Alternatives to Inovalon Eligibility Verification
Compare Inovalon Eligibility Verification alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to Inovalon Eligibility Verification in 2026. Compare features, ratings, user reviews, pricing, and more from Inovalon Eligibility Verification competitors and alternatives in order to make an informed decision for your business.
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1
Incredable
Intiva Health
Incredable streamlines and simplifies the complex process of medical credentialing for hospitals and medical facilities, helping you save valuable time, reduce costs, and minimize risks. With Incredable, you can effortlessly manage all your healthcare providers and their credentials within a single, unified platform. Our state-of-the-art technology ensures top-notch data security, giving you peace of mind. Our platform offers comprehensive features such as Expiration Management to keep track of credential renewals, detailed Reporting for insightful analytics, and Task Management to streamline your workflow. Additionally, Payer Tracking helps you stay on top of insurance requirements, while Privileging and Appointments ensure seamless provider assignments. We also provide Exclusions and Sanctions Monitoring, keeping you compliant with regulations, and License Verification to confirm the validity of provider credentials. -
2
expEDIum Medical Billing
iTech Workshop
A secure, SaaS-based Medical Billing, RCM software that helps doctors to increase the collection, and receive faster payment with improved automation. Features like Seamless Insurance Eligibility Verification (IEV), Appointment scheduling, Claims scrubbing, Claim Status Inquiry (CSI),Auto Posting, and Public health clinic make the software efficient and easy to use. expEDIum SDK is available with several APIs to integrate EMR software seamlessly with expEDIum Medical Billing / RCM software. -
3
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 -
4
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 -
5
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. -
7
Rivet
Rivet Health
Patient cost estimates and upfront collection. Understand patient responsibility instantly with automatic eligibility and benefit verification checks. Hyper-accurate estimates based on your own practice data, creating better care and a healthier business. Send estimates via HIPAA-compliant text or email. It's time to treat 2020 like 2020. Collect more than ever with upfront mobile patient payments. Ditch the write offs and decrease patient AR. Run eligibility checks and provide accurate cost estimates, even for multiple payers, treatments, facilities or providers. Collect payment up front via HIPAA-compliant text or email. Reduce A/R days, collect more revenue and increase patient satisfaction all at once. Identify, analyze and resolve denials, as well as track ROI from reworked claims. Automate denial assignments to team members via Rivet, and leave notes and links along the way to resolve future denials even faster. -
8
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. -
9
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. -
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SSI Access Director
SSI Group
Making the front end your first priority. Integrated front-end solutions to improve patient financial experience and revenue cycle results. Determine address deliverability, minimizing returned mail and unpaid invoices. Reduce input errors by confirming patient identity and demographic information. Verify patient insurance eligibility at the point of service. Maximize revenue and regulatory compliance by verifying medical necessity before service. Automate PA end to end in just seconds. Automate the notification process to ensure timely notice of inpatient hospital admittance to payers. Promptly and accurately communicate patient out-of-pocket expenses. Increase collections by determining propensity to pay and financial aid eligibility. Once overlooked, patient access has become a driving force in hospitals. Our flexible platform provides a powerful synergy of integrated information from multiple verification sources combined with intelligent guidance. -
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Infinx
Infinx Healthcare
Leverage automation and intelligence to overcome patient access and revenue cycle challenges and increase reimbursements for patient care delivered. Despite the progress AI and automation is making in automating patient access and revenue cycle processes, there still remains a need for staff with RCM, clinical and compliance expertise to ensure patients seen were financially cleared and services rendered are accurately billed and reimbursed. We provide our clients with complete technology plus team coverage with deep knowledge of the complicated reimbursement landscape. Our technology and team learn from billions of transactions processed for leading healthcare providers and 1400 payers across the United States. Get quicker financial clearance for patients before care with our patient access plus a platform that provides complete coverage for obtaining eligibility verifications, benefit checks, patient pay estimates, and prior authorization approvals, all in one system. -
12
GreenSense Billing
GreenSense Billing
GreenSense Billing Medical Scheduling tool that simplifies your day conveniently for all your medical scheduling needs. You would never have to worry about your medical billing hassles ever again. Insurance Eligibility Verification Find out about any insurance coverage before the patient makes an appointment. With our eEligibility verification tool you can run queries for individual cases as well as run a batch. Appointment Alerts and Reminders Reduce delays and late arrivals with automated alert reminders. Notify your patients before each appointment to avoid late arrivals and no-shows. Snapshot Your Medical Schedule In the Instant view, you can see the number of your daily medical appointments for each provider and for any particular practice location.Starting Price: 3% -
