Alternatives to Virtual Examiner
Compare Virtual Examiner alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to Virtual Examiner in 2026. Compare features, ratings, user reviews, pricing, and more from Virtual Examiner competitors and alternatives in order to make an informed decision for your business.
-
1
XpertCoding
XpertDox
XpertCoding is an AI-powered medical coding software by XpertDox that uses advanced AI, natural language processing (NLP), and machine learning to code medical claims automatically within 24 hours. It automates the coding process, enabling faster and more accurate claims submissions to maximize financial gains for healthcare organizations. Features include minimal human supervision, easy EHR connectivity, flexible cost structure, a significant reduction in denials and coding costs, a HIPAA-compliant business intelligence platform, risk-free implementation with no initial fee and a free first month, and higher coding accuracy. XpertCoding's autonomous coding solution helps healthcare providers and organizations get paid faster, accelerating the revenue cycle and allowing them to focus on patient care. Opt for XpertCoding for a reliable and accurate medical coding software solution for your practice. -
2
Speedy Claims
SpeedySoft
Speedy Claims became the top CMS-1500 Software by providing the best customer service imaginable to our thousands of clients all over America. Medical billing isn't the kind of thing most people get excited about - it is just a tedious task you have to do. But while it will never be a fun task, it doesn't have to be as difficult or time consumimg as it is now. With Speedy Claims CMS-1500 software you can get the job done quickly and easily, allowing you to focus on the things you love about your job, like helping patients. With a simple interface, powerful features to eliminate repetitive work, and unrivaled customer support, it's simply the best HCFA 1500 software available on the market. A powerful built-in error checking helps ensure your HCFA 1500 form is complete and correctly filled out, preventing CMS-1500 claims from being denied.Starting Price: $29.95 per user per month -
3
Cloud Claims
APP Tech
Improve claim outcomes with streamlined First Notice of Loss (FNOL), claim processing and flexible reporting. INCIDENT BASED CLAIMS MANAGEMENT Effective claims management is about more than simply managing claims outcomes. It is about having an automated process that ensures efficiency and accuracy across the organization, getting timely notice of losses, and taking swift action are keys to success. The incident-based approach of Cloud Claims covers all accidents and losses, delivering a complete picture of loss to executives and claims managers. Cloud Claims by APP Tech is an integrated solution that is highly configurable, with actionable reports to guide decision-making and a friendly UI so you can get work done faster and more confidently. Cloud Claims runs in the cloud, so there’s minimal IT burden and no installation required — just simple configuration, effortless system upgrades, best-in-class security, and the ability to scale quickly.Starting Price: $2,500 per month -
4
iVEcoder
PCG Software
iVECoder, the decisive code tool with payor intellect, was built on the same intelligence of PCG's Virtual Examiner® claims review engine that healthcare payors worldwide have been using for 25 years. Users can enter multiple codes, and in just a single click, receive multiple answers on a single page. Ramp up coding accuracy and boost your bottom line by using the same billing and coding intelligence platform the payors use. iVECoder is PCG's Virtual Examiner® (VE) claims review engine. This advanced rules based engine —with 45 million edits— is used by healthcare payors throughout the USA and abroad. VE tells payors what to deny or pend for review. -
5
Artsyl ClaimAction
Artsyl Technologies
Processing high volumes of medical claims through intelligent automation helps businesses deliver higher levels of efficiency that does more than reduce costs. For organizations that rely on manual processes, managing medical claims documents and data is labor-intensive and error-prone, injecting unnecessary risk into the process. With ClaimAction medical claims processing software from Artsyl, your organization can improve margins, minimize touch points and eliminate processing bottlenecks. Capture medical claims data without the need for custom software coding. Route claims data and documents automatically to the right claim examiner, based on your business rules. Configure complex benefits and reimbursement rules to streamline processing and reduce payment delays. Respond quickly to changing government regulations and support data, document and process compliance. -
6
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. -
7
Pro Health Billing
Pro Health Billing
Pro Health Billing's Medical Billing Software has simple tools that help with data entry, automated task that take only minutes to setup and very easy to use. You can print your first claim in 20 minutes! With tools like Auto-Codes, Repeat Last Claim and Auto Co-Pays. Pro Health Billing is a wrist saver! Small Medical Practice Companies love Pro Health Billing's Claim and Patient Scheduling Modules. Together they become a powerful tool that cuts your workload almost in half! With tools like Non Payment and Non Billed Alerts your revenue will increase as your workload shrinks! 'Pro Health Billing' is the best medical billing software to help you bring in more income and quickly! With our Claim Catcher Dashboard and our industry leading 'Revenue Cycle Manager' to fix those alerts, claims never go unnoticed! Know the status of all your claims with just a glance. -
8
ediLive!
