Alternatives to SKYGEN Provider Data Management
Compare SKYGEN Provider Data Management alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to SKYGEN Provider Data Management in 2026. Compare features, ratings, user reviews, pricing, and more from SKYGEN Provider Data Management competitors and alternatives in order to make an informed decision for your business.
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CredentialStream
HealthStream
Finally, a single solution to affirm and continuously assess medical provider competency. Ensure excellence in care by offering the industry-leading software for enrolling, onboarding and privileging to continuously evaluate your providers. CredentialStream® incorporates patented technology that provides everything necessary for requesting, gathering, and validating information about a provider, all to establish a reliable Source of Truth for downstream processes. With a modern platform that is continuously updated, along with best-practice content libraries and industry-leading data sets, CredentialStream stands out as the most comprehensive provider lifecycle management solution available. Say goodbye to the headaches, hassles and manual processes that slow you down. Say hello to a modern, continuously updated platform, best-practice content, and industry-leading data that all works together to get your providers where they need to be— seeing patients. -
2
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. -
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H1
H1
At H1, our mission is nothing short of creating a healthier future worldwide by unlocking and democratizing global access to critical expertise, HCP information, claims data, ground-breaking research and discoveries, and connected insights for all – doctors, researchers, industry and, ultimately, patients – bringing everyone closer together to advance medicine and clinical outcomes. Insights derived from H1’s solutions help life sciences and other healthcare organizations accelerate the development, launch, and dissemination of life-saving treatments, drive meaningful engagements with key opinion leaders, and help ensure equitable access to healthcare services. -
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symplr Payer
symplr
Save on costs, eliminate data silos, and deliver better outcomes for your members with a unified, automated provider data solution. symplr Payer provides a single source of truth for provider data that is consistently reconciled and validated against primary sources. It improves data quality, access, and transparency. Further, it eliminates duplicate requests for information, reducing provider frustration. Using symplr Payer as the enterprise-wide hub for provider data, payers can feed timely, accurate information to other downstream systems. Our highly configurable, end-to-end provider data management solution manages all pre-contract and renewal contract negotiations. Standardize and streamline your contracting processes, while capturing contract details such as sentinel events, trigger dates, configuration efforts, process steps, fee schedule info, and more. symplr Payer’s unique design allows your organization to consolidate contracting and credentialing. -
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symplr Provider
symplr
symplr Provider credentialing software helps create a single source of provider data, shrinks turnaround times, and shortens revenue cycles, all while prioritizing patient safety. symplr Provider credentialing software makes data gathering, secure access, reporting, and ongoing compliance less burdensome for providers, credentialing staff, and internal approval committees. Our customers report a 20% reduction in credentialing timelines, including a 50% reduction in committee review meetings. Collect, verify, store, and share provider lifecycle data and documents in one automated, user-friendly hub, resulting in time savings and cost containment. With a built-in payer enrollment module, you can enroll providers with payers and easily track applications step-by-step, to get reimbursed faster. Leverage automation to gather data from hundreds of primary sources and auto-check for expired/suspended licenses, NPDB, DEA, SAM, and more. -
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Medallion
Medallion
Medallion is the first solution for healthcare companies to fully offload their clinician operations—state license management, payor enrollment, credentialing, and more—in one modern management platform. By empowering digital health companies, hospitals, payers, and other organizations to credential, license, and monitor their providers with ease from one modern platform, they eliminate time-consuming and laborious tasks that ultimately increases accessibility of care to millions of patients nationwide. Since inception in 2020, Medallion has saved over 100,000 administrative hours for leading healthcare companies like Cerebral, Ginger, MedExpress, Oak Street Health, and hundreds more, and has raised $50M from leading investors like Sequoia Capital, Spark Capital, Optum Ventures, Elad Gil, and Peter Reinhardt. -
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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. -
8
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. -
9
Madaket
Madaket Health
Get hours back in your day and millions back in your pocket with our automated solutions. Access the key players—providers, payers, and partners—and the real-time, accurate data you need to never miss a beat in care delivery. We handle all the complex connections across thousands of payers. All you need to know is fast and easy enrollments to any payer starts here. The cloud has never looked this good. Central command to manage, store, and share provider data in real-time—connected everywhere it needs to be. Provider verification made simple. You request it, our platform processes it fast. -