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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. -
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eClaimStatus
eClaimStatus
eClaimStatus provides simple, practical, efficient and cost effective real time Medical Insurance Eligibility Verification system and Claim Status solutions that power value added healthcare environments. At a time when healthcare insurance companies are reducing reimbursement rates, medical practitioners must monitor their revenue closely and eliminate all possible leakages and payment risks. Inaccurate insurance eligibility verification causes more than 75% of claim rejections and denials by payers. Furthermore, refiling rejected claims cost an organization $50,000 to $250,000 in annual net revenue for every 1% of claims rejected (HFMA.org). To overcome the revenue leakages, you need a no-fuss, affordable and effective Health Insurance Verification and Claim Status software. eClaimStatus was designed to solve these specific challenges. -
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Inovalon Claims Management Pro
Inovalon
Keep revenue flowing with a powerful tool that speeds up reimbursements with eligibility checks, claims status tracking, audits and appeals, and remittance management for government and commercial claims, all in a single system. Leverage an advanced rules engine that immediately scrubs claims against the most up-to-date CMS and commercial payer rules, allowing you to correct errors before claims go out the door. Verify eligibility across all payers during claim upload and see flagged errors so claims can be edited before submission. Decrease days in A/R with automated workflows for audit responses, appeal submissions, and ADR tracking. Customize staff workflow assignments based on the type of claim and action needed. Automate secondary claims submissions to stop timely filing write-offs. Increase claims revenue with automated workflows for faster, more successful audits and appeals. -
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Optum AI Marketplace
Optum
Optum AI Marketplace is a curated ecosystem of AI-powered solutions designed to transform healthcare by providing payers, providers, and partners with tools to deliver better outcomes efficiently. It offers a diverse range of products and services across categories such as patient & member engagement, eligibility & claims, care operations & management, payment & reimbursement, and analytics & insights. Notable offerings include the prior authorization inquiry API, which enables payers to check a patient's prior authorization status in real-time, and SmartPay Plus, an e-cashiering payment platform that simplifies patient payments and streamlines the collection process. Additionally, Optum Advisory Technology Services provides expert support for digital transformation initiatives, offering system selection, procurement, implementation, and AI tools. It also features partnerships with trusted resellers, such as ServiceNow, to offer cutting-edge healthcare solutions. -
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PrognoCIS Practice Management
Bizmatics
Seamlessly integrating with, our cloud-based Practice Management solution allows for quick and easy billing management, which enables your practice to quickly identify and confirm patient insurance benefit eligibility level and copay. Work with many different clearinghouses. Efficiently manage your accounting books. Easily reconcile patient accounting and insurance billing. Quick and easy online patient payments and EOB/ERA processing. Our healthcare practice management system has a very robust tasking system. You can quickly find and assign claims to work on using a filter-based search function. You can filter and search outstanding claims by around 100 different parameters, including patient vs. insurance responsibility, primary/secondary/tertiary payer or payer grouping, provider, date of service, aging bucket, and denial reason. Filters can be saved and reused later.Starting Price: $250 per month -
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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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Eligible
Eligible
Eligible's powerful APIs are the easiest way to add insurance billing experiences into your applications. These accreditations assure patients and providers that Eligible has accomplished the strictest compliance with privacy and security best practices while processing millions of healthcare cases each month. We fully understand the role of a mature and proven information security program in meeting Eligible and customer goals. We are happy to announce the successful completion of our Type II SOC2 review. Achieving this certification helps us assure our customers and the companies with which we interact that we understand our responsibilities in keeping protected health information safe. Instantly deliver exceptional experiences for patient insurance billing to your end users. Run estimations, perform insurance verifications and file patient's claims all with simple APIs.Starting Price: 3% Fee -
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Availity
Availity
