Alternatives to eReconciliation
Compare eReconciliation alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to eReconciliation in 2026. Compare features, ratings, user reviews, pricing, and more from eReconciliation competitors and alternatives in order to make an informed decision for your business.
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Checkr
Checkr
Upgrade Your Hiring Workflow Checkr’s AI-powered technology helps you reduce time, human error, and bias from manual reviews. Our award-winning adjudication tools make your hiring process more efficient, while our analytics can help you identify opportunities to expand your talent pool. Legacy background checks require manually pulling data from disparate sources, sorting through inconsistent language, and managing ever-evolving local compliance laws. We’ve rebuilt the background check to automatically standardize charge data, accurately predict report completion ETAs, and keep up with local compliance laws. Unlock talent. Unlock Opportunity.Starting Price: $29.99/check -
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Medrio
Medrio
Medrio is on a mission to ease complexity in today’s hybrid, decentralized, and site-based clinical trials by delivering a flexible suite of eClinical technologies and services, including EDC, eCOA, ePRO, eConsent, Direct Data Capture, and Randomization and Trial Supply Management (RTSM). Trusted by CROs, sponsors, and sites across all therapeutic areas and trial phases from study startup and feasibility to post-market approval, we are industry-recognized for delivering eClinical software with intuitive interfaces and time-saving “drag and drop” configurations as well as high-touch customer engagement, onboarding, and support services. Medrio’s innovative software, as well as the robust and flexible training and support resources we provide our customers, have earned us a 98% customer satisfaction rating. -
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Virtual Examiner
PCG Software
Virtual Examiner®, PCG Software’s flagship product, monitors the internal claims process of an organization to trend provider data for fraudulent and abusive billing patterns, and maximizes financial recoveries. PCG Software’s Virtual Examiner® allows healthcare organizations to enhance their current claims adjudication system with more than 31 million edits per claim. The software solution monitors an organization’s internal claims process to identify unclean claims and reduce payment for improper or erroneous coding to conserve premium dollars. Virtual Examiner® is more than a claims review solution with a focus on code combinations. It is a cost containment solution that evaluates the claim not only for abusive billing patterns but also identifies those claims that may involve third-party liability/coordination of benefits, case management opportunities, physician billing education and many other cost recovery reports. -
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eAdjudication
Ethical
Ethical eAdjudication is an innovative endpoint adjudication and e-clinical software solution. With an intuitive and user-friendly cloud service designed exclusively for study leaders, QA staff, and committee members, Ethical eAdjudication offers the simplest solution to seamlessly manage event database, committee assessment, and disagreement and consensus meetings in a GxP controlled environment. By leveraging Ethical eAdjudication, users are given the opportunity to accomplish independent review and adjudication procedures in an effective, timely, and quality controlled manner. -
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Judi
Judi
Judi is a cloud-based clinical-trial collaboration platform built to simplify, secure, and streamline complex workflows across sponsors, CROs, trial sites, and partners. It supports a full range of trial functions, from endpoint/event adjudication, central eligibility review, data-safety-monitoring, remote monitoring, medical imaging, and site/user qualification, to fully custom workflows (Judi Flex). Judi replaces manual processes, spreadsheets, untracked emails, or siloed file-sharing tools with a unified, compliant workspace: every document, communication, image, query, and decision goes through secure, traceable pipelines. Built-in features include role-based permissions, audit trails, real-time chat, query management, dashboards and worklists, flexible document submission and review, eCRFs with edit checks, and reporting tools, making trial data collection, review, and reporting far more efficient and less error-prone. -
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TrialStat
TrialStat Solutions
Compared to other EDC solutions on the market from MediData, DataTrack, Omnicomm and others, TrialStat is the most all-encompassing suite of study management tools that can be seamlessly connected to external data sources such as EMR, wearables, and other clinical and non-clinical data and information sources. TrialStat offers a fully unified platform suitable for all phases and types of trials. Our single-sign-on, multi-tenant EDC suite includes modules for Randomization, Adjudication, Coding, Safety, Patient Diaries/ePRO, Vendor Neutral Imaging Archive, a robust Reporting and Analytics Portal and custom Machine Learning programs. With a focus on data analytics, TrialStat offers real-time reporting, data extracts on demand, and analytics across a single study, a program, or your entire research portfolio – providing all stakeholders relevant, customized, timely insight into all aspects of study data and highlighting areas of risk or potential delays. -