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Change Healthcare
Change Healthcare
Our platform builds consistency, continuity, and scalability across our integrated portfolio, enabling our customers to improve operational efficiency, decision-making, and patient outcomes—and enabling innovation as our healthcare system evolves. With innovative data and analytics, plus patient engagement and collaboration tools, the Change Healthcare platform helps providers and payers optimize workflows, access the right information at the right time, and support the safest and most clinically appropriate care. We enable access to data and facilitate the interoperability of data between sources to support CMS patient access and interoperability rules, as well as enable real-time access to clinical documents to help better manage risk adjustment, improve HEDIS scores, and support accurate payments with faster adjudication. -
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symplr Directory
sympr
symplr Directory is a centralized provider data management solution designed to streamline healthcare operations and improve patient experiences. By consolidating and maintaining accurate provider data in a single platform, symplr Directory helps healthcare systems reduce errors, enhance network retention, and improve the accuracy of patient-provider matching. The platform enables seamless integration with electronic health records (EHRs), allowing providers to spend less time on administrative tasks and more time delivering care. It also helps healthcare organizations reduce patient leakage, improve revenue cycles, and increase patient acquisition through a user-friendly, digital front door. -
12
Verisys
Verisys
For three decades, Verisys has served some of the largest and most complex healthcare organizations in the United States, credentialing more than two million events annually. Our provider credentialing services get and keep you compliant. Credentialing and re-credentialing providers is a complex process for health plans, hospitals, and health systems. Physicians are licensed in multiple states and provide telehealth services across state lines. This requires license verification with each state board and compliance with that state’s unique regulations. Identity matching is complicated due to physicians having the same name, maiden names, alias names, nicknames, or abbreviated names. To get a complete view, each physician must be screened, and credentials verified against thousands of primary sources. We can help you do anything from a simple provider credential search to implementing a full end-to-end credentialing solution. -
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CertifyOS
CertifyOS
CertifyOS delivers API-first credentialing, licensing, and enrollment to payors, health systems, and rapidly-scaling digital health companies. We unlock insights and power performance for clinicians, teams, and organizations. Build best-in-class provider networks with our one-click credentialing solution. Real-time, automated NCQA-compliant credentialing to scale provider networks. Automated ongoing monitoring to ensure your provider networks remain compliant. We take the guesswork (and paperwork) out of licensing–so you can scale to new markets, seamlessly. Get in the network and get reimbursed faster, so you can get back to care. Streamlined processes for cross-state licensure in all 50 states for any license category. Streamlined payor enrollment process to get providers in-network in new markets. Track enrollment progress with our individualized dashboards. Leverage our best-in-class methodology to clean, normalize, and enhance your provider data. -
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Provider Credentialing
Visualutions
Our Provider Enrollment and Credentialing services enable practice providers to get and remain enrolled for the services they provide by ensuring that payers have the data they need to process claims for the services you provide. New Provider Enrollment. Establish relationships with new or missing payers to optimize revenue opportunities. Re-credentialing. Commercial payers and hospital applications. Annual Maintenance. CAQH Maintenance and Attestation, re-validations for Medicaid and Medicaid, Expirables: DEA, License, Malpractice, etc. Expert Credentialing Services For Healthcare Physicians Trying to manage and understand the required credentialing for your health center can be time-consuming, and take up valuable staff resources. As a full service revenue cycle management company we understand the impact provider credentialing can have on your cash flow. Our provider credentialing service includes options for new and existing providers. -
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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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Conexia
Conexia
Provide authorizations, claims processing and payment in real-time at the point of care. Enhance care coordination and improved outcomes to lower medical cost while streamlining administrative processes. Engage providers at the point of care to capture and share data in real-time resulting in an unparalleled exchange of health information. We partner with our clients to implement risk management strategies that result in better outcomes with lower costs. We strive to improve the user experience for everyone involved in the ecosystem. We deliver a minimum 3:1 ROI for our clients to allow them to optimize their resources. Conexia has developed a core technology platform (ONE) that is customizable to meet the diverse regulatory requirements and operational processes for each client in each geography. In most cases, our initial implementation is an overlay on the payer’s existing technology ecosystem to create real-time processes. -
