Alternatives to Inovalon Claims Management Pro
Compare Inovalon Claims Management Pro alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to Inovalon Claims Management Pro in 2026. Compare features, ratings, user reviews, pricing, and more from Inovalon Claims Management Pro 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
Cloud Claims
APP Tech
Improve claim outcomes with streamlined First Notice of Loss (FNOL), claim processing and flexible reporting. INCIDENT BASED CLAIMS MANAGEMENT Effective claims management is about more than simply managing claims outcomes. It is about having an automated process that ensures efficiency and accuracy across the organization, getting timely notice of losses, and taking swift action are keys to success. The incident-based approach of Cloud Claims covers all accidents and losses, delivering a complete picture of loss to executives and claims managers. Cloud Claims by APP Tech is an integrated solution that is highly configurable, with actionable reports to guide decision-making and a friendly UI so you can get work done faster and more confidently. Cloud Claims runs in the cloud, so there’s minimal IT burden and no installation required — just simple configuration, effortless system upgrades, best-in-class security, and the ability to scale quickly.Starting Price: $2,500 per month -
3
Guidewire ClaimCenter
Guidewire Software
Guidewire ClaimCenter is a leading claims management system designed to streamline the entire claims lifecycle for property and casualty (P&C) insurers. It offers comprehensive functionality from initial claim intake to resolution, enabling insurers to process claims efficiently and accurately. Key features include automated workflows, embedded analytics, integrated fraud detection, and real-time performance monitoring, all of which enhance operational efficiency and improve customer satisfaction. ClaimCenter supports various lines of insurance, including personal, commercial, and workers' compensation, and can be deployed as a standalone solution or as part of the Guidewire InsuranceSuite. By leveraging ClaimCenter, insurers can accelerate claims processing, make data-driven decisions, and adapt to evolving market demands. -
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Duck Creek Claims
Duck Creek Technologies
Duck Creek Claims is a comprehensive claims management solution designed to streamline the entire claims lifecycle for insurers. From the initial report to final settlement, it automates workflows, simplifies data analysis through integrated analytics, and ensures seamless integration with existing systems. Key features include dynamic first notice of loss (FNOL) capabilities, automated assignment based on adjuster skills and workload, instant access to policy and coverage data, and efficient adjuster workflows. By enhancing operational efficiency and reducing manual workloads, Duck Creek Claims enables faster claims resolution, improved customer satisfaction, and compliance with the latest regulations. -
5
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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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. -
7
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. -
8
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 -
9
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 -
10
AltuMED PracticeFit
AltuMED
Conducting thorough checks on the financial eligibility of the patients, running their insurance’s analysis and monitoring discrepancies, the eligibility checker covers all. If however any error does creeps in the data submitted, our scrubber working on deep AI&ML algorithms is capable of scrubbing errors be it coding errors, incomplete or wrong patient financial information. The software, at present, has 3.5 Million edits pre-loaded in its memory. To further streamline the process, automatic updates are issued by the clearing house to inform about the status of in-process claims. Covering the entire billing spectrum from verifying the patient financials to working on denied or lost claims and also has a through follow-up feature for appeals. Our intuitive systems warns if a claim could be denied, taking corrective actions to prevent it but also is capable of tracking and appealing for lost or denied claims. -
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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. -
12
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. -
13
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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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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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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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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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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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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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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Sapiens ClaimsPro
Sapiens
Sapiens ClaimsPro is a comprehensive claims management software designed for Property & Casualty (P&C) insurers, offering auditable, configurable, and AI-driven automation across all lines of business. Its intelligent, rules-driven workflow ensures faster claims cycle times, resulting in lower expenses and settlement costs. The intuitive, easy-to-use interface provides one-click access to key features, enhancing the adjuster's experience. A central repository offers a 360-degree view of claims, policies, and accounts, improving customer service and vendor management. ClaimsPro enables insurers to adapt quickly to new business requirements, efficiently handle complex claims with superior case management, identify and prevent fraud, and proactively manage exposure for responsive service during catastrophic events. -
21
Claims Signal
Athenium Analytics