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Complete Claims
Complete Health Systems
Claims Adjudication for medical, dental, vision, prescription, short and long-term disability claims. Available for on-site license or as a hosted application (ASP). Microsoft technology: SQLServer database with a Windows front end. Acclaimed Customer service staffed by health care claims experts with a minimum of 12 years’ experience in the field. Support calls are logged with status available via the internet. Plan copy and modification feature enable quick setup of plans. Auto-adjudication using benefit codes built using business rules based on over 25 variables from both the claim and the claimant records made available to the adjudication engine. Inbound claims can be scanned images, EDI or paper. HIPAA EDI 5010 transaction sets. Re-pricing fee and UCR Schedules can be loaded on the system in advance of the effective date. The date-driven logic will re-price based on the date of service. -
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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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HEALTHsuite
RAM Technologies
HEALTHsuite is a comprehensive benefit administration system and claims processing software solution designed for health plans administering Medicaid and / or Medicare Advantage benefits. HEALTHsuite is a rules-based auto adjudication software solution designed to automate all aspects of enrollment / eligibility, benefit administration, provider contracting / reimbursement, premium billing, medical management, care management, claims adjudication, customer service, reporting and more. RAM’s Medicare Advantage-in-a-Box offering is unique in the industry; the product of RAM’s extensive experience in Medicare Advantage and an unwavering commitment to changing our industry. HEALTHsuite Advantage™ and eHealthsuite™ are the cornerstones of our pre-configured Medicare Advantage-in-a-Box offering. HEALTHsuite Advantage is a fully integrated suite of modules providing our clients with an unmatched solution to administer their Medicare Advantage and Special Needs Plans (SNP’s). -
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PlanXpand
Acero Health Technologies
PlanXpand™ is Acero’s proprietary transaction processing engine, one that powers each of our products for health benefits administrators. Leveraging this engine, clients may choose to implement Acero’s products concurrently or incrementally. In addition to selecting one of our standard products, administrators also may choose to utilize PlanXpand™ to develop a custom solution to extend existing system capabilities. Acero’s unique, integrated solutions feature Service-Oriented Architecture, allowing health benefits administrators and insurers to add features and functions to existing adjudication platforms. At the same time, our sophisticated design and engineering enables real-time adjudication of every type of claim, all in direct interaction with the core claims system, resulting in more accurate processing, more satisfied customers and less need for claims adjustments. -
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ClaimAdept
Isoft
This product is an end to end claims system. The primary functions are claims adjudication, claim workflow and payment disbursement. The flexible design allows the addition of adjudication modules on a line of business basis. Each new line of business added reuses the core functionality of the system. This system takes advantage of the user friendly windows screen design and makes use of a relational database to store information within the system. The software platform is Powerbuilder with an SQL database such as Oracle or Sybase. This combination of software supports a client server based environment that is capable of processing large volumes of claims. Installation and training are available and source code is included as part of the licence fee. Expert staff is available for customizations and tailoring of the system to meet any special requirements identified by the client. All modifications are available with detail design and support for acceptance testing. -
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Acceptd
Acceptd
We have the tools to make your recruitment, applications, auditions, adjudication, and communication easier than ever. Accept online video auditions, collect applications, collaboratively adjudicate online with custom rubrics, schedule in-person auditions, communicate directly with applicants, seamlessly process payments, and much more. Acceptd is a powerful and secure partner to your team. We provide custom applications, access for multiple reviewers, easy navigation, and tools to view and sort your data. This allows us to serve organizations and programs of all shapes and sizes through the entire audition process. From day one, our team comes alongside yours to set up your personalized account, provide valuable feedback from our experience working with thousands of programs, and guide you through simplifying your process. Simply put, we’ve got your back. -