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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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CAQH
CAQH
CORE brings the industry together to accelerate automation and develop business processes that streamline healthcare for patients, providers and health plans. Drawing on the industry's most trusted source of provider and member data, CAQH enables healthcare organizations to reduce costs, improve payment integrity and transform business processes. In the ever-evolving landscape of healthcare, continuous improvements in payment and claims processing systems are vital. The nation’s providers and health plans trust CAQH to collect and manage professional information, verify primary sources, and monitor for sanctions. The result, is streamlined administration, greater regulatory compliance, and better provider data management. -
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Harris Affinity RCM
Harris Healthcare
Optimize transforming patient care into cash with clear insight into every financial decision. Affinity Revenue Cycle Management reduces the need for bolt-on applications thus lowering an organizations overall cost to collect from both payers and guarantors. Bringing together the best of healthcare software solutions under one integrated platform. Lower the cost to collect by automating the revenue cycle and expediting claim processing. Harris Affinity helps healthcare organizations focus on what matters most: patient care. We do this through our RCM software, which helps automate the revenue cycle, expedite claim processing and lower the cost to collect. Use electronic transactions (EDI) to send & receive data directly to a payer or clearinghouse. Unlock screens without needing to contact support. Analyze data with easy to read dashboards. Optimize complex scheduling procedures. Send automatic appointment reminders to patients. -
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EchoOneApp
HealthStream
EchoOneApp is a legacy platform supported by HealthStream. New customers should check out CredentialStream. As a current customer with EchoOneApp, you can take advantage of additional modules that will further optimize your platform and processes. These are just a few of the additional tools available to you. Contact your sales representative for more information or to discuss a migration to CredentialStream platform! Enrolling providers with payers, networks, and in contracts has never been more important. Meeting deadlines for enrollment applications and providing accurate provider data is critical to ensure that providers will be enrolled with the requested payers to receive reimbursements. Submit paper and online payer applications with validated provider data directly from EchoOneApp Enroll. Automate the enrollment process with the most advanced tools in the industry to reduce enrollment timelines and aging receivables. -
21
mydimed
mydimed
Preventive medicine is the future of medicine. We help healthcare providers identify and intervene with high risk patients. Helping clinicians keep patients safe. Lowering ADR inside Healthcare providers facility Between 5%-10% of hospitalized patients have an ADR during their hospitalization, an adverse event that increases risk, increases length of stay, and denies reimbursement from payers for additional hospitalization days and procedures. These Adverse Drug Reactions can be prevented. Helping ACO's, HMO's and payers to reduce preventable ER visits and hospitalization. Lowering ADR among the population with emphasis on the Elderly. Between 15%-30% of all 65+ years old patients ER visits are due to an ADR. These visits are often accompanied by hospitalization. These Adverse Drug Reactions are preventable. What We Do. Advanced Science Multi disciplinary science. Our technology is based on medical research and advanced data science, a powerful combination that yields better -
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PayerPrice
PayerPrice
PayerPrice is a healthcare data analytics platform that provides comprehensive insights into negotiated rates between payers and providers across the United States. By aggregating and analyzing data from all 50 states, specialties, and practice sizes, PayerPrice enables healthcare organizations to benchmark commercial rates, optimize managed care contracting, and enhance revenue cycle integrity. The platform offers tools for in- network analysis, rate benchmarking, and payment auditing, supporting stakeholders such as hospitals, providers, contracting consultants, and healthcare innovators in making informed decisions. -
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Infosys HELIX
Infosys
Driving AI - first as a business strategy for payers, providers and PBMs with products and platforms which are built on AI and runs on cloud. A “healthcare digital platform” is the integration of applications and emerging technologies to provide a tailored healthcare solution that drives business outcomes—a significant modern and accelerated approach to disintermediate legacy core administration processing systems (CAPS). To better understand the role of digital platforms and emerging technologies in achieving business objectives, the impact of digital platforms on healthcare payer KPIs, and the relative attractiveness of healthcare platforms, Infosys, in partnership with HFS, reached out to 100 C-suite healthcare payer executives in US. -