Claims Signal™ is the next-generation open claims quality platform from Aon & Athenium Analytics that enables insurers to identify high-risk claims sooner. Enhance the policyholder experience while achieving a 4-6% improvement in claims indemnity and expenses. Today’s claims teams are under increasing pressure to improve the customer experience, operate more efficiently and mitigate leakage. Routine quality audits are effective at identifying root causes and deviations from best practices, but audit results may not be available for weeks or even months after claims are closed. What if you could monitor open claim files and address quality issues before they affect outcomes? The Claims Signal platform from Aon & Athenium Analytics uses artificial intelligence to analyze open claims, spot potential issues and push instant alerts so your front-line managers can intervene before a claim is closed. Reduce claims leakage by up to 4% with predictive analytics and proactive alerts. -
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ALFRED Claims Automation
Artivatic.ai
Filing claims are complex and critical processes. More than 60% of people do not file complex due to its complex processes and time taking nature. Artivatic’s dedicated claims platform for each insurance vertical helps insurance businesses to enable digital claims journeys, self-claims processing, automated assessment, risk & fraud intelligence and claims payout. ONE PLATFORM FOR ALL YOUR CLAIMS NEEDS. End to End Claims Automation and Assessment Platform AUTO CLAIMS – HEALTH CLAIMS – TRAVEL CLAIMS – ACCIDENTAL CLAIMS – DEATH CLAIMS – FIRE CLAIMS – SME CLAIMS – BUSINESS CLAIMS – COMMERCIAL CLAIMSStarting Price: $10/claims/month -
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MediConCen
MediConCen
The ultimate insurance claim automation solution powered by patented blockchain technology. Claims are the moment of truth for all insurance, and with our solutions, everything has been craftily designed to automate insurance claims for insured and insurers with unbeatable accuracy and speed, from claim estimation before a claim occurs, to making the right claim decision and settling the payments. MediConCen is a leading insurance technology that automates insurance claims and makes insurance usable for insurance companies, medical networks, and clinics using Hyperledger Fabric blockchain. We empower claim assessors with powerful AI models and expert knowledge decision rule engines so that fraud and abuse can be spotted instantly and clean cases can be approved right away for consistently perfect claim cost management and unbeatable efficiency. Be in the know with powerful claim analytics that simply work for underwriting and product development. -
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Paradigm
Paradigm
Paradigm Senior Services offers a full-service, AI-powered revenue cycle management platform specifically tailored to home-care agencies that bill third-party payers such as the U.S. Department of Veterans Affairs (VA), Medicaid, and other managed-care payers. It automates and streamlines every step of the billing and claims process: from eligibility/authorization verification, state- or payer-specific enrollment and credentialing, to submission of clean claims, denial handling, and payment reconciliation. It integrates with common agency management software and electronic visit verification tools to scrub shifts, verify authorizations weekly, and reconcile payments, reducing denials and minimizing administrative burden. Paradigm also supports “back-office as a service” for providers; even if they already have internal billing staff or scheduling software, Paradigm can take over claims processing as a specialized, expert billing department. -
25
Nirvana
Nirvana
We work with private insurance clients to get your therapy sessions covered, every time. Navigating mental health billing and your health insurance plan shouldn’t feel like wandering in the dark. From eligibility to reimbursement, Nirvana makes the insurance process seamless for you and your therapist, so you can save time, headaches, and get paid faster. Instead of spending hours on the phone with insurance trying to figure out what you’re covered for, get a clear understanding of your coverage as soon as you sign up. From eligibility to reimbursement, Nirvana makes the insurance process seamless for you and your client. Seamlessly monitor the lifecycle of your claims with the ability to track submission, processing, and adjudication. Filter between sessions and date ranges to get an in-depth understanding of reimbursement amounts for your sessions.Starting Price: $129 per therapist per month -
26
Insurium
Insurium
A unified solution providing a 360º view of the P&C insurance process lifecycle. Generate premium and save time with a powerful rules-based, multi-state underwriting module that automates the collection of information and the creation of quotes, endorsements, cancellations, audits, and renewals. Reduce combined ratios with a modern and streamlined approach to the claims adjudication process that is both intuitive and collaborative. Increase new business by making it easy to exchange information with brokers. From streamlining and standardizing the intake of information to providing brokers access to the information they need anytime. Control what submissions your underwriters are focusing on. Drive customer satisfaction and retention by providing your policy holders self-service access to policy information, claims intake and review, online bill pay and more. You decide what portal features to provide your customers for the best user experience. -
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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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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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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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HEALTHsuite
RAM Technologies
HEALTHsuite is a comprehensive benefit administration system and claims processing software solution designed for health plans administering Medicaid and / or Medicare Advantage benefits. HEALTHsuite is a rules-based auto adjudication software solution designed to automate all aspects of enrollment / eligibility, benefit administration, provider contracting / reimbursement, premium billing, medical management, care management, claims adjudication, customer service, reporting and more. RAM’s Medicare Advantage-in-a-Box offering is unique in the industry; the product of RAM’s extensive experience in Medicare Advantage and an unwavering commitment to changing our industry. HEALTHsuite Advantage™ and eHealthsuite™ are the cornerstones of our pre-configured Medicare Advantage-in-a-Box offering. HEALTHsuite Advantage is a fully integrated suite of modules providing our clients with an unmatched solution to administer their Medicare Advantage and Special Needs Plans (SNP’s). -