Texas Medical Systems
ediLive! claims processing software works with any NSF, ANSI, or print file claim image, allowing the HIPAA complaint transmittal of any practice management software's claim file. Additionally, ediLive! customers benefit from real-time connectivity and claim collections workflow management. ediLive! attaches all claim status messaging from payers directly back to the claim for easy follow-up and correction, taking all incomplete claims and compiling them into a single on-screen worksheet for fast corrections and resubmittal. If you use ediLive!, we have a wonderful product call claims scrubber that can help you to get your claims paid – not only faster, but better! Call our office to schedule a free on-line demonstration. We can scrub the first 100 claims for you as a free trial. Every coding error you make costs your practice money. -
9
Context 4 Health Plans Suite
Context4 Healthcare
Protect the integrity of your health plan and determine accurate pricing with the Context4 Health Plans Suite, our modular, cloud‑based technology platform. Immediate, actionable, and defensible Fraud, Waste, and Abuse (FWA) detection built by our team of certified clinical, dental, and health benefits experts. Accurate data and cutting-edge cloud technology combine to create a proven and defensible medicare reference-based pricing (RBP) solution. More than 100 healthcare data sets, with professional support to optimize efficiency and compliance. Advanced medical coding software designed to expedite claim submission and minimize denials. Our cloud based Payment Integrity Platform utilizes our proprietary analytics engine to identify coding errors, medical necessity, unbundling, fraud-waste-abuse, audit risks, pricing and other aberrations that can impact your business. -
10
Dr. Bill
Grouse Software Labs
Dr. Bill makes billing on the go easy and pain free. Add a patient in as little as 3 seconds and submit a claim with just a few taps. Remove the pain of manual data entry, paper, index cards and clunky software. Take a picture of a patient label and log your claims in seconds. We alert you in real-time with tips and suggestions to help you maximize your billing. No need to memorize codes. Select from a list of favorites or simply search by keyword. Our easy-to-use app makes billing simple and convenient. As new patients roll in, Dr.Bill keeps up. All it takes is a simple snap of a patient’s label to add their profile information to your account. Find the Right Codes Quickly. When it’s time to find the code you need, Dr.Bill is ready. We make it easy to search and even save the ones you use the most. Get Helpful Tips. It pays to know the ways to maximize your claims. Dr.Bill keeps you up to date with tips and suggestions.Starting Price: $30 per month -
11
Iridium Suite
Medical Business Systems
Iridium Suite was developed with a focus on seamless processing of electronic claims and electronic remittances through its fully-integrated, web-based program. Shavara is an innovator in the field of medical billing software. Shavara's differentiator is the cumulative experience of 100+ years of laser focus in solving gaps and vulnerabilities in billing, coding and connectivity. Iridium Suite is purpose-built for Oncology. Built-in capability to enable Record & Verify integration; OncoChart integration; CureMD integration are powerful features matched to the requirements for Medical Oncology and Urology Billing Software. Shavara's Iridium Suite features leading-edge technology such as a built-in scheduler, a customizeable automatic medical claim scrubber, seamless electronic billing, and premium reporting. Iridium Suite is platform-agnostic, allowing you to use it as Medical Billing Software for Mac, PC, and even Linux systems.Starting Price: $425 per month -
12
ZOLL Billing
ZOLL Data Systems
Progressive revenue cycle management is, in many ways, the backbone of a thriving medical services operation. Controlling costs, increasing productivity, and accelerating reimbursements are essential activities that keep EMS agencies rolling. Yet efficiently progressing a claim through its lifecycle has traditionally been labor-intensive and prone to delays caused by documentation and coding inaccuracies. ZOLL® Billing is a cloud-based solution that enables revenue cycle professionals to turbo-charge billing performance and deliver more revenue. By automating workflows and eliminating billing errors, ZOLL Billing helps you process more claims with fewer resources and address compliance risk at the same time. Increase productivity and revenue with automated workflows that enable you to process more claims. -
13
E-COMB
KBTS Technologies