24
CredentialMyDoc
HealthStream
Amazingly simple to use, CredentialMyDoc walks you step-by-step through the credentialing and enrollment process to help you stay focused on running a successful healthcare organization. Today’s medical groups face a unique set of challenges including sometimes having just one individual in charge of all onboarding, credentialing, and enrollment tasks. To make matters worse, that one person must often juggle a cobbled together mix of spreadsheets and software to get the work done! But it doesn’t have to be so hard. Automated, web-based provider enrollment, onboarding, reporting, expirables management and credentialing services for growing medical groups. Features include payer management, provider portal, expiration management, form generation, reporting, workflow tools and more. -
25
Kyruus Connect
Kyruus Health
Industry-leading provider search, scheduling, and data management solutions that help health systems match patients with the right providers and optimize patient access enterprise-wide. Our provider search and scheduling solutions—built on the Kyruus Connect provider data management platform—enable health systems to optimize patient-provider matching; boost patient acquisition and conversion; and deliver a consistent patient experience across key points of access. Differentiate your digital presence with a modern patient access experience that enables people to find the right care options for their needs and book easily online. Connect consumers with the right providers through your call center by empowering agents with the technology they need to match and schedule patients more precisely. Boost patient retention by giving providers and staff new visibility into the providers in your network and enabling patients to leave their appointment with the next one booked. -
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Post Acute Analytics
Post Acute Analytics
Post Acute Analytics (PAA) leads the transformation of care delivery to improve patient lives by actioning real-time insights across a connected healthcare system. This is possible by implementing our AI-based, turnkey integration solution – PAA Anna™ Platform – with healthcare providers’ and payers' systems. Anna permits total transparency of their patients’ journeys through post-acute care in real-time and enables proactive intervention to prevent negative quality and cost events from occurring. Through proprietary analytics, turnkey integration engine, and medical leadership, our solutions ensure that providers and payers can make real-time decisions that improve patient outcomes while reducing total cost of care. -
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Anomaly
Anomaly
Anomaly is an AI-powered payer management platform built for healthcare revenue teams to “know your payers as well as they know you.” It surfaces hidden payer behaviors by decoding complex rules and detecting payment patterns across hundreds of millions of healthcare encounters. The core engine, Smart Response, continuously analyzes payer logic, adapts to shifting policies, and embeds learnings directly into existing revenue cycle workflows to provide real-time denial prediction, assisted claims correction, and alerts to revenue risks. By integrating payer-specific insights into existing systems, users can anticipate revenue loss, negotiate payer contracts from a stronger position, and proactively correct or reverse denials before they impact cash flow. The system helps level the playing field between providers and payers by turning opaque billing logic into actionable intelligence and embedding it into day-to-day financial operations. -
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MedScout
MedScout
MedScout is a revenue acceleration and sales intelligence platform designed specifically for medical device, diagnostic, and life sciences companies to improve how their commercial teams identify opportunities and execute sales strategies in healthcare markets. It transforms large volumes of healthcare claims data into actionable insights that sales representatives, marketing teams, and sales leaders can use to prioritize the right physicians, facilities, and healthcare systems to target. It aggregates multiple data sources, including Medicare and commercial payer claims, public healthcare data, proprietary datasets, and the company’s existing CRM data, creating a unified view of the healthcare landscape and enabling teams to analyze procedure volumes, diagnosis trends, prescription activity, referral networks, and payer mix for individual providers or institutions.Starting Price: Free -
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Inovalon Payer Cloud
Inovalon
Improve clinical quality metrics, risk score accuracy, patient and provider engagement, patient outcomes, operational transparency, and economic performance, all with one comprehensive suite of software solutions. The Inovalon Payer Cloud transforms traditional workflows into data-driven processes that support your health plan’s key objectives. Backed by industry-leading analytics capabilities, our converged SaaS solutions deliver the member-centric insights and speed, accuracy, and flexibility you need to stay ahead in this diverse, ever-changing marketplace. Inovalon's SaaS suite of healthcare payer solutions delivers member-centric insights and actions to help health plans measure, manage, and improve healthcare outcomes, economics, and quality of care. Payer solutions to improve member care and outcomes while achieving greater operational performance and efficiency with sophisticated analytics and dynamic business intelligence. -
