnered with the best vendors to develop wholesale price lists that better align with the needs of you and your patients. Provide rebates on the same products you already stock. Incentivize your patients, drive more conversions, and collect more revenue. With Anagram Prosper, you can save patients money without offering discounts or lowering your margins. Use our rebate program to drive more sales and make your patients happy. Most patients don’t know about their out-of-network benefits. Anagram Access can pull real-time vision plan eligibility to maximize savings for your patients. With Anagram Access, you can quickly calculate how much your patient owes and how much their vision plan reimburses. -
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QNotes Office
Quick Notes
QNotes Office™ is your safe and secure medical records solution. Notes can be created with one of our Portable Solutions like PDQ Touch Notes™ or QuiX™, or by using traditional typing, voice dictation or Easy Reports™. QNotes Office™ is fully HIPAA and Medicare compliant. Our patient charting solutions offer you the ultimate protection against Medicare Audits, as well as, Medical/Legal Issues and Catastrophic Loss. Along with our new QDaySheet™ system, we really help you get paid. All our systems are easy to own. Safe and Secure Medical Records and Patient Charting. Fully HIPAA and Medicare compliant! Protection for the practice against Medicare Audits, Medical/Legal Issues & Catastrophic Loss. Easy-to-Learn and Easy-to-Implement for the staff. Learn the features in less than one hour. Transcription features such as Document Export, Save to Pdf, and Batch Print options. Works extremely well with your favorite Voice Recognition software.Starting Price: $1995 one-time payment -
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TheraTracker
Turn Key Therapy
With Medicare changes every year, all home health providers will soon be required to have electronic medical records systems to manage patient information. Turn Key Therapy offers a way to stay ahead of that curve while giving you a distinct advantage over you competition. TheraTracker is a complete online based software that allows users to fully manage the home health therapy cycle 24/7, 365, from anywhere! Individual therapists and therapy staffing companies use TheraTracker as the launching pad to build their business. Even home health agencies subscribe to TheraTracker because it offers more function and outperforms their expensive out of date software. TheraTracker is a custom built software created by home health therapists who have worked in the field and in management for years. All features in TheraTracker are geared to keep therapists fully compliant with new Medicare regulations and help create a blueprint for exceeding expectations in documentation and communication.Starting Price: $279.00/month -
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EvolveNXT
EvolveNXT
Whether you are a health insurance carrier or any other broker commissions-centered business, EvolveNXT’s platform offers the ability to customize a suite of solutions to effectively streamline your sales performance and day-to-day management of complex business processes. We’ve spent more that a decade working with premier insurance carriers and developing a solution to handle the complex needs of highly competitive and regulated carrier markets. Our compliance-based solution will enable you to increase your organization’s sales channel efficiency while achieving sustainable enrollment growth. The most complex and highly regulated commissions are paid to Medicare brokers. Utilize EvolveNXT to manage and automate your Medicare compensation while keeping CMS compliance. Our commission's management software for insurance carriers improves operational efficiency while enabling teams to reach optimal sales performance. -
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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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Data Decisions Reach
Data Decisions Group
Reach is DDG’s audience-targeting support tool designed for FMOs supporting the senior market. It offers same-day turnaround, providing a full visualization of key descriptor variables to identify the best audience for medicare advantage, medicare supplements, final expense insurance, and more. Reach delivers the specific names and addresses of individuals in your target audience to your preferred mail supplier, ensuring accurate customer acquisition models tailored to your county’s unique attributes. With model types like the look-alike model, Reach generates audience profiles that help develop relevant advertising copy. The response model predicts campaign outcomes, optimizing direct marketing budgets by targeting individuals with a high likelihood to purchase. Reach also ensures data security, being SOC 2 Type 2 certified, and manages the entire modeling process, from suppressing deceased records to ensuring USPS standards are met. -
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TotalEclipse
Startech Software
Startech Software’s TotalEclipse™ product is a fully featured single-database Claims Management & Medical Bill Review Software application. Representing the culmination of over three years of development and testing, TotalEclipse™ is designed by real claims adjusters, bill reviewers, and administration managers who use this mission-critical software to do their jobs every day. Many companies develop their software with the user in mind. TotalEclipse is developed with our users involved. The result is an application designed around real-world workflow with a strong focus on making easily available the information most often needed on the job. Eclipse offers the specific processing power, functionality and reporting capabilities you need to maximize productivity while controlling costs. The single-database backend is scalable for use with either the Microsoft SQL Server™ or Oracle™ platform. -