Collaborating for patient care requires constant connectivity and up-to-date information. Simplifying how you exchange that information with your payers is more important than ever. Availity makes it easy to work with payers, from the first check of a patient’s eligibility through final resolution of your reimbursement. You want fast, easy access to health plan information. With Availity Essentials, a free, health-plan-sponsored solution, providers can enjoy real-time information exchange with many of the payers they work with every day. Availity also offers providers a premium, all-payer solution called Availity Essentials Pro. Essentials Pro can help enhance revenue cycle performance, reduce claim denials, and capture patient payments. Availity remains your trusted source of payer information, so you can focus on patient care. Our electronic data interchange (EDI) clearinghouse and API products allow providers to integrate HIPAA transactions and other features into their PMS. -
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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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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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Clearwave
Clearwave
Save 20% of all administrative hours for your practice, check patient insurance eligibility in real-time and streamline patient check-in with our kiosks, tablets, and software. Simplify your patients’ check-in process by allowing your patients to check in before their scheduled appointment—anytime from anywhere. Patient registration is simplified, and patient intake is streamlined. Get patients through the check-in process quickly with our customizable workflow. Average check-in time for new patients is 3 minutes. Check-in for returning patients is less than a minute. Increase successful payments and cash flow to your practice. Medical practices have seen an increase their point-of-sale collections by 25% – 65%. Clearwave is the cure for patients’ impatience. Establish a digital front door that’s always open for scheduling convenience, automated eligibility verification, patient check-in and frictionless financial transparency. -
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Stedi
Stedi
Stedi is the only clearinghouse built on modern APIs, while supporting both real-time and batch EDI processes. It enables health techs and incumbents to exchange mission-critical transactions - from eligibility to claims and remits. With a security-first cloud infrastructure, built-in payer redundancy via 3,400+ route connections, and market-leading sub-10-minute support response times, Stedi provides reliability and responsiveness to avoid billing outages and reduce denials.Starting Price: $2,000 per month -
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AMS Ultra Schedules
American Medical Software
AMS Ultra Schedules is designed to make scheduling the ideal appointment a breeze. The paperless, easy-to-use software helps avoid delays at check-in through early account and eligibility verification, search functions, and patient tracking. Open Encounter Tracking ensures that each patient is accounted for from the waiting room to the exam room. If a patient requests an appointment change, making edits and tracking patients’ missed, moved, and canceled appointments is all just a click away. Tracking your patients is vital to a healthy and efficient practice. AMS makes it that much easier. From the moment a patient requests an appointment, AMS Ultra Schedules begins full, simple electronic documentation. The software’s features let patients verify their eligibility and account balances prior to their visit to avoid delays at check-in, while “Search Next Available” and “Pop-Up” calendars make it easy to find the ideal appointment. -
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MantraComply
MantraComply
MantraComply is a provider credentialing and enrolment platform. We deliver comprehensive services in provider credentialing, payer enrollment solutions, license verification, hospital privileging, and healthcare compliance management. Trusted by thousands of providers, health plans, payers, group practices, and digital health companies, MantraComply ensures faster provider onboarding, reduced denials, and improved regulatory compliance. Our model integrates AI-driven insights, customizable credentialing workflows, and 24/7 expert support, enabling providers and organizations to stay compliant while focusing on patient care. MantraComply is proudly backed by $15M in funding from Impanix Capital. -
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Remedi PM
Ecognize
Remedi PM provides a workflow-driven integration of front-office, clinical, and back-office areas of your practice. The system intelligently tracks all activities and alerts your employees of their tasks. Staff can collaborate and share documents across locations. All your practice locations can be on the same page instantly via the Remedi desktop. Access real-time status of your practice from anywhere, any time, and any device. It starts with scheduling a patient and continues through with eligibility verification. It has features that are unique to our product. Maintains a list of all area Referring providers, Nursing homes, Hospitals for integration. Manage provider schedules and vacations. Create alerts on patient and guarantor accounts. Create reminders for patients. Have a list of patients for the next working day for reminder and confirmation calls. Never miss a patient to be rescheduled as the system has a way to remind you. -
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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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MedicsPremier
Advanced Data Systems
Keep your practice on track with MedicsPremier (MedicsPM), a reliable practice management software from Advanced Data Systems. MedicsPremier comes with a wealth of tools that enables practices to streamline operations and get paid more, faster. This includes specialty-specific scheduling, automated patient workflow, patient information management, tax rates, products and inventory, specialty-specific EDI, patient statements, and integrated document scanning. With our system, get out-of-network alerts while scheduling patients. Access the patient responsibility estimator for an approximation of what they’ll owe after insurance. Remind patients about their copayments. Perform pre-appointment batch eligibility verifications. Get proactive alerts on claims likely to be denied. Yes…protect your revenue in advance! -