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ClaimBook
Attune Technologies
ClaimBook enables faster settlement of insurance claims, improved accountability and fewer rejections. It is well equipped with the features to address every part of the claims and evidence submission. ClaimBook supports international patient treatment with dedicated workflows, therefore enabling medical tourism. A built-in Rules Engine that disallows incomplete submissions, and knows what information and documents need to be submitted. This results in error-free submissions that are complete and guarantees that it is pre-authorized. ClaimBook's Smart Data Extraction can read documents uploaded to extract relevant data from the Hospital's Information System (if integrated with ClaimBook) to prevent the need for manual entries. ClaimBook also features Integrated Emailing by creating a virtual inbox in your dashboard. Withing the dashboard, emails can be composed, the design feature is similar to Microsoft Outlook. -
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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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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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360Globalnet
360Globalnet
360Globalnet's award-winning no-code digital claims platform, 360SiteView, enables insurers to orchestrate and automate the entire claims process from First Notice of Loss (FNOL) to settlement. This fully digital end-to-end solution allows customers to report and manage their claims through a simple, incident-specific template accessible via a website, app, or contact center. The platform maximizes the use of video, imagery, and documents to streamline the claims process, reducing lifecycle times and enhancing customer satisfaction. An automated customer portal keeps clients informed of claim progress without the need for additional logins or passwords. 360SiteView is virtually 100% configurable, allowing operational teams to design and implement digital processes without technical expertise. It supports various claim types, including motor, property, casualty, travel, pet, warranty, commercial, engineering, aviation, and marine. -
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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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Claims Workspace
Cotality
Claims Workspace is a comprehensive solution designed to streamline property claims management by integrating data, automation, and collaboration tools. It simplifies workflows, enabling better outcomes for insurers and restoration professionals. Claims Workspace offers seamless integration with various data sources, providing real-time access to property information, damage assessments, and repair estimates. Automation features reduce manual tasks, accelerating claim processing and improving accuracy. Collaboration tools facilitate communication between all stakeholders, ensuring transparency and efficiency throughout the claims lifecycle. By leveraging advanced analytics and intuitive interfaces, Claims Workspace empowers users to make informed decisions, enhance customer satisfaction, and optimize operational performance. -
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AI Insurance
AI Insurance
AI Insurance is a modern, cloud-based, AI-powered insurance management platform designed to streamline and automate workflows for program managers, captives, third-party administrators, and risk retention groups. The platform consolidates various functions into a single interface, including claims management, financials, digital portals, and application processes, premium billing, policy issuance and signature, rating engine, and data management. Key features include AI-backed automation for tasks such as invoice auditing, where defense counsel invoices are parsed and audited against guidelines to prevent unauthorized legal fees, and application parsing, which extracts data from received applications to populate forms automatically. Additionally, the platform offers indemnity prediction capabilities, claiming to be 25% more accurate than adjusters after a year of usage, providing cost predictions and recommendations for claims.Starting Price: $1,089 per year -
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eOxegen
eOxegen
eOxegen is an AI-powered claims management system designed to streamline and enhance the efficiency of health insurance operations. Automating claims processing through a Straight Through Process (STP), reduces manual intervention, leading to faster claim settlements and improved accuracy. It incorporates advanced fraud detection capabilities, utilizing AI algorithms to identify and flag potentially fraudulent activities early in the process. Additionally, eOxegen offers features such as provider contracting and empanelment, pre-authorization management and adjudication, and robust reporting with business intelligence analytics dashboards. Its AI-driven workflow automation ensures consistent task completion, minimizes repetitive activities, and enhances overall productivity. By integrating these functionalities, eOxegen empowers insurance companies and third-party administrators to optimize their claims management processes, and reduce operational costs. -
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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. -
40
RevCycle Engine
Aptarro
RevCycle Engine applies built‑in, customizable rules and AI‑powered automation to correct coding and charge errors at the source, ensuring billing data is accurate before claims are submitted. By integrating seamlessly with EMRs and practice management systems, it ingests claims data in real time, applies industry‑proven rules tailored to each organization’s needs, and fixes errors automatically, reducing preventable denials and costly rework. Streamlined workflows prioritize and route only complex or exception claims for human review, boosting team efficiency and reducing burnout. With AI‑driven charge accuracy, the platform increases clean claim rates, lowers cost‑to‑collect, and stabilizes cash flow, all visible through clear dashboards and real‑time insights. Scalable automation handles high claim volumes without overtime or late‑night efforts, while features such as charge accuracy validation, denial prevention, coding review optimization, payment collection support, and more. -
41
Inovalon Insurance Discovery
Inovalon