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Claim Agent
EMCsoft
EMCsoft’s Claims Management Ecosystem assures that healthcare providers and billing companies deliver clean claims to insurance payers for proper claim adjudication. It is the integration of our versatile claims processing software Claim Agent and comprehensive fitting process called the Four Step Methodology into your claim adjudication process. This approach enables, supports, and automates your work process to maximize claim reimbursement. Request our free online demo for a great introduction into the functionality/features of Claim Agent and how it fits into your claim adjudication process. Claim Agent scrubs and processes your claims from the provider system to the insurance payers in a efficient, cost effective, and timely manner. The software is compatible with any system making implementation process quick and simple. We provide custom edits, bridge routines, payer lists, and work flow settings that are unique to each user. -
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Endear
Endear Health
Endear is an API-connected, white-labeled platform that empowers you to deliver cutting-edge benefits and programs, without the associated technical burden. Additionally, our flexible onboarding process teaches members how to get the most out of their plan. Endear partners with innovative medicare advantage plans, ACOs, and DCEs to increase star ratings, improve their onboarding experience, ease their technology burden, and differentiate themselves in an increasingly crowded market. The Endear platform onboards and provides members with a single location through which they can access all of their core & supplemental benefits, member tools & resources, and any 3rd party programs or vendors you might be working with. Our white-labeled and intuitive user interface mirrors best-in-class consumer brands, reducing confusion and ensuring that your members maintain the trust they have in their plans. -
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MediClaims
WLT Software
WLT’s MediClaims system offers a cost-effective, straightforward, and efficient approach to benefit and claims administration. WLT’s rules-based architecture and integrated EDI processes allow claims to be processed quickly, easily, and accurately. MediClaims’ administration and processing capabilities encompass a range of benefit and claim types, from Medical, Dental, Vision, and Prescription Drugs, to Consumer-Driven Healthcare, Disability, and Capitation processing. With WLT’s MediClaims system, you have the flexibility to configure your groups for a single line of coverage or for complex benefit packages with multiple lines of coverage. No plan can work efficiently without support from reliable information systems. WLT makes a point of always working with the most advanced technologies, providing you with the most sophisticated and flexible systems available today.Starting Price: $1 one-time payment -
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QuickCap
MedVision
MedVision Solutions' QuickCap is an administrative and clinical data process management solution that lets users focus on business and not the paperwork. With QuickCap, users have scalable control over their workflow and information to work smarter. QuickCap features a customizable dashboard for ease and gives them automation of their process for speed. QuickCap also streamlines claims work that makes users' work easier. QuickCap also allows users to easily determine profitability for individual providers with analytics. -
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Origami Risk
Origami Risk
Origami Risk provides integrated SaaS solutions designed to help organizations—insured corporate and public entities, brokers and risk consultants, insurers, third party claims administrators (TPAs), risk pools, and more, transform their approach to managing critical workflows, leveraging analytics, and engaging with stakeholders. Origami Risk is a 5-time Business Insurance Innovation Award Winner, and we've kept that title because we collaborate closely with our clients to develop solutions that address real-world challenges they're facing. Since our founding, Origami Risk has aimed to deliver industry-leading, real-world solutions for risk professionals around the globe. Our acceptance of the 2021 European Risk Management Award for Technology Innovation of the Year underlines this continuous effort. Fully-integrated, comprehensive solutions for reducing incidents & hazards. -
44
SNFCB
Consolidated Billing Services
Use our proprietary Claims Analysis feature to save time and money by knowing what codes are bundled and the Medicare allowable amount. Avoid the hassle and confusion of searching multiple online links. We have everything you need in one place, fee schedules, drug lookup, CMS transmittals, and much more. We run over 30 specific code edits on each claim to determine whether CMS considers the code bundled to the SNF. Our database includes over 16,000 Medicare billing codes and 112 geographic locations. Our reports detail the Medicare allowable amount based on your specific zip code. We include fees from ALL CMS applicable fee schedules, including physician, ambulance, ambulatory surgery centers, DMEPOS, drug, laboratory, PEN, and hospital outpatient. We include carrier priced codes for those carriers that report prices. CMS coding errors are corrected on our site as soon as they are identified. Save all your reports for future use.Starting Price: $340 per year -