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TrialKit
Crucial Data Solutions
TrialKit is a unified eClinical platform that brings mobility, automation, and efficiency to modern research teams. Accessible from any browser or native app (iOS, Android, and Mac), TrialKit supports rapid study setup, real-time data collection, and centralized oversight—ideal for CROs and sponsors seeking agility without compromising compliance. Its drag-and-drop design tool makes it easy to build studies quickly, while advanced features like AI-powered reporting and mobile ePRO/eCOA enhance visibility and decision-making. Trusted by over 40,000 across the globe, TrialKit enables teams to work smarter from first patient in to database lock. Recognized with the 2024 SCDM Innovation Award, it’s the all-inclusive solution for today’s studies. -
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eKare inSight
eKare
inSight is a comprehensive integrated suite of applications designed to empower researchers with accurate and timely information. The wound assessment and documentation are streamlined with single image capture and synced to a secure HIPAA, GDPR, and 21 CFR Part 11 compliant environment. Create a unified integrated research experience. Leverage emerging data and clinical evidence to develop study protocol, imaging charter, and adjudication manual. Build and configure the database with ease and efficiency. Customize clinical workflow and integrate seamlessly with your EDC. Dedicated project manager to ensure timely start and project maintenance. De-risk your clinical study with the highest quality standards, quality assurance, and control procedures. Analyze data and uncover insights in real time. Curate data sets, and augment clinical studies with real-world evidence. Our wound imaging solution is CE-marked and registered with the FDA. It has been clinically validated.Starting Price: Free -
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Smart Data Solutions
Smart Data Solutions
Streamline Your Complete Healthcare Data Workflow. Smart Data Solutions has the tools and experience needed to streamline both your paper and electronic workflows. Our integrated validation, matching, and normalization tools ensure the highest quality data possible, increasing auto-adjudication and reducing manual processing. Whether you’re new to Smart Data Solutions or a long time partner, our development process helps guide you through projects to ensure the best possible position for overall success. Whether your needs are basic or complex, our staff will work with you to understand your needs and the impacts of your workflows. We believe in focusing on your goals, what you want to accomplish, and from that, identifying the best way to get there. Smart Data Solutions provides complete front-end pre-adjudication solutions for hundreds of Payers nationwide. Whether you need basic services or a completely custom workflow, Smart Data Solutions offers a variety of solutions. -
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eDeviation
eDeviation
eDeviation supports all the operations for Protocol Deviation assessment and management. From software design and validation to collecting supporting documents and exporting data for the TMF, eDeviation® relieves your clinical team from the risks associated with missing or wrongly assessing one-time or recurring protocol deviations. eDeviation® is part of Ethical’s eClinical Software Platforms Solutions supporting faster and more accurate clinical trials management. Whether your protocol deviation assessments are performed by an independent expert committee or by your study team, our eDeviation® software is configured to exactly match your needs. Forms, workflows and exports altogether contribute to a GxP quality and effectively managed study. Study teams, Investigators’ Sites and Committee Members, when applicable, work seamlessly online in real-time to expedite judgments, consensus and timely completion of the protocol deviation assessments and management. -
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Tyler Ethics Management
Tyler Technologies
Tyler's Ethics Management solution automates ethics management programs through the preparation, review, and filing of annual financial disclosure and ethics training reports. Tyler’s Ethics Management software adheres to the complex rules and regulations that drive ethics management programs and includes numerous summary reports that can be run by users based on defined roles and access permissions. Additional reports can be easily configured to match an organization’s needs. The audit finding management solution is an efficient tool to manage and administer an audit compliance program. A background investigation software solution plays a critical role in the larger personnel security and suitability process, which also includes adjudication, evaluation, analytics, and even invoicing. Tyler’s Criminal Justice Information System application tracks and manages data and workflows to help federal law enforcement with any kind of case. -
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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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Roker PLUS
Roker Inc.