EDI Compatible Medical Billing (E-COMB) is a web based solution for generating medical claims complying with the HIPAA transaction and code set standards, regulated by the US Government following the recommendations of American National Standards Institute (ANSI). The application is designed to generate, submit and reconcile the claims to the insurance carriers, guarantors and/or patients. This is one of the most important tools for doctors in realizing their revenue by reducing the turnaround time in the claims reimbursement. All the information related to environment of the Doctor’s Office/Hospital is grouped together as Master Data. This information is frequently used for claims processing and is less likely to change quite often. Master Data contains details of the Procedures, Diagnoses, Doctors, Payers, and Billing Providers etc. This data is created as part of the initial set up and can be updated easily at any time. -
14
Curacel
Curacel
Curacel’s AI powered platform enables insurers track fraud and automate claims seamlessly. Collect your claims from your Providers in real-time and easily auto-vet the claims. Curacel Detection helps you detect and curb fraud, waste and abuse in the Claims Process. Collect claims from their providers and prevent fraud, waste and abuse in the claims process. We studied the Health Insurance industry to understand where the most value is lost by Insurers. This was identified to be the Claims Process. The Process is mostly manual and is fraught with a lot of fraud, waste and abuse. Our solution, driven by AI, helps to curb wastage and make the Insurer more efficient, thereby making them unlock hidden value. ravel insurance is peculiar in that it is built on on-demand policies that cover relatively short periods of time. Should a policy holder want to make a Claim, both the insurer and the insured want claim settlement to be as efficient and accurate as possible. -
15
ClaimBook
Attune Technologies
ClaimBook enables faster settlement of insurance claims, improved accountability and fewer rejections. It is well equipped with the features to address every part of the claims and evidence submission. ClaimBook supports international patient treatment with dedicated workflows, therefore enabling medical tourism. A built-in Rules Engine that disallows incomplete submissions, and knows what information and documents need to be submitted. This results in error-free submissions that are complete and guarantees that it is pre-authorized. ClaimBook's Smart Data Extraction can read documents uploaded to extract relevant data from the Hospital's Information System (if integrated with ClaimBook) to prevent the need for manual entries. ClaimBook also features Integrated Emailing by creating a virtual inbox in your dashboard. Withing the dashboard, emails can be composed, the design feature is similar to Microsoft Outlook. -
16
PlanXpand
Acero Health Technologies
PlanXpand™ is Acero’s proprietary transaction processing engine, one that powers each of our products for health benefits administrators. Leveraging this engine, clients may choose to implement Acero’s products concurrently or incrementally. In addition to selecting one of our standard products, administrators also may choose to utilize PlanXpand™ to develop a custom solution to extend existing system capabilities. Acero’s unique, integrated solutions feature Service-Oriented Architecture, allowing health benefits administrators and insurers to add features and functions to existing adjudication platforms. At the same time, our sophisticated design and engineering enables real-time adjudication of every type of claim, all in direct interaction with the core claims system, resulting in more accurate processing, more satisfied customers and less need for claims adjustments. -
17
Precision Practice Management
Precision Practice Management
Whether you're looking to outsource all of your revenue cycle management functions or just some of them, Precision Practice Management has the experience and expertise to help you stay on top of the constantly changing landscape in this most important area. Precision can successfully address all areas of revenue cycle management, from compliance, credentialing, coding, claims processing, clearinghouse edits and electronic lockbox to claim denial management, reporting, financial analyses and more. Your in-house staff may be doing a tremendous job in managing some or most aspects of your medical billing, but your office staff has many other important clinical functions to perform. Sometimes billing matters receive lower priority and suffer as a result. Precision's medical billing experts are focused entirely on medical billing and nothing else; that's all they do. -
18
Venue Claims Management
KLJ Computer Solutions
Venue ™ Claims Management for Independent Adjusters provides end-to-end management of the entire claims processing workflow. Whether you are an adjustment firm, third-party administrator, insurance carrier, or a self-insured organization, Venue ™ is for you. The user-configurable interface allows for extensive self-customization of the claim system by an end client. Built-in web service interface that allows for real-time or batch data import, update and export to virtually any third-party data sharing source of ALL claim-related information. Integration with policy and billing systems allows real-time synchronization on all policy-related details, which may include critical policy dates and flags such as active fraud investigation and assumed policy. Comprehensive capabilities for every aspect of claims processing, including claim payments and recovery, reserves tracking, contact management, excess and trust accounts, forms templates, reporting etc.Starting Price: $5 per month -