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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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Axora
Axora.AI
Axora AI is an intelligent, end-to-end claims engine that blends AI-powered automation with billing expertise - managing everything from eligibility to payment posting. But it’s more than automation. Axora AI prevents denials before they happen, adapts to payer rule changes, and prioritizes what matters - so you recover more revenue with less effort. 1. Manages your full claims cycle from start to finish 2. Flags denial risks before submission 3. Prioritizes actions that improve cash flow 4. Seamlessly fits into your EHR, payer, and finance systems 5. No migrations. No disruption. Just faster, cleaner paymentsStarting Price: $30/month -
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RCM Cloud
Medsphere Systems Corporation
The RCM Cloud® “software as a service” (SaaS) model strives to replace resource-intensive medical billing processes with digital solutions that reduce manual processes and optimize workflow thru automation. This approach significantly improves operational efficiency and further allows the business to expand service delivery capacity with only minor increases in administrative staff. Leverage your investment in technology to grow and sustain your business as opposed to increasing the headcount necessary to expand. On the administrative side, RCM Cloud® and associated services are delivered via the powerful, proven and secure medsphere cloud services platform. RCM Cloud® modules include patient/resource scheduling, enterprise registration, in-stream payer eligibility checking, contract management, medical records, billing, claims, payer and self-pay collections, POS payment posting and bad debt which enable all types of healthcare entities to truly transform their revenue cycles. -
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ServiceNow Vaccine Management
ServiceNow
The ServiceNow® Vaccine Administration Management application enables organizations, such as governments and healthcare providers, to create and manage vaccination programs. Vaccine recipients can visit a self-service portal to review and provide privacy consent, use the knowledge base or Virtual Agent to address common questions, and self-schedule their appointment after responding to an eligibility questionnaire. Providers can schedule appointments for groups of eligible recipients, notify citizens and patients, administer and record vaccinations, and manage vaccination tasks. Request, reschedule, and cancel vaccination appointments, collect relevant pre-vaccination information and privacy consent, notify and remind users via email about upcoming appointments, schedule appointments for groups of eligible recipients, administer and record vaccinations. -
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CureAR
TechMatter
CureAR is an AI-powered medical billing and revenue cycle management software designed for in-house billers, billing companies managed-service providers and DME companies. The software consolidates eligibility verification, charge capture, AI-assisted coding suggestions, claim scrubbing, electronic claim submission, ERA ingestion, and automated payment posting into a single cloud-hosted system. It is configurable for specialty billing rules and supports multi-tenant operations for practices that handle multiple client accounts. Key Features: AI-assisted coding and claim scrubbing: Machine learning highlights likely coding errors and applies payer-specific validation rules before submission. Real-time claim status and alerts: Tracks claims from submission to adjudication and surfaces exceptions for prioritized follow-up. ERA ingestion and automated posting: Electronic remittance advice handling with configurable reconciliation workflows reduces manual posting effort.Starting Price: $129/month/user -
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Provider Passport
Provider Passport
Provider Passport is an all-in-one healthcare administration tool that centralizes and automates critical provider management functions including payer enrollment, credentialing, privileging, and provider data management using its TruMation AI automation engine. It aggregates provider data into unified profiles, automatically tracks expiring credentials and licenses, monitors sanction databases in real time, and shares data securely with other systems via APIs or standard messaging protocols while reducing manual data entry and error risk. Provider Passport’s credentialing tools run primary source verifications from hundreds of integrated sources in seconds, enable customizable workflows for different provider types, and help expedite onboarding by automating re-credentialing and approval processes. Its AI-powered payer enrollment engine evaluates criteria across thousands of payer plans, automates application submission and follow-ups, and accelerates enrollment approval. -
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BeneLink
Servarus Systems
Servarus Systems provides several benefits administration services coupled with our Benelink Connect platform. Integrated administrative services allow Human Resource experts to better focus on their “Human Capital” and spend less time on administrative tasks. Communications, Enrollment and in-service through our call center, premium Billing and bill collection, COBRA administration data and information carrier EDI interface setup, management and validation and Dependent verification plan inquiry and issue resolution are all part of the services we offer. For the Broker our benefits administration services and Benelink Connect platform provide an idea competitive advantage solution. We partner with brokers to help them grow their business and retain their clients. Web based electronic enrollment and eligibility management system. -