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Valer
Valer
Valer’s technology speeds and simplifies prior authorization and referral management by automating submissions, status checking, verification, reporting, and EHR synchronization across all mid-to-large-sized healthcare settings, specialties, and payers from one platform and portal. Valer is the all-specialty, all-payer technology solution designed around your needs, not ours. Unlike off-the-shelf products that limit specialties, service lines, and payer mix (that don’t even automate submissions), Valer is explicitly customized to fit your needs. Because Valer is so easy to use, the dashboard increases staff productivity, simplifies staff training, and measures staff and payer performance across all service lines to enable continuous improvement. Valer doesn’t just connect to some of your payers for some of what you need. We link to all payers for all specialties, service lines, and care settings with real-time payer rule updates. -
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Claim Agent
EMCsoft
EMCsoft’s Claims Management Ecosystem assures that healthcare providers and billing companies deliver clean claims to insurance payers for proper claim adjudication. It is the integration of our versatile claims processing software Claim Agent and comprehensive fitting process called the Four Step Methodology into your claim adjudication process. This approach enables, supports, and automates your work process to maximize claim reimbursement. Request our free online demo for a great introduction into the functionality/features of Claim Agent and how it fits into your claim adjudication process. Claim Agent scrubs and processes your claims from the provider system to the insurance payers in a efficient, cost effective, and timely manner. The software is compatible with any system making implementation process quick and simple. We provide custom edits, bridge routines, payer lists, and work flow settings that are unique to each user. -
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Myndshft
Myndshft
Experience a seamless workflow by having real-time transactions driven within existing technology platforms. Providers and Payers reduce time and effort by up to 90% for benefits and utilization management. Eliminate the current benefits and utilization management black box – eliminating confusion for patients, providers and payers. Self-learning automation and fewer clicks mean more time for patients, providers and payers to focus on care. Myndshft eliminates the quagmire of point solutions by providing a unified, end-to-end platform for in the moment payer-provider-patient interactions. Myndshft dynamically updates automated workflow and rules engines based on the actual responses and results from provider-payer interactions. Our technology continuously adapts to the rules in use by payers. The more you use it, the smarter it gets. A library of continuously-updated thousands of rules for national, state and regional payers. -
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MedInsight
Milliman MedInsight
Founded in 1998, Milliman MedInsight® is a leading provider of healthcare data and analytics, trusted by over 300 payers, providers/ACOs, employers, and government agencies worldwide. Our comprehensive suite of analytics and data solutions empowers organizations to leverage healthcare data for informed decision-making and improved clinical and financial outcomes. With deep industry expertise and advanced technology, we deliver actionable insights into healthcare utilization, costs, quality, and performance. From risk management to value based care, Milliman MedInsight empowers stakeholders to navigate the complexities of the healthcare landscape and achieve sustainable success. -
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NaviNet Open
NantHealth
As an organization that prioritizes value-based care, your ability to communicate across a flexible, extensible platform is critical. NaviNet Open is one of America’s leading payer-provider collaboration platforms, facilitating provider engagement and generating trustworthy, actionable data throughout the continuum of care delivery. A secure multi-payer platform, NaviNet Open enhances communication, boosts operating efficiency, cuts costs, and improves provider satisfaction. It lets payers and providers exchange vital administrative, financial, and clinical information in real time. For NantHealth, security is a priority. HIPAA compliant and steadfast in our values, our demonstrated commitment has led us to hold EHNAC HNAP accreditation since 2006. NaviNet Open is HITRUST certified, having met key regulations and industry-defined requirements. It appropriately manages risk regarding third-party privacy, security and compliance. -
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TreatWrite
TheraTech Pathways
TreatWrite is a visionary, responsible, web-based service that produces quality, accountable healthcare documentation, improves the patient care process, improves patient health, enhances the clinical provider experience, supports provider reimbursement, and optimizes allied health practices to conserve payer resources. Progress tracking technology data opens future doors of opportunity for TheraTech to lead the allied health professions into Learning Healthcare. Planned product expansions include the addition of an allied health performance quality center. The performance quality center, coupled with progress tracking data, offers exciting possibilities to define service delivery efficiencies that conserve payer resources and grow a culture of constantly improving healthcare service and delivery models. Customizable templates, and data transfer from document to document make TreatWrite efficient.Starting Price: $49.00 -