19
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. -
20
PowerMed Billing
PowerMed
PowerMed Billing has been built from the ground up to be state-of-the-art. With its powerful feature set, numerous reporting options and electronic claims processing, it will meet the needs of any busy practice. The software can be configured to each individual user's style, including screen appearance, custom navigation commands, and even individual language settings. It contains a full ICD coding library, customizable CPT, HCPCS, super codes, and enterprise-level patient demographics. Because Billing and EMR are essentially one program, all coded visits and claims are automatically pulled for electronic processing or for standard UB92 or CMS1500 printing. Complete with full search and reporting capabilities, practice managers have immediate access to an extensive library of predefined productivity and financial reports broken down by providers, payors and individual patients. -
21
Benchmark PM
Benchmark Solutions
Benchmark PM enhances patient engagement from initial intake through final encounter with features such as patient onboarding, easy appointment scheduling, customizable reminders, robust reporting, and user-friendly dashboards. For billing, Benchmark PM simplifies filing, processing, and follow-up with integrated claims management, an integrated clearinghouse, electronic billing, insurance verification, and a versatile payment portal. Benchmark Solutions operates as healthcare practices’ one-stop management solution, comprising of Benchmark EHR software, Benchmark PM software, and Benchmark RCM services. Benchmark Solutions' offerings come together to form a comprehensive electronic toolset that can streamline daily internal operations and increase revenue earned all while improving the overall patient experience. Each piece of the Benchmark Solutions suite is modular so it can easily integrate with other technologies already in place. -
22
ResolvMD
ResolvMD
ResolvMD is an experienced full-service medical billing company that processes all health service claims (AHCIP etc.) on behalf of physicians. Our goal is to make physicians as confident and competent in their billing as they are in their practice through surfacing data-derived insights and democratized knowledge. We have the most modern, cost-effective, and secure platform on the market for processing claims. Our target audience are physicians (mainly specialists such as emergency physicians, urgent care, plastic surgeons, anesthesiologists, paediatricians, general surgeons etc.). They need a billing agent to process their health service claims. They value time, trust, cost, efficiency and knowledge. We are targeting physicians in Alberta today (mainly in Calgary, Edmonton, Red Deer, Medicine Hat, Lethbridge, Okotoks and any other centre with a population in excess of 25,000. -
23
TrackAbility
Recordables
Liability claims management software solutions from Recordables. Software solutions to improve claims management including General Liability, Auto, Property, Incidents, and more. Recordables Liability insurance tracking software organizes incidents and claims that include auto, property, and general liability policies. Tracking all liability and risk incidents and claims, TrackAbility provides comprehensive liability claims tracking software solutions Benefits of TrackAbility liability claims management include start to finish injury liability claims management from incident through completion. Create customizable liability claim types with user-selectable criteria. Safety professionals and field users can collaborate on claims and reports, continuing to add pictures and videos for incidents or claims. Receive a holistic view of financial data necessary for claims management, such as payments and losses based upon individuals, locations, policy specifications, and other data. -
24
Clinicaid
Clinicaid.ca
ClinicAid helps you efficiently optimize your time by letting our cloud based medical billing software do the heavy lifting for you. Keeping patient care as your priority requires keeping administrative work to a minimum with next generation medical billing and coding software. Automatically add your practice and patient information to claims and avoid complicated workflows. ClinicAid physician billing software keeps your practice on track with powerful report options designed with feedback from our clients. That means you have detailed Remittance, Rejection, Efficiency, and other vital reports available at a click. The reporting within our medical billing software meets your changing practice needs. You can customize and save your own reports with up to 46 individual data points for maximum intelligence in your practice.Starting Price: $19 per month -