Introducing Roker PLUS – a Hardware-agnostic Solution, leveraging Proprietary IP to address the needs of Governments, Institutions, Businesses, and Real-estate owners with Registrations, Listings, Space Management, Enforcements, and more. True to our mission of finding Smart Urban Spaces, Roker PLUS transforms Curb Spaces to Smart Spaces for supply fleets and on-demand driver’s requirements. The result is less congested streets and simplified curb-space accessibility for short-duration parking. A comprehensive solution to design, manage and administer almost all permit category requirements. Empowers an organization’s ability to authenticate users and adhere to compliances. Encapsulates the lifecycle of parking enforcement, tickets, payments, appeals and adjudication. Designed for enabling secured payments, integrated with industry-leading payment services. Even a single parking space can be leveraged for leasing out and used by those in the vicinity. -
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BizNet
Sarjen Systems
Sarjen delivers an AI-enabled Clinical Trial Management System and Bioanalytical LIMS that drives digital transformation across early-phase and late-phase clinical trials. This integrated eClinical platform supports end-to-end trial management, site management, subject tracking, regulatory compliance, and real-time laboratory sample management within a unified ecosystem. Built for pharma, biotech, and CRO organisations, the software enhances operational efficiency through workflow automation, centralised data management, and advanced analytics. Its AI features include predictive enrollment forecasting, risk-based monitoring insights, anomaly detection in lab data, automated query resolution, and intelligent dashboards that improve decision-making. By leveraging machine learning and smart automation, the platform accelerates study timelines, improves data quality, ensures compliance readiness, and transforms clinical research operations!Starting Price: $79 -
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Cohere PaaS Intelligent Prior Authorization
Cohere Health
Cohere helps health plans digitize the process and apply clinical intelligence to enable in-house, end-to-end automation of prior authorization. Health plans can directly license Cohere’s PaaS intelligent prior authorization for use by the plan’s internal utilization management staff. As a result, our client health plans achieve both significant administrative efficiencies and faster, better patient outcomes. Cohere delivers a tailored, modular, and configurable solution suite for health plans. Digitizes all prior authorization requests into a single automated workflow. Automates prior authorization decisions using health plan-preferred policies and accelerates manual review. Helps clinical reviewers adjudicate complex requests, using responsible AI/ML and automated capabilities. Leverages clinical intelligence with AI/ML and advanced analytics to improve utilization management performance. Improves patient and population outcomes with innovative, specialty-specific programs. -
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ImagineMedMC
Imagine Software
Manage your members' healthcare and networks with a cloud-based healthcare delivery system. Automate claims processing for managed care organizations. Includes eligibility, referral and authorization processing, provider contracting, benefit administration, auto claims adjudication, capitation (PCP and Specialty), EOB/EFT check processing, and EDI transfers and reporting. Deploy as a cloud solution or an in-house system. Ideal for managed care organizations (MCOs), independent physician organizations (IPAs), third-party administrators (TPAs), preferred provider organizations (PPOs), and self-insured groups. Streamline the complexities of administrating eligibility, referral authorization and claims processing. Features and functions maximize data integrity while reducing data entry. -
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Synergy eCase
Synergy International Systems
Enhance efficiency, transparency and accountability in courts and criminal justice agencies. Ensure equal access to justice for everyone in your community. Streamline case management workflows to support the investigation cycle, from crime reporting to evidence processing and intelligence analysis. Perform accurate investigation, in less time, with less effort. Gain control of the entire prosecution cycle, from pretrial to trial and sentencing. Focus on core activities and effectively manage your caseload while reducing paperwork and eliminating case delays. Integrate all courts under one tech umbrella and handle cases from initiation to post-disposition. Reduce case backlog, speed up case disposition, improve adjudication while providing a more accessible public service. Mitigate risks by managing all inmate information and processes in a single environment. Bring together prisons, community corrections, courts and other agencies to efficiently provide public safety. -
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iA NEXiA
iA
iA’s proprietary software platform for pharmacy. The nexus of people, process, and technology, NEXiA software provides comprehensive and flexible fulfillment throughout the entire prescription lifecycle. Seamlessly manages inventory with prioritization and trend forecasting through iA’s sophisticated warehouse management system. Creates the opportunity for pharmacies to more easily and efficiently offer patients choice on prescription delivery. 700 configuration parameters and 70 existing bidirectional interfaces that can integrate with third-party hardware. Intelligent production control from adjudication through distribution. Ability to meet your unique operational needs with flexible configurations and dynamic routing. -
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Tyler's Workers’ Compensation Software
Tyler Technologies
Tyler Technologies' Workers' Compensation software automates processes while adhering to the complex rules and regulations that drive workers' compensation programs. It enables agencies to efficiently receive, track, and process a wide variety of workers' compensation claims, including work-related injuries and occupational diseases, ensuring timely and accurate benefits delivery. It supports the entire claims lifecycle, from initial intake through adjudication and resolution, providing tools for document management, workflow automation, and reporting. It is designed to enhance operational efficiency, reduce administrative burdens, and improve compliance with regulatory requirements. Streamlining case management processes helps agencies focus on delivering quality services to claimants while maintaining program integrity. -
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Facctum
Facctum
Facctum is a next-generation compliance intelligence platform that enables financial institutions to detect, screen, and manage financial crime risks in real time. Leveraging AI and high-performance infrastructure, Facctum automates watchlist screening, sanctions compliance, name matching, and alert adjudication across customer and transaction data. Built for modern compliance teams, Facctum reduces false positives, accelerates decision-making, and integrates seamlessly into complex regulatory workflows via scalable APIs. Whether you’re a fintech, bank, or payments firm, Facctum delivers faster, smarter, and more accurate risk control — without compromise. -