Insurance Discovery reduces uncompensated care and underpayments by identifying active billable coverage previously unknown to the provider. Using sophisticated search capabilities, this solution identifies if patients have multiple active payers to help boost reimbursement opportunities. Prevent reimbursement delays and increase the speed of revenue capture by sending claims to the right payers on the first submission, enabled by more accurate coverage information. Run Insurance Discovery with verified patient demographic data to get accurate coverage and eligibility information. Replace manual insurance discovery methods with one quick, comprehensive search that inquires numerous databases in seconds to deliver detailed, accurate coverage information. Improve the patient/resident experience and estimate accurate out-of-pocket costs to improve their financial experience. -
42
Five Sigma
Five Sigma
Five Sigma set out on a mission to allow claims organizations to innovate. With the set of claims management tools and unique platform, Five Sigma's suite is what Insurers need to bring their claims operation to the rapidly changing world. With our suite of Claims-First Cloud-Native and User-Centric products, we enable adjusters to handle claims better and faster. With Automating administrative tasks, Adjusters can focus on making the right decisions, while the system takes care of everything else. Clive™ by Five Sigma is the industry's first AI-powered claims adjuster, transforming how claims are processed by insurers, MGAs, and TPAs. Leveraging advanced AI and automation, Clive streamlines the entire claims lifecycle, from FNOL (First Notice of Loss) through to settlement. The AI agent enhances claims handling efficiency, accuracy, and cost reduction by automating tasks. -
43
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. -
44
LexisNexis Claims Compass
LexisNexis
Automate with confidence and improve efficiency by embedding timely, reliable insights directly into your claims management system. Embed timely, reliable insights directly into your claims management system through Claims Compass, a scalable, system-to-system multi-solution platform. Improve cycle time and streamline the claims handling process while reducing your costs with a platform that delivers robust data and analytics. Streamline workflows and more easily apply powerful analytics to gain insightful intelligence that drives better decisions at every step of the claims handling process. Help reduce fraud through a more efficient way of receiving predictive analytics, sophisticated investigation and medical provider management tools. Make customers whole again faster with a claims management system that taps unparalleled processing power. -
45
Dragonfile
Dragonfile
Dragonfile – The Smarter Way to Manage Claims. Dragonfile is a powerful, intuitive claims management solution designed specifically for adjusters and adjustment companies. Built by industry experts, Dragonfile streamlines workflows, automates updates, and organizes files—helping adjusters save time, reduce stress, and focus on resolving claims efficiently. ✅ Centralized File Management – Keep all claim documents in one secure place. ✅ Automated Notifications & Reminders – Never miss a deadline again. ✅ Seamless Accessibility – Work from desktop, tablet, or mobile—anytime, anywhere. ✅ Zero to Minimal Training Required – Simple, user-friendly interface built for adjusters. ✅ Customizable Workflows – Adapt to your process and work smarter, not harder. Whether you’re managing P&C or Flood claims, Dragonfile simplifies the process, eliminates manual work, and enhances productivity. -
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ESO Billing
ESO
Automate your workflow and integrations, and put an end to the repetitive manual work associated with revenue cycle management. ESO Billing frees your team to focus on what they do best. In today’s reimbursement world, efficiency counts. ESO Billing was built to save you time at every possible point in the billing process. Even its interface has been freshly redesigned for the ultimate in speed and ease of use. Customize your workflow based on your business process, task-based workflow moves each claim through its stages with minimal touches. It even alerts you automatically when payments aren’t on time, for the ultimate peace of mind. Our payer-specific proprietary audit process ensures that each claim contains all critical billing information prior to claim submission. The result? The lowest clearinghouse and payer rejection rate in the industry. Pair billing with ESO Health Data Exchange (HDE) and ESO Payer Insights to tap into hospital-generated billing information with one click. -
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ClaimScore
ClaimScore
ClaimScore is the only independent software solution dedicated to resolving the ever-expanding claim fraud problem in class action settlements. Each claim is reviewed individually using our proprietary AI, ML, & Cloud Architecture in real-time and each result is reported instantaneously in an interactive dashboard. Each claim begins with a ClaimScore of 1,000 and is reduced each time it fails a criterion. Each criterion has either a fixed weight or sliding weight depending on both the correlation to fraudulent claims and the correlation to valid claims. To maximize transparency, each claim is tagged with deduction codes associated with the criteria it fails, thus ensuring that the parties, the administrator and the court definitively know all specific reasons why each claim was rejected. -
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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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Wisedocs
Wisedocs
Wisedocs' document processing platform features enable insurance companies, independent medical evaluation firms, and legal entities to process claims with more speed, accuracy, and efficiency. Automatic organized medical records by date, service provider, title, and category. Automatic page duplication saving up to 30% of your time and money processing extra pages. The administrative hurdles with medical record reviews and sorting can be a challenge. Wisedocs has made automating medical record reviews a breeze for insurance, legal, and medical firms. Wisedocs will create an organized medical record index with insights based on your custom needs. Get important insights and easily searchable and indexible records pulled from the medical record review and intelligent summary. -
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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.