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Chiron Health
Chiron Health
As a premier, HIPAA-compliant telemedicine solution provider company, Chiron Health is dedicated to making routine visits easier and more convenient, both for the doctors and the patients. Our cloud software platform for video visits is secure, easy-to-use and designed to improve practice efficiency and patient care. Automated eligibility checks, and a reimbursement-specialist support team. Drive revenue and practice efficiency with seamless integrations into existing practice workflows and EHR/PMs. Intuitive cloud software for both patients and physicians means no downloads, up and running in minutes on patient-owned devices. Simple telemedicine software that allows physicians to connect with patients for routine appointments over secure video visit – and receive full reimbursement through private payers. The Chiron Health cloud software contains full support for patients and physicians, EHR integrations, plus billing and reimbursement tools. -
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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. -
39
ProviderTrust
ProviderTrust
From healthcare license verifications and OIG exclusion checks to enterprise compliance and eligibility monitoring, we deliver it all in one powerful platform. We enrich both primary source data and our client’s data records with identifiers to catch and verify issues no one else can, alerting you to issues you would never otherwise find. From the beginning, we set out to do healthcare monitoring better than anyone else. This meant we had to aggregate, clean, and enrich primary source data until our proprietary dataset was smarter than the original sources. Our approach is engineered to combine sophisticated automation with human governance. We analyze and interpret thousands of primary sources across every state and healthcare discipline to resolve and verify every potential match, leaving you with only exact-match results and peace of mind. The future of enterprise compliance and eligibility monitoring is instant access to insights when and where you need them. -
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Secova DEMS
Secova
Dependent Eligibility Management Service Secova’s Dependent Eligibility Verification Audit handles verifications with sensitivity, ensuring employees understand exactly why a dependent may be ineligible and explaining the process every step of the way, which helps maintain employee goodwill. Features: - Reduce compliance risk under ERISA &DOL guidelines - Guaranteed Organization Savings of 6-10% after audit cost - Our competitors hold the SSAE-18 Type II certification only. Secova takes a step further, with an ISO – 27001 credential. - Live-answer call centres with IVR and 24x7capabilities. Our Participant Advocacy Services and Multi-lingual support ensure access to assistance. - We treat every client as a unique entity by designing, branding, and implementing customized solutions as per company culture - Our vast experience includes clients with audit populations ranging from 1,000 to over 180,000 dependents. -
41
CERTIFY Health
CERTIFY Health
CERTIFY Health is a unified healthcare platform purpose-built to eliminate fragmentation across outpatient care delivery and practice operations. It brings patient experience, patient management, practice operations, communication, interoperability, and revenue cycle workflows together in a single, connected platform designed to support how modern healthcare organizations actually operate. From digital intake, eligibility verification, and scheduling to check-in, patient communication, billing, claims, and payments, CERTIFY Health coordinates every step of the patient and administrative journey while integrating seamlessly with existing EHR and EMR systems. Rather than replacing core clinical systems, the platform sits around them, connecting front-desk teams, clinical staff, billing teams, and patients through shared workflows and clean data exchange. By replacing disconnected tools and manual processes, CERTIFY Health reduces operational friction. -
42
Experian Health
Experian Health
Patient access is the starting point for your entire revenue cycle process. Ensuring correct patient information on the front end reduces the errors that cause rework in the back office. 10 to 20 percent of a health system's revenue is forced to remediate denied medical claims and 30 to 50 percent of those occur during patient access. By adopting an automated, data-driven workflow—not only are you reducing the errors that lead to claim denials, you’re also improving access to care for your patients through capabilities like online scheduling options that are available 24/7. Access is further improved by reducing the friction around patient billing by leveraging real-time eligibility verification to deliver accurate patient estimates at registration. Increase staff efficiencies by improving registration accuracy. Correct discrepancies and errors in real time to avoid costly denials and rework. -
43
MD-Staff
Applied Statistics & Management