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PrimeRx
Micro Merchant Systems
PrimeRx is a robust pharmacy management platform designed to optimize every part of pharmacy operations, from prescription intake and automated refill management to dispensing, inventory tracking, label printing, billing, and patient engagement, with modules that support retail, specialty, long-term care, compounding, mail order, 340B, and physician office workflows. PrimeRx’s intuitive dashboard shows scheduled refills and compliance metrics, maintains complete patient profiles with medication history and clinical notes, and actively alerts for potential medication conflicts to support safety and adherence. Integrated features include two-way SMS and email communication, an online refill portal, secure payment capture, real-time insurance and adjudication, and flexible inventory management with automatic reordering and wholesaler EDI ordering; complementary mobile apps extend refill, delivery, and inventory tools to handheld devices.Starting Price: $150 per month -
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LifeSphere CTMS
ArisGlobal
Complete control. Full visibility. LifeSphere CTMS is an easy-to-use trial management solution that helps clinical operations teams accelerate timelines, stay organized, and reduce complexity. Reduce study timelines with a modern, easy-to-use cloud application that streamlines study management and automates key activities across the trial lifecycle. Navigate complexity with a simple, yet powerful trial management application that provides full oversight of trial activities to keep study teams aligned and on time. Streamline your clinical environment with a turn-key platform for operations that includes payments and monitoring and delivers a seamless connection with LifeSphere eTMF. Create seamless connections with TMF Reference Model Exchange Mechanism Standard compliance for seamless, cross-platform document sharing. -
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Zapclinica
Zapclinica
Manage your clinical trial in one platform. Zapclinica is an eClinical suite designed to manage and conduct every aspect of your decentralized clinical trial - hybrid or virtual. Automate complex processes, identify outliers, optimize resources, improve decision making and collaboration between sponsors, CROs, and sites. Zapclinica reduces the time and costs to run a successful clinical trial. Manage your clinical trial in one platform. Zapclinica is an eClinical suite designed to manage and conduct every aspect of your decentralized clinical trial - hybrid or virtual. Automate complex processes, identify outliers, optimize resources, improve decision making and collaboration between sponsors, CROs, and sites. Zapclinica reduces the time and costs to run a successful clinical trial. Cover all aspects of your study with one platform. No extra vendors, no extra third-party, choose the app you need in a single environment, including EDC, ETMF, Payments, Logistics, and many more. -
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You don’t have to choose between supporting regulatory compliance and using the latest, most innovative cloud services. Help manage the requirements for your regulated workloads with just a few clicks. Reduce costs and risk through simplified management of required controls. The FedRAMP High platform controls support access controls for first and second-level support personnel who have completed enhanced background checks and are located in the US. The CJIS platform controls support access controls for first- and second-level support personnel who have completed state-sponsored background checks and are located in the US. Escorted session controls are also used to supervise and monitor support actions by non-adjudicated staff.
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FormFox
FormFox
FormFox makes industry-leading workplace health and safety tools and technology available to all collectors, laboratories, TPAs, MROs and employers. With purposeful automation, our web-based, software-driven service offering streamlines entire collection and event processes from initial order to final decision and reporting. FormFox mitigates errors, saves time, and expedites data delivery to improve quality, accuracy, speed and efficiency for our client partners and those they serve. The FormFox MRO solution delivers faster results adjudication and turn-around time, using a more efficient set of workflows to conduct the review process. The “Common Platform” approach has been embraced across the industry, allowing laboratories to significantly reduce costs while improving the quality and integrity of the testing process. FormFox is the leading Electronic Custody and Control (ECCF) solution for all clinics in the employee health and safety industry. -
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Clinical Concepts
IVR Clinical Concepts
IVR Clinical Concepts specializes in providing virtual clinical trial technology and patient engagement solutions. Their offerings include electronic patient-reported outcomes and patient diaries, which aim to deliver better data with fewer errors, resulting in shorter timelines and lower costs. They also provide patient recruitment and outreach services, focusing on outreach, pre-screening, and real-time data collection. Their subject screening, registration, and randomization solutions are described as modular, custom, flexible, and configurable. Additionally, IVRCC offers clinical trial material management solutions designed to reduce workload while providing more control, as well as eClinical integration services to seamlessly thread data together. Their chart review services provide real-world data and clinical insights. IVRCC emphasizes custom, modular, and configurable solutions to improve the patient experience and optimize clinical trial success. -
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Oracle Health Specialty Practice Management is part of the Oracle Health family of clinical and practice management solutions, designed to provide the tools needed to run a profitable medical practice. Oracle Health Specialty Practice Management is customizable and integrates well with user-friendly EHRs offering medical document management, patient appointment scheduling and health record management. With an internet connection, Oracle Health Specialty Practice Management provides near real-time updates on claim status. With most payers, Oracle Health Specialty Practice Management is designed to help your practice have its claims adjudicated, paid and posted weeks sooner than a paper-based system. Other key features include patient scheduling, monitoring and posting payments. Oracle Health Specialty Practice Management includes capabilities to help your practice improve efficiencies during the scheduling, monitoring and payment process.