25
PayorIQ
Compliance PT
Receive notifications when Payors make policy changes. Staying informed makes all the difference. Instead of reading through hundreds of pages of insurance-speak, our software detects policy changes and writes easy-to-digest notes for your billing and coding staff to implement. Quickly find policy specifics for a given claim date. Use our data as evidence to win more cases.Starting Price: $199 per user per month -
26
ENTER
ENTER Health
Enter gets Providers (doctors, practices & hospitals) paid faster than anyone in history. Enter processes health insurance claims and pays in 24 hours while automatically communicating and collecting patient responsibility with a white label collection engine, complete with payment plans. Enter is 30x faster at getting claims paid and 45x faster at getting patients billed at the same cost as existing medical billers. - $150mm+ of claims processed in just 1 year of operations. - $100mm credit facility actively being deployed for providers. - Revenue Cycle Management Partner for United Healthcare Nevada. - Enter supports a wide variety of specialties including ASC, Orthopedics, Neurology, Dermatology, Emergency Rooms, Behavioral Health, Pain Management and more. - Enter works with all commercial and government health insurance carriers. - Enter integrates with all EMR / practice management systems. - No monthly fees. No integration fees. - Enter is venture backed -
27
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 -
28
CMS-1500 Software
Med Claim Software
Our CMS-1500 software is an excellent choice for submitting claims by paper. Download a free trial. We can get you started with the software right away! Order online and our secure shopping cart will guide you through the process to receiving a code which will activate the software any time of the day or night. Type data on the screen as it would be typed on the form itself. Or import from excel (xls or xlsx). Print on pre-printed red Medicare forms or print the entire form in black & white. Align print perfectly with any printer. Save common data for quick completion and to eliminate redundant typing. UB-04 Forms are medical insurance claim forms used by facilities such as hospitals, inpatient and outpatient clinics and ambulatory surgery centers to bill insurance companies for services rendered. The CMS-1500 software functions on any Windows operating system. The software functions on networks or stand-alone personal computers and will work with any printer.Starting Price: $69.95 one-time payment -
29
PatientStudio
PatientStudio
Maximize your appointment calendar with improved visibility into your clinic's schedule and provider availability. View and schedule appointments across many providers, rooms or locations to ensure a steady patient flow. Automatically invite patients to complete patient intake online. Custom digital paperwork can be completed and submitted using a smartphone or personal device. The patient's data will sync directly to their patient chart. Reduce no-shows with perfectly timed patient reminders via email and text message. Patients and staff can communicate, confirm or reschedule with two-way text messaging. Easily generate claims from patient notes and suggested ICD-10 codes. Automatically scrub and submit claims electronically. Services to manage your entire billing process, from submission to payment collection. Quickly create defensible, legible, and comprehensive clinical notes with documentation templates, assessment reports and pre-populated patient data. -
30
Newgen Claims Processing
Newgen Software
Newgen’s Insurance Claims Automation & Management software, built on AI-first low-code platform, streamlines the full claims lifecycle, from first notice of loss to final settlement, through automated workflows, smart routing, and integrated document management. Customers can register and track claims through a web or mobile self-service portal, while the system automatically retrieves policy details, prevents duplicate entries, and routes cases based on workload and expertise. Built-in rules classify claims as fast-track or non–fast track, with flexibility to add assessors, investigators, and other stakeholders. Adjusters gain a unified view for registration, adjudication, document review, and communication. AI-driven insights support fraud detection, highlight missing information, and improve decision accuracy. Real-time dashboards monitor KPIs, SLAs, and escalations for transparent and timely processing. -
31
SSI Claims Director
SSI Group
