Alternatives to TriZetto
Compare TriZetto alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to TriZetto in 2026. Compare features, ratings, user reviews, pricing, and more from TriZetto competitors and alternatives in order to make an informed decision for your business.
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RXNT
RXNT
RXNT is an ambulatory healthcare technology pioneer that empowers medical practices and healthcare organizations to succeed and scale through innovative, data-backed, AI-powered software. Our fully-integrated, ONC-certified suite of medical software—like Clinical EHRs, Practice Management, Medical Billing and RCM, E-Prescribing, Practice Scheduling, Patient Portal, and more—optimizes clinical outcomes and RCM for your practice. Used by tens of thousands of medical professionals—from large physician practices to medical billing companies—to drive growth, streamline business operations, and improve patient care across all 50 U.S. states. Our unified “Full Suite” system employs a secure, central database so your data passes through every product in real-time from anywhere, and more than 125 million prescriptions have been transmitted and over $7 billion in claims have been processed using RXNT. -
2
Service Center
Office Ally
Service Center by Office Ally is a trusted Revenue Cycle Management and patient payments platform used by more than 80,000 healthcare providers and health services organizations, which process more than 950 million transactions annually. Service Center is a cost-effective solution enabling providers to control their revenue cycle. With a user-friendly interface, Service Center helps providers check and verify patients’ eligibility and benefits, submit, correct, and check the status of their claims online, and receive remittance advice. Accepting standard ANSI formats, data entry and pipe-delimited formats, Service Center helps streamline administrative tasks and create more efficient workflows for providers. -
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CredentialStream
HealthStream
Finally, a single solution to affirm and continuously assess medical provider competency. Ensure excellence in care by offering the industry-leading software for enrolling, onboarding and privileging to continuously evaluate your providers. CredentialStream® incorporates patented technology that provides everything necessary for requesting, gathering, and validating information about a provider, all to establish a reliable Source of Truth for downstream processes. With a modern platform that is continuously updated, along with best-practice content libraries and industry-leading data sets, CredentialStream stands out as the most comprehensive provider lifecycle management solution available. Say goodbye to the headaches, hassles and manual processes that slow you down. Say hello to a modern, continuously updated platform, best-practice content, and industry-leading data that all works together to get your providers where they need to be— seeing patients. -
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NextGen Healthcare EHR
NextGen Healthcare
NextGen Healthcare provides ambulatory practices of all sizes award-winning solutions along with dedicated support and professional services. We align with your goals to achieve the success that results in healthier patients and happier providers. NextGen® Enterprise EHR offers your practice configurable clinical content, intuitive workflows, and an integrated patient experience platform that incorporates telehealth. With NextGen® Mobile, your providers’ smartphones become an extension of your EHR, which saves valuable time. Managed cloud hosting keeps your practice secure and makes upgrades easy, though on-premise options are also available. NextGen® Office is a cloud-based EHR designed to support your practice growth, save staff time, and increase patient volume. This fully integrated clinical and billing platform features specialty-specific EHR content, mobile accessibility, a revenue cycle management system, and a convenient patient portal. -
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Foothold
Foothold Technology
Our human services software offers full functionality for case management, client tracking, electronic health record (EHR), and homeless information management (HMIS) all under one roof. We work with agencies across the spectrum of human services: including developmental disabilities, mental health, substance use disorder, homelessness, supportive housing, HCBS, and much more. Foothold is HIPAA-compliant mental health software, federally certified as an EHR, and offers full interoperability as you navigate the new landscape of care coordination and value-based care. Transform the way you provide care with nimble software and a partnership guided by experience. -
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Tebra
Tebra
Independent practices need complete solutions to maximize patient and provider well-being. While each Tebra product is purpose-built to modernize and optimize every step of the patient-practice journey, the combined platform delivers a complete operating system that provides added value for providers and patients alike. Power your connected practice with everything you need to attract new patients and keep current ones through the power of digital presence. Empower patients through every communication touchpoint and deliver a uniquely frictionless experience and convenient access that builds trust and a healthier practice. A modern, certified EHR solution built for the needs of today’s provider, delivering everything your practice needs. This includes robust charting, streamlined documentation, a comprehensive view of patients and their history, eRx, eLabs, telehealth, and more, allowing providers control of how they deliver care. -
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CAQH
CAQH
CORE brings the industry together to accelerate automation and develop business processes that streamline healthcare for patients, providers and health plans. Drawing on the industry's most trusted source of provider and member data, CAQH enables healthcare organizations to reduce costs, improve payment integrity and transform business processes. In the ever-evolving landscape of healthcare, continuous improvements in payment and claims processing systems are vital. The nation’s providers and health plans trust CAQH to collect and manage professional information, verify primary sources, and monitor for sanctions. The result, is streamlined administration, greater regulatory compliance, and better provider data management. -
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Rectangle Health
Rectangle Health