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ServiceNetwork
ServiceCentral
ServiceNetwork™ helps unify and simplify contract service for both Service Providers and Authorizers. An application to onboard and manage a provider network, eligible products and services, parts and pricing, and view services in progress. A guided workflow defined by an Authorizer following best practices for receiving, servicing, and reporting back. A brandable portal for consumers to request services, select locations, schedule appointments, and check service status. Consumer engagement and appointment scheduling. Service Provider network connection. Provider and location qualification. Technician guided workflows. Adjudication and resolution. 2000+ Walk-in service centers and mail-in depots in North America. Majority of locations are medium and large retail brands. These service providers are already on our platform and available for quick onboarding. Additional partners may be added through our application, provider portal or integrated through our service provider API. -
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FBCS Enterprise
DSS
FBCS Enterprise is a centralized system for guiding decisions about non-VA Purchased care to improve fee basis claims management and adjudication through efficient claims processing. A web-based solution, CTM Plus streamlines workflows and provides oversight to resolve consult and Return to Clinic (RTC) tracking pain points, and ensure patients are called and scheduled on time. Purchasing analytics help to reduce cost and waste, for greater overall accountability. Expired and recalled items are also monitored automatically to keep patients safer. Delayed or misplaced orders can have significant consequences for your bottom line and quality of care. Time spent sorting through paper records and scrolling through screens is time you won’t have for patients. Checking every patient for opioid prescriptions can be an exhausting, multi-step process. DSS PDMP streamlines everything into one simple step. -
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PLEXIS Payer Platforms
PLEXIS Healthcare Systems
PLEXIS’ suite of best-in-class apps has a proven record of giving payers the extended functionality necessary for modern core administrative ecosystems. From real-time benefit administration and adjudication to automatic EDI transmission and self-service customer portals, PLEXIS Business Apps have you covered. Passport provides essential connectivity from the core admin and claims management engines to PLEXIS business apps, your own apps, and existing in-house systems. With its flexible API layer, Passport delivers real-time integration with portals, automated workflow toolsets, and business apps. Connectivity is limitless. Streamline workflows with a centralized, modern core administration & claims management platform. Process claims in a timely and accurate manner, and automate the complexities of benefit administration to capture a quick ROI and deliver superior customer service. -
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ClaimScape
DataGenix
Emerged in the year 2000, DataGenix is strongly resolved to provide TPAs, adjusters, and insurance companies with modern claims processing solutions. We understand that claims processing and health benefits management can include several complications. So that your business does not suffer any losses, our experts have created the advanced ClaimScape software that can automate the entire adjudication process. The goal of our business and the Claims software is to resolve the perplexities that hinder the reach of unmatched customer experience for your clientele network. Keeping in mind the modern trends and requirements, we can assure your business's optimum growth with our software products. We have won the trust of top TPAs of the nation and are willing to serve more. -
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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. -
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Immediation
Immediation
Immediation is a comprehensive online dispute resolution platform designed to streamline and simplify the process of mediation, arbitration, adjudication, and automated negotiation. Tailored for legal professionals, including mediators, arbitrators, and law firms, the platform offers a suite of over 30 purpose-built tools that facilitate secure, efficient, and user-friendly dispute resolution. Key features include automated intake forms, customizable workflows, case and panel management, financial tools for invoicing and payments, and a secure client portal. It supports seamless video conferencing, real-time transcription, exhibit management, and document sharing, ensuring a comprehensive digital environment for all parties involved. Immediation is ISO27001 certified, ensuring high standards of security and compliance, and integrates with platforms like Microsoft Teams and Clio to enhance functionality.Starting Price: $49 per month -
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Oracle's Digital Insurance Platform empowers insurance providers to deliver innovative solutions and exceptional digital customer experiences. This comprehensive insurance management system streamlines operations from sales channels to back-office processes, enabling rapid deployment of new offerings and seamless implementation of necessary changes. With real-time analytics, insurers gain valuable insights into their business, facilitating informed decision-making. The platform supports both individual and group life and annuity insurance, consolidating underwriting, policy processing, billing, and claims into a single, efficient system. Health insurers benefit from simplified enrollments, premium billing, and claims adjudication, enhancing member satisfaction through transparent and personalized services. Additionally, the platform accelerates the bancassurance lifecycle by providing real-time connectivity between banks and insurers, ensuring speed, consistency, and reliability.