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MEDENT
Community Computer Service
MACRA impacts all providers with $90,000+ in Part B charges that are treating more than 200 Medicare beneficiaries. Physicians ranked compared to peers, with potential negative adjustments to total Medicare revenue. Two reimbursement programs: MIPS and Advanced APMs. The Patient Portal is a powerful tool that can modernize the way your office communicates with patients. The tools built into the MEDENT system are second to none when it comes to managing your practice. Our EMR/EHR was developed from the ground up with a focus on efficiency and reliability. -
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Cortex EDI
Cortex EDI
Cortex EDI provides medical, institutional, and dental practices with all the services they need to increase efficiency in the workplace. Our free medical billing software and claims clearinghouse software can help you streamline your workplace processes. We have the user-friendly tools you need to help you manage client billing and save you time. Our tools also provide you with such necessities as patient eligibility verification for private health insurance, Medicare, and Medicaid. We provide our free medical billing software to medical, institutional, and dental practices with no signup fees and no contracts. Sign up today to receive free training on how to properly use our practice management and medical claims clearinghouse software. Consolidate your various EDI service needs with Cortex EDI today to start streamlining your workplace processes. Cortex EDI is a leading clearinghouse and practice management software vendor for electronic medical transactions. -
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Colleton Software
Colleton Software
Colleton Software is unique. We offer solutions to your ePCR needs as well as revenue management services. Why deal with multiple vendors when one professional company stands ready to handle all your needs. Colleton does not bill for Emergency rooms, doctor’s office, or hospitals. We are 100% dedicated to EMS services. 100% compliance record for providing Medicare EMS billing services with full adherence to regulations. Extensive knowledge of the Southeast and experience working with all current EPCR Products. Our clients regularly experience between 25% and 50% increase in their collections. When combined with our software, your insurance and Medicare claims are filed within 24 – 48 hours and the reporting can be executed immediately. -
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OneTouch Claims Processing Software
Apex EDI
OneTouch is a tool that allows a user to conveniently transmit claims or statements to Apex, login to the Apex website, or search for claims that have been sent in the past all from of your computer desktop. In order for OneTouch to work, the user must be a registered client with Apex EDI and have a username and password setup. Once a user has a username and password OneTouch can be configured so the user can utilize the tools described. With OneTouch Search you can search your claim and statement files that have been sent to Apex from the convenience of your desktop. The OneTouch search feature allows you to search your statement and claim files for patient names, subscriber IDs, or several other options. After you click the search button you will be logged into your Apex webpage and shown the results of your search. To perform a search first choose what you want to search for by clicking on the magnifying glass dropdown menu. -
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TL LeadManager
TargetLeads
TL LeadManager® is our lead management system designed exclusively for Life and Health Insurance Agents. Managing your Medicare Supplement, Long Term Care, Final Expense and Annuity leads has never been easier. If you don't have or don't love your current lead/contact management system, you need to check out TL LeadManager. This feature rich, easy to use contact management system, CRM, is designed to minimize the time you spend working leads and maximize your selling time. Reduce your paperwork, be more organized than ever before and start selling more policies. Used in conjunction with TargetLeads® we can make your direct mail marketing efforts as seamless as possible. Whether using Turning 65 lists for Medicare Supplement or any other kind of insurance leads, TLLM will allow you to manage, follow-up and run reports on all of your campaigns.Starting Price: $40 per month -
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FINEOS
FINEOS
The FINEOS Platform provides clients the only complete end-to-end SaaS core product suite that includes FINEOS AdminSuite enabling quote to claim administration as well as add-on products, FINEOS Engage to support digital engagement and FINEOS Insight for analytics and reporting. The foundation of your digital insurance strategy. The FINEOS Platform seamlessly blends FINEOS AdminSuite + FINEOS Engage + FINEOS Insight + Platform Capabilities to create the most modern single core insurance platform for Life, Accident and Health. Legacy core systems utilized a ‘one size fits all’ business technology approach that no longer fits the needs of an agile business. Today, consumers, employers and brokers have access to powerful SaaS computing platforms and software tools that set a much higher bar for an insurer’s digital strategy. Monolithic insurance software models of the past focused solely on details of the insurance contract.