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HexIQ
HexIQ
The HexIQ software provides fast and easy access to negotiated rate data and tools that help users search, download, and analyze complex healthcare reimbursement rates for any code, payer, provider (NPI), or tax identification number (TIN) of interest so they can leverage transparency in coverage requirements to inform business decisions and negotiations. It ingests hundreds of machine readable files (MRFs) from payers every month, cleans and enhances the data with provider names, addresses, and network relationships, and updates it regularly so users can benchmark their negotiated rates against peers in the same specialty and region without manual Excel manipulation. Advanced search features let users filter by code, specialty, state, place of service, payer, NPI, or TIN and download results in CSV format for further analysis, while built-in analytics and visualization tools show rate distributions, average and mode rates, and contracted provider networks to reveal market insights.Starting Price: $25 per month per code -
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MMIT
MMIT
MMIT (Managed Markets Insight & Technology) offers a comprehensive healthcare market access and analytics platform that centralizes high-value coverage, policy, restriction, payer, and real-world data to help life sciences and healthcare organizations understand and act on how therapies are covered, reimbursed, and accessed across the U.S. healthcare system. The MMIT Platform serves as a single point of entry where users can explore integrated solutions, including formulary, medical policy, and restriction intelligence, payer landscape and enrollment data, coverage search tools, API access, and analytics, organized by workflow and strategic priority to support commercialization, competitive analysis, and patient access strategy. It provides detailed insights into drug coverage status, restriction rules, payer behavior, and market segmentation, with features that help evaluate patient access barriers, inform field engagement, predict policy shifts, and integrate coverage data. -
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Talix
Talix
The Talix platform powers intelligent workflow applications that enable risk-bearing healthcare organizations to succeed in the age of value-based care. Our workflow solutions for payers and providers require intelligent underlying technologies to work in unison and at scale. We’ve engineered the Talix Platform to support the needs of thousands of end-users, anywhere in the world simultaneously. Moreover, our platform architecture enables multiple SaaS application solutions in order to harness the efficiencies derived from being able to process millions of patient charts and encounter data. The Talix Platform is comprised of several technology components, intricately linked, to power software applications at scale for healthcare payers and providers. These components form the building blocks of artificial intelligence (AI). -
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Turquoise Health
Turquoise Health
Turquoise Health delivers a comprehensive suite of solutions built around healthcare price-transparency and contracting workflows, offering modules such as Clear Rates Data (which aggregates over a trillion provider, payer, professional, drug, and device rate records covering institutional and professional services) and Clear Contracts (a centralized cloud application that supports contract creation, negotiation, and storage for payers and providers). It also includes Compliance+ to help organizations remain compliant with machine-readable file requirements and Good Faith Estimate rules, Analytics tools to benchmark and query market-level rate data, Custom Rates extracts tailored for specialty healthcare segments, Standard Service Packages (pre-built bundles of common procedures), Search and Care Search dashboards for rate discovery and comparison, and a Turquoise Verified program enabling providers and payers to publish and manage price transparency data. -
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Rhapsody
Rhapsody
Build the interoperability solutions you need. Adapt to any modern environment with Rhapsody, a flexible toolbox that enables your team to build connections quickly and securely. Support the highest level of service with Rhapsody by ensuring that healthcare data is flowing where, when, and how your unique environment demands. Design flexible solutions to every connection need. Streamline workflows with a solution that is infinitely configurable and purpose-built for healthcare. Create intricate integrations with a robust toolkit that has been proven across the world. The platform is represented globally with customers in 36 countries. Develop cutting-edge FHIR-based interfaces simply and easily with REST and FHIR-specific JSON support. Security is of primary concern and is built into every part of the product, with a view to safeguarding any protected health information (PHI) that passes through the engine. -
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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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Bottomline Paymode
Bottomline