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CURATE
QReserve
From collecting submissions to printing exhibit labels to displaying galleries on your website, CURATE by QReserve is your organization's trusted exhibition management solution. Collect submissions directly from your website, and the information will feed directly into your CURATE portal. Assign tags to instantly organize and distinguish between artists, artwork and exhibitions. Allow judges to view artwork and adjudicate submissions directly from our platform. Can't find the feature you need? QReserve can work with you to develop custom reports, integrations, or logic to satisfy the most demanding requirements. Access downloadable reports with flexible filters from simple submission spreadsheets to complex customized exhibition information. Collect submission payments directly from your submission form. Customize the login page and application with your logo and colours. -
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assisTek
assisTek
AssisTek is a leader in innovative clinical technology solutions for clinical research, offering custom clinical software solutions to streamline and enhance patient data collection. With over 25 years of excellence, they have supported more than 800 clinical research trials across 46 therapeutic areas, including over 500 multinational Phase I–IV clinical trials. Their eCOA solutions are highly scalable, customizable, and efficient, powered by a proven, cloud-based technology platform. AssisTek's product suite includes TEK eCOA Tablet, designed to support any questionnaire used in a clinical trial, TEK eDiary for capturing patient-reported outcomes at home, TEK Configurator for building clinical trial projects from start to finish, and TEK Study Portal for eClinical tracking, training, and reports in one place. Their systems and services have made them the top choice for collection and analytics among patients and clinicians. -
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Insurium
Insurium
A unified solution providing a 360º view of the P&C insurance process lifecycle. Generate premium and save time with a powerful rules-based, multi-state underwriting module that automates the collection of information and the creation of quotes, endorsements, cancellations, audits, and renewals. Reduce combined ratios with a modern and streamlined approach to the claims adjudication process that is both intuitive and collaborative. Increase new business by making it easy to exchange information with brokers. From streamlining and standardizing the intake of information to providing brokers access to the information they need anytime. Control what submissions your underwriters are focusing on. Drive customer satisfaction and retention by providing your policy holders self-service access to policy information, claims intake and review, online bill pay and more. You decide what portal features to provide your customers for the best user experience. -
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GenHealth.ai
GenHealth.ai
GenHealth.ai is a healthcare-focused generative AI platform built on a proprietary Large Medical Model (LMM) trained using data from over 100 million patient histories rather than natural language. The LMM processes medical codes and events to predict future patient trajectories, forecast costs, and simulate clinical pathways with higher accuracy and fewer hallucinations than traditional large language models. It supports a suite of purpose-built applications, including Intake Automation (PDF routing, data extraction, medical necessity), Prior Authorization Agent for automated adjudication, and G‑Mode analytics, which enables users to “chat” with historical and projected population‐health data via natural language, all without coding. This AI‑powered co‑pilot has shown 94 % accuracy in prior‑auth cases, a 120× improvement in medical loss ratio forecasting, and 110 % better cost prediction versus standard HCC scoring. -
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Oracle Clinical One
Oracle
Clinical One RTSM can support a randomization strategy for the simplest to the most complex studies without the need for programming or coding, which eliminates the need for prolonged user acceptance testing. Take control of your study through self-service configurations and build a study in days instead of weeks. Assess the status of the drug inventory and make modifications in real-time without reverting to the vendor and incurring cost and change requests. Eliminate change request costs and avoid delays by quickly implementing changes and promoting your studies in seconds. The only platform that truly unifies people, processes, and data to simplify and accelerate the clinical trials of the future. Virtual components in clinical trials allow greater patient participation and significantly improve clinical trial data quality. Transformative digital strategies are needed for faster study startup to harmonize data from any source and to streamline workflow. -