Elevate your claims management process and decrease denials through unmatched edits and an industry-leading clean claim rate. Health systems require access to technology that facilitates accurate claim submission and rapid reimbursement. Claims Director, SSI’s claims management solution, streamlines billing practices and provides visibility by guiding users through the electronic claim submission and reconciliation process from beginning to end. As payers change or modify reimbursement criteria for services, the system actively monitors and incorporates these changes and requirements. And with a comprehensive mix of edits at the industry, payer and provider levels, the solution aids organizations in making the most of reimbursement efforts. -
32
ALYCE Claims Management
Brightwork
ALYCE is specifically designed for self-insureds, municipalities and small TPAs handling Workers’ Compensation, Auto Liability, Auto Property, General Liability, and Property claims. ALYCE has an intuitive design with important data elements on the main claim page, including the claim’s financial summary, with all of the other important details available with a quick scroll or a single click. Multi-tiered infrastructure for employer reporting requirements, based on locations and departments. Recoveries, including salvage, subrogation, and excess carrier payments. Automated scheduled and repeating payments with diary alerts. Automatic diaries based on events, time lines, and financial transactions. Automatic generation of form letters to claimants, lawyers, and other claim parties. -
33
ClaimAdept
Isoft
This product is an end to end claims system. The primary functions are claims adjudication, claim workflow and payment disbursement. The flexible design allows the addition of adjudication modules on a line of business basis. Each new line of business added reuses the core functionality of the system. This system takes advantage of the user friendly windows screen design and makes use of a relational database to store information within the system. The software platform is Powerbuilder with an SQL database such as Oracle or Sybase. This combination of software supports a client server based environment that is capable of processing large volumes of claims. Installation and training are available and source code is included as part of the licence fee. Expert staff is available for customizations and tailoring of the system to meet any special requirements identified by the client. All modifications are available with detail design and support for acceptance testing. -
34
CyberSource Medical
ComCom Systems
The market's most powerful and accurate solution for claims processing. CyberSource Medical Claims Scanning Solution, a complete turn key system for HMO, PPO, TPA, or Self Funded Organization, is installed at your location for automated data entry of CMS-1500, ADA-2006 UB-04 and enrollment forms. Using advanced "intelligent" features combined with your business rules, CyberSource recognizes, validates and formats the data from medical claim forms. Fuzzy Matching performs an intelligent search of your member and provider database correctly identifying the exact match. The matched data is then utilized to verify and correct data on the medical claim before being passed through to adjudication. The combination of industry-leading OCR efficiency, your business rules and “Fuzzy Matching” results in exceptional accuracy of the data from your medical claims forms. -
35
Complete Claims
Complete Health Systems
Claims Adjudication for medical, dental, vision, prescription, short and long-term disability claims. Available for on-site license or as a hosted application (ASP). Microsoft technology: SQLServer database with a Windows front end. Acclaimed Customer service staffed by health care claims experts with a minimum of 12 years’ experience in the field. Support calls are logged with status available via the internet. Plan copy and modification feature enable quick setup of plans. Auto-adjudication using benefit codes built using business rules based on over 25 variables from both the claim and the claimant records made available to the adjudication engine. Inbound claims can be scanned images, EDI or paper. HIPAA EDI 5010 transaction sets. Re-pricing fee and UCR Schedules can be loaded on the system in advance of the effective date. The date-driven logic will re-price based on the date of service. -
36
RevCycle Engine
Aptarro
RevCycle Engine applies built‑in, customizable rules and AI‑powered automation to correct coding and charge errors at the source, ensuring billing data is accurate before claims are submitted. By integrating seamlessly with EMRs and practice management systems, it ingests claims data in real time, applies industry‑proven rules tailored to each organization’s needs, and fixes errors automatically, reducing preventable denials and costly rework. Streamlined workflows prioritize and route only complex or exception claims for human review, boosting team efficiency and reducing burnout. With AI‑driven charge accuracy, the platform increases clean claim rates, lowers cost‑to‑collect, and stabilizes cash flow, all visible through clear dashboards and real‑time insights. Scalable automation handles high claim volumes without overtime or late‑night efforts, while features such as charge accuracy validation, denial prevention, coding review optimization, payment collection support, and more. -