Paymode, Bottomline’s business payments network, securely processes over $425B annually. Paymode has long been recognized as a leading business payments network, bringing benefits to both payers and suppliers. Over 550,000 verified businesses use Paymode to lower their cost of payment processing, reduce the risk of fraud, and deliver significant time savings for AP and AR functions. Bottomline customers slash processing time by over 50% through digitizing payments, streamlining approvals, and automating receipt and reconciliation processes. -
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BillFlash
NexTrust
Eliminate headaches when you choose BillFlash as your one-stop shop for Billing & Payment Services that work together for you. Send cost-saving paperless bills securely online through our site MyProviderLink.com. Customize accepted payment methods and messages. Expedite online payments through MyProviderLink.com. Payers (patients or customers) pay you online at our site MyProviderLink.com. Payers can send messages to you with their online ePay. ePays are included in your consolidated Payments Report. Send professionally printed bills via USPS First-Class Mail. Customize accepted payment methods, messages, and color. Simplify processing with payment coupons and return envelopes. Process walk-in, mail, and phone payments. Payers can see OfficePays online at MyProviderLink.com. OfficePays are included in your consolidated Payments Report. BillFlash integration with your Billing Application further reduces the steps for you to complete your work. -
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The Physician Empowerment Suite
SE Healthcare Quality Consulting
SE Healthcare’s Physician Empowerment™ Suite, a set of specialty-specific data analytics tools, contains solutions that empower your practice to be more successful in an increasingly competitive market. Get the reimbursement you deserve from payers. Make your practice more attractive to networks. Improve your reputation and transparency to convert website visitors into new patients. Retain current patients by uncovering issues and creating a better patient experience. Enhance workplace culture for physicians. Enhance patient engagement and satisfaction. Address critical issues like physician burnout, quality, and safety. Insights into hidden problem areas to improve patient experience, patient engagement, quality, safety, and overall practice performance. -
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Jopari ProPay
Jopari
Jopari ProPay is a cloud-based payment processing solution for healthcare payers. It offers a comprehensive suite of payment methods, including EFT/ERA, virtual card payments, and paper checks, as well as a self-service provider portal for EOB/R delivery and support for compliant 835 delivery for eBilling transactions. Jopari ProPay helps healthcare payers to eliminate paper and reduce operational expenses by streamlining their payment and remittance processing. It also allows payers to outsource their payment processing, which can free up their resources to focus on other core tasks. For providers, Jopari ProPay offers a multi-tiered choice of payment delivery options, so they can choose the method that best meets their needs. Providers can also access a self-service portal to view their EOBs/Rs and track their payments. Jopari ProPay is a secure and compliant payment processing solution that is trusted by over 50,000 ERISA health plans and fully insured groups. -
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HealthEC
HealthEC
HealthEC’s best population health management platform, comprising our care management module CareConnect™ and our analytics module 3D Analytics™ - is designed to elevate quality of care and patient experience by overcoming the healthcare industry's toughest data challenges. Conquer system chaos with a universal data warehouse of normalized claims, clinical, and SDoH data, from any source. CMS certified for reuse. Eliminate workflow disruption with integrated, customizable care plans, decision-support tools and robust care management support. Deliver patient-centric care by seamlessly coordinating with community resources and addressing social determinants of health. Inform strategies with actionable insights at the diagnosis, provider, practice, and organizational levels, presented in clear dashboards or at the point of care. Enhanced MCO performance reviews and CMS interoperability rule compliance. -
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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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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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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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HRA
HRA
HRA® (Healthcare Research & Analytics) is a full-service healthcare market research agency that provides unique access to a pure, proprietary panel of physicians, payers, patients, caregivers, pharmacists, and other key stakeholders to support your brand strategy. More than 100,000 community-based healthcare professionals and key opinion leaders (KOLs), payers, pharmacists, patients, and caregivers who provide unique insight on issues that are critical to your success. Leveraging 75+ years of combined experience partnering with healthcare companies to deliver insights and guidance for pre-launch, launch, and post-launch success. Supporting your commercial needs through brand strategy development, execution and real-time assessment of stakeholder attitudes, behaviors, and insights. Offering strategic solutions for a breadth of healthcare clients, HRA® combines clinical and commercial expertise, powerful connections, and creative solutions to keep you ahead of the healthcare community.