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ClearForce
ClearForce
ClearForce, Secure Your Organization, Promote a Trusted Environment. 24/7 Employee Risk Management. Risk Management Means Spotting & Mitigating Employee Stress. Pre-Hire Background Checks Aren’t Enough. Why ClearForce? The ClearForce Resolve™ platform protects organizations and employees through the continuous evaluation of risky behavior. It delivers real-time, event-based alerts of external employee misconduct and high-risk behavior that may present a level of risk to the organization, its employees, or its customers. In addition, ClearForce Resolve™ is the only cross-departmental platform that enables HR, Security and Legal to work together in a single, centralized environment—investigative work is streamlined and efficient. All external and internal behavioral alerts, incident reports and complaints are centrally captured, archived, and adjudicated within the Resolve system. Resources previously needed to aggregate, research, and match data points can now be redirected.Starting Price: $15000 per user, per year -
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CyberSource Medical
ComCom Systems
The market's most powerful and accurate solution for claims processing. CyberSource Medical Claims Scanning Solution, a complete turn key system for HMO, PPO, TPA, or Self Funded Organization, is installed at your location for automated data entry of CMS-1500, ADA-2006 UB-04 and enrollment forms. Using advanced "intelligent" features combined with your business rules, CyberSource recognizes, validates and formats the data from medical claim forms. Fuzzy Matching performs an intelligent search of your member and provider database correctly identifying the exact match. The matched data is then utilized to verify and correct data on the medical claim before being passed through to adjudication. The combination of industry-leading OCR efficiency, your business rules and “Fuzzy Matching” results in exceptional accuracy of the data from your medical claims forms. -
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QuantaVerse
QuantaVerse
The QuantaVerse Financial Crime Investigation Platform uses RPA, AI, and machine learning to automate data gathering, identify financial crime and document findings. Our solutions have proven to make AML case adjudication and reporting more effective and more efficient. Comprehensive data gathering and validated analytics deliver the consistent findings and uniform reporting you and your regulators require. Multiply the efficiency of your investigation team by eliminating up to 40% of false positives before they’re generated and by cutting 70% of investigation time through automation of data gathering and analysis. Create consistency across your AML/BSA program with innovative solutions that deliver the timely, transparent, and fully-explainable findings that regulators expect. Find the risk your current systems are missing and drive criminals and terrorist organizations out of your institution. -
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elluminate Clinical Data Cloud
eClinical Solutions
eClinical Solutions helps life sciences organizations around the world accelerate clinical development initiatives with expert data services and the elluminate® Clinical Data Cloud — the foundation of digital trials. Leveraged by 100+ biopharmaceutical companies, elluminate is a purpose-built clinical data platform designed to accelerate digitization efforts in order to proactively manage the exponential growth of clinical data volume, variety, and velocity. According to Gartner’s 2022 Hype Cycle for Life Science Clinical Development, life science companies continue to accelerate scaling digital capabilities and the adoption of hyperautomation, AI and advanced analytics is becoming mainstream. With elluminate’s automated data pipeline and scalable infrastructure organizations are able to keep up with the complexities of modern clinical trials to deliver business value across clinical development functions. -
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eOxegen
eOxegen
eOxegen is an AI-powered claims management system designed to streamline and enhance the efficiency of health insurance operations. Automating claims processing through a Straight Through Process (STP), reduces manual intervention, leading to faster claim settlements and improved accuracy. It incorporates advanced fraud detection capabilities, utilizing AI algorithms to identify and flag potentially fraudulent activities early in the process. Additionally, eOxegen offers features such as provider contracting and empanelment, pre-authorization management and adjudication, and robust reporting with business intelligence analytics dashboards. Its AI-driven workflow automation ensures consistent task completion, minimizes repetitive activities, and enhances overall productivity. By integrating these functionalities, eOxegen empowers insurance companies and third-party administrators to optimize their claims management processes, and reduce operational costs.