37
I-CAPS
W.O. Comstock & Associates
I-CAPS is an Intelligent Claims Administration System that addresses all functional areas of the health claims payment environment with a single common architecture that spans the needs of payers including membership, billing, enrollment, mailroom, claims, network management, contracting, pricing, utilization review and customer service. Our Intelligent Claims Administration System (I-CAPS) and our coding compliance software (Advanced Value Scale-AVS) , support knowledge-based decision-making to help our clients contain costs. Guaranteeing the integrity of Provider information has never been easier with (Advanced Network Administrator-ANA) while our (RB-UCR) is the industry's first Resource-Based, Usual Customary, and RESPONSIBLE fee schedule based on RBRVS and NCCI. Need a check-up for your plan or provider, use Cost Containment Audit and Recovery Services (CCARS) for a completely noninvasive audit retrospective look at claims effectiveness. -
38
Snapsheet
Snapsheet
Snapsheet makes claims simple. We do this through a suite of innovative insurance software solutions which transform insurance companies' ability to seamlessly manage claims, reduce cycle time, increase appraisal accuracy, and deliver payments effortlessly. We started it all with virtual appraisals, and followed that up with our leading claims management system. Today we are driving an industry-wide movement in claims by delivering solutions that enhance customer experiences while our customers create innovative, data-driven claims organizations. -
39
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. -
40
Claims Software
Claim Ruler
A new and smarter way to process and settle claims. Modern, end-to-end solutions to settle claims for all lines of property, liability, and workers’ compensation insurance. ClaimRuler™ is a cloud-based claims management system designed specifically for I/A firms and Third-Party Administrators, CAT Adjusters, Insurance Carriers, Self-Insureds, and Municipalities. The platform supports end-to-end claims processing with built-in guided workflows, robust reporting capabilities, and a fully automated diary system to streamline the settlement of claims. ClaimRuler™ was purposefully built to service the needs of real people in the industry. Its functional and intuitive approach to design makes working with forms, lists, documents, and photos a simpler and more natural experience. From I/A firms, TPAs, and insurance carriers to municipalities and self-insured corporations, ClaimRuler™ adapts and scales along with your organization. -
41
bestPT
Billing Dynamix
bestPT is a complete, cloud-based physical therapy billing service and practice management software solution. Created for private practices of all sizes, bestPT helps solo practitioners and franchise owners of physical therapy clinics to manage payment and revenue generation as well as keep track of claims processes. Integrated with the most popular EHR systems, including webPT and Cedaron, bestPT helps streamline billing processes to make the entire office's workflow more efficient. -
42
CLAIMExpert
Acrometis
The Acrometis flagship claims processing solution offers unparalleled workflow management, with documents automatically routed by a configurable rules engine. Based around claim assessment scoring, body part to claim compensability matching, jurisdictional directives, relatedness scoring and a host of other claim elements the Acrometis business rules are designed to reduce claim duration and costs. CLAIMExpert automatically processes 65 percent of incoming medical bills and non-medical documents with no user intervention. Documents requiring adjuster intervention are flagged and sorted for easy review and straightforward decision making. Automatically processes incoming documents with NO adjuster intervention. Clients typically see between 11 and 23 points medical loss improvement in the first year. CLAIMExpert contains rules for over 190 different document types, quickly handling whitemail and any other documents that come across your adjuster’s desk. -
43
PulsePro Practice Management
Pulse Systems
PulsePro practice management system applies automated workflow logic to join financial, clinical and administrative processes into one package. PulsePro is easy to use and implement, offering advanced scheduling, patient registration, medical billing, coding and claims processing. And because implementation is quick and PulsePro is so easy to learn, your team will be up and running in hours — not days or weeks — performing daily tasks using an industry leading practice management system. Pulse is a leading EHR/PM Company that is a part of the Amazing Charts and Harris Healthcare family. We have a long history supporting medical practices with technology and value-added services. -