MD-Staff is a cloud-based, AI-enabled, and user-friendly credentialing software solution backed by over 30 years of innovation. Over 2,000 clients world-wide use MD-Staff to automate credentialing, track clinical privileges and advanced patient safety initiatives. MD-Staff is an industry proven software solution backed by personalized service. MD-Staff’s Aiva™ Credentialing engine uses AI and deep automation to slash application processing times while flagging practitioner files with issues. MD-Staff automates primary source verifications using web crawlers, Pronto reference verifications, and deep integrations with many primary sources such as the NPDB, OIG and SAM. MD-Staff’s privileging module provides a simple drag-and-drop user interface for creating and managing both core and laundry list-style privilege delineation forms. -
44
Accord
Accord
Measuring the numerous periods that determine eligibility requires focused resources on ACA fundamentals. Multi-source data assembled on the best ACA platform in the industry means your 1094-C & 1095-C are accurate. Prevents incorrect forms from being issued to employees by instantly examining code combinations. Accord has created and continues to evolve a first-class platform for employers and licensees to manage the complexities of ACA reporting. View your dashboard where ongoing eligibility and affordability data associated with multiple measurements, stability, and wait periods are displayed. Generate all necessary ACA reporting and filing from our easy-to-use interface, no software to load and all upgrades come online seamlessly. Be prepared for IRS inquiries by maintaining diligent internal audit management. With easy access to historical data and your Accord team, audits are quickly performed when needed. -
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I-Med Claims
I-Med Claims
I-Med Claims provides top-tier medical billing and revenue cycle management (RCM) solutions, trusted by healthcare practices across the U.S. We handle all aspects of RCM, from eligibility verification to denial management, helping practices streamline operations and maximize reimbursements. With billing plans starting at just 2.95% of monthly collections, we offer affordable solutions that enhance financial workflows, maintain compliance, and improve cash flow. By outsourcing billing to us, practices can focus on patient care while benefiting from reduced claim denials and faster payments. -
46
DocVilla
PS3G
DocVilla is a comprehensive, multi-specialty, mobile-friendly, HIPAA-compliant cloud-based health technology platform that integrates EHR/EMR, telehealth, e-prescribing, patient engagement, medical billing, analytics and reporting, direct primary care, inventory management, remote patient monitoring, and more into a unified, configurable suite. Providers simply sign in to access a customizable electronic medical records system with secure messaging, video visits, controlled-substance e-Rx, and a free patient portal for scheduling, payment, and secure communications. The platform streamlines workflows by automating eligibility checks, claim submissions, charge posting, insurance eligibility and claim filing, ERAs/EOBs, medical dictation and speech-to-text, patient consent forms, lab integrations, electronic fax, and automatic appointment reminders.Starting Price: $100 per month -
47
FundOfficeXG
basys
FundOfficeXG from basys can dramatically increase your benefits administration efficiency by tracking every aspect of your contributions accounting and eligibility operations. The versatile and powerful FundOfficeXG administration suite from basys, coupled with convenient online self-service portals, provides everything you need to manage, track and calculate eligibility and employer contributions. FundOfficeXG includes a wide range of enhanced processing features, giving you an end-to-end solution for managing both remittance and collection of benefit contributions and eligibility for your members and their families – all built on our secure, time-tested calculation engine with highly configurable parameters you control. FundOfficeXG can simplify even the most complicated tasks, including multiemployer health eligibility, hour bank administration, retiree health benefits, premium billing and COBRA processing. -
48
OMS C3
Objective Medical Systems
OMS C3® RPM Platform gives you the process, equipment, and software to provide care where and when it’s needed most, wherever your patients are, without burdening your workflow. Our OMS C3® platform streamlines the processes of preventive services with intelligent eligibility verification, automated patient outreach, and easy-to-use checklists, documentation, and billing and coding support. OMS C3® platform plugs seamlessly into your current workflow to help it work harder, guiding staff through care plan creation, simplifying patient engagement, and automatically logging patient interaction time. Remote monitoring of physiologic parameters like weight, blood pressure, pulse oximetry, respiratory flow rate, etc. Set-up and patient education on the use of equipment. Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication. -
49
ArcheMedX Ready
ArcheMedX
Pharma and biotech trust Ready by ArcheMedX to better equip their trial teams, improve decision making, and reduce study delays. Prevent the most common sources of study delays, by better understanding which sites and teams are most prepared to start and effectively conduct the study. Reduce time and costs spent resolving issues, especially early in the trial. Confidently know which sites truly understand your patient eligibility requirements. Enjoy knowing they’ll be better equipped to enroll eligible patients sooner, hit enrollment targets, and avoid screen failures. With detail down to each individual and study objective, you can know with confidence that trial team members truly understand the specifics of the protocol. Predict where risks lie so you can prevent them, and experience fewer deviations overall. -
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DRM Plus provides VA dental health care facilities with an intuitive, user-friendly Windows interface for VA Dental providers to manage the dental care workflow in the treatment of eligible Veteran patients.