44
Logik
Therapy Brands
Transform Billing For Your Health Organization. Logik elevates health organizations by improving billing processes, increasing revenue collection, and optimizing patient care. Maximize your revenue with our powerful health billing software. Our intuitive platform streamlines billing processes from charge generation to collections, improves your clean claims rate and accelerates cash flow. It’s built for enterprise-level behavioral health practices—addressing the specific needs of this market including insurance requirements. We are industry experts with deep insight into the operational strategies that help behavioral health practices thrive. From improving claims and patient management, implementing specialized software, to other aspects of your practice, we help you identify new opportunities to optimize workflows and create efficiencies. -
45
Quanum RCM
Quest Diagnostics
Quanum Revenue Cycle Management (RCM) delivers a holistic solution for managing the financial component of a medical practice with a focus on increasing revenue. Created by Quest Diagnostics, a leading provider of pre-employment drugs-of-abuse screening for employers and risk assessment services for the life insurance industry, Quanum RCM offers a complete medical billing solution, from billing claims to denial management and other billing related activities and support. -
46
Beagle Labs
Beagle Labs
Streamlining the claims process from end to end. Technology-driven, people-centric, and built on integrity. A robust claims service interaction platform for insurance carriers, MGAs, captives, and self-insured entities. Deployments, claims organization, and advanced file management at your fingertips. At Beagle, we understand the unique challenges faced by insurance service providers and independent adjusters when it comes to claims handling. Our core software functionality is designed to streamline the process, reduce costs, and provide rapid responses to your claims. Our technology brings efficiency and expertise to every step of the adjustment process. Express claims and inspection responses that reduce liability and drive efficiency. New policy inspections, policy renewals, and daily losses. Beagle was developed to handle the processes required on a daily basis. Streamlined claims handling by leveraging the latest technologies that enable a more efficient resolution. -
47
HEALTHsuite
RAM Technologies
HEALTHsuite is a comprehensive benefit administration system and claims processing software solution designed for health plans administering Medicaid and / or Medicare Advantage benefits. HEALTHsuite is a rules-based auto adjudication software solution designed to automate all aspects of enrollment / eligibility, benefit administration, provider contracting / reimbursement, premium billing, medical management, care management, claims adjudication, customer service, reporting and more. RAM’s Medicare Advantage-in-a-Box offering is unique in the industry; the product of RAM’s extensive experience in Medicare Advantage and an unwavering commitment to changing our industry. HEALTHsuite Advantage™ and eHealthsuite™ are the cornerstones of our pre-configured Medicare Advantage-in-a-Box offering. HEALTHsuite Advantage is a fully integrated suite of modules providing our clients with an unmatched solution to administer their Medicare Advantage and Special Needs Plans (SNP’s). -
48
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. -
49
ALFRED Claims Automation
Artivatic.ai
Filing claims are complex and critical processes. More than 60% of people do not file complex due to its complex processes and time taking nature. Artivatic’s dedicated claims platform for each insurance vertical helps insurance businesses to enable digital claims journeys, self-claims processing, automated assessment, risk & fraud intelligence and claims payout. ONE PLATFORM FOR ALL YOUR CLAIMS NEEDS. End to End Claims Automation and Assessment Platform AUTO CLAIMS – HEALTH CLAIMS – TRAVEL CLAIMS – ACCIDENTAL CLAIMS – DEATH CLAIMS – FIRE CLAIMS – SME CLAIMS – BUSINESS CLAIMS – COMMERCIAL CLAIMSStarting Price: $10/claims/month -
50
ClaimScape
DataGenix
Emerged in the year 2000, DataGenix is strongly resolved to provide TPAs, adjusters, and insurance companies with modern claims processing solutions. We understand that claims processing and health benefits management can include several complications. So that your business does not suffer any losses, our experts have created the advanced ClaimScape software that can automate the entire adjudication process. The goal of our business and the Claims software is to resolve the perplexities that hinder the reach of unmatched customer experience for your clientele network. Keeping in mind the modern trends and requirements, we can assure your business's optimum growth with our software products. We have won the trust of top TPAs of the nation and are willing to serve more.