A leader in innovative healthcare technology for over 30 years, Rectangle Health is a trusted partner to more than 40,000 healthcare providers. The company’s comprehensive platform, Practice Management Bridge®, streamlines daily business operations including communications and engagement, payments and reimbursements, and office compliance. Customers of all sizes, in all sectors of healthcare, rely on Rectangle Health’s easy-to-use, scalable software to deliver a measurable increase in productivity and profitability, while improving patient experience. -
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Availity
Availity
Collaborating for patient care requires constant connectivity and up-to-date information. Simplifying how you exchange that information with your payers is more important than ever. Availity makes it easy to work with payers, from the first check of a patient’s eligibility through final resolution of your reimbursement. You want fast, easy access to health plan information. With Availity Essentials, a free, health-plan-sponsored solution, providers can enjoy real-time information exchange with many of the payers they work with every day. Availity also offers providers a premium, all-payer solution called Availity Essentials Pro. Essentials Pro can help enhance revenue cycle performance, reduce claim denials, and capture patient payments. Availity remains your trusted source of payer information, so you can focus on patient care. Our electronic data interchange (EDI) clearinghouse and API products allow providers to integrate HIPAA transactions and other features into their PMS. -
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Inovalon Provider Cloud
Inovalon
Optimize revenue cycle management, care quality management, and workforce management all in one single-sign-on, easy-to-use portal. More than 47,000 provider sites rely on our innovative tools to simplify complicated operations across the patient care journey. Improve the patient financial experience and simplify administrative and clinical complexities with the Inovalon Provider Cloud – all while saying goodbye to siloed workflows. Our SaaS solutions help you strengthen financial and clinical outcomes across the patient journey, from creating front- and back-end revenue cycle processes for better reimbursement to ensuring appropriate staffing levels for optimal care. This is all managed in one comprehensive portal to take your organization to new heights improving revenue, staff equity, and care quality. Enhance your organization’s efficiency, productivity, and overall effectiveness. Discover what the Provider Cloud can do. -
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Veradigm Payerpath
Veradigm
Veradigm Payerpath is an end-to-end revenue cycle management suite of solutions built to assist organizations to improve revenue, streamlining communications with payers and patients, and boosting practice profitability for practices of all sizes and specialties. Eliminate missing information, incorrect coding, and data entry error to ensure clean claim submission. Ensure claims pre-submission are correctly coded, have no missing information, and are error-free. Compare performance against peers at the state, national, and specialty levels to optimize productivity and improve financial performance with advanced analytical reporting. Remind patients of their appointments and confirm their insurance coverage and benefits information. Automate the billing and collection of patient responsibility. Veradigm Payerpath’s integrated solutions are practice management (PM) agnostic, interfacing seamlessly with all major PM systems. -
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CareCloud
CareCloud
Grow your practice with the number one cloud-based EHR and practice management software, CareCloud. CareCloud offers a complete suite of tools for healthcare professionals and providers of all sizes and practices. These include Concierge, a comprehensive revenue cycle management solution; Central, a user-friendly practice management tool; Charts, an easy-to-use electronic health records solution; Community, patient engagement and social tools; and Companion, a clinical and administrative mobile app. -
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ImagineBilling
ImagineSoftware
The industry’s first intelligent, multi-specialty medical billing software. Streamlining billing and patient collections for over 75,000 physicians across the country. Globalized data eliminates the need for duplicate entry. Visit-driven to allow for large volume and complex information. Flexible data structure accommodates requirements across multiple practices and specialties. Helping you get paid faster. Post payment manually or through electronic remittance. Automatically scrub claims for errors and missing information. Automatically refile insurance claims based on selected criteria. Fast review to evaluate and approve charges. Audit charges by modality, procedure, insurance, user, doctor or date of service. Intuitive reports for tracking the financial health of your front-end and back-end billing. Never lose another charge again. Integrates with your preferred clearinghouse or statement vendor. -
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Quadax
Quadax
How well you manage the challenges of your revenue cycle has a direct effect on your bottom line and the success of your entire organization. It doesn’t matter how many patients seek your care if it’s taking months to receive the expected payments for the services you provide. And, you shouldn’t have to spend hours each day tracking down the payments you’ve worked hard to earn. There’s a better way to maximize healthcare reimbursement. Let Quadax be your guide to creating a comprehensive, sustainable and orderly strategic plan, and select the right technology solutions and services that best fit your business model. With us as your partner, you can achieve operational efficiency, optimize financial performance and enhance the patient experience. The goal for every claim going out the door is to avoid a denial and get paid as quickly as possible. -
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Assurance Reimbursement Management
Change Healthcare
An analytics-driven claims and remittance management solution for healthcare providers who want to automate workflows, improve resource utilization, prevent denials, and accelerate cash flow. Increase your first pass claim acceptance rate. Our comprehensive edits package helps you stay current with changing payer rules and regulations. Heighten your staff’s productivity with intuitive, exception-based workflows and automated tasks. Your staff can access our flexible, cloud-based technology from any computer. Manage your secondary claims volume through automatic generation of secondary claims and explanation of benefits (EOB) from the primary remittance advice. Focus on claims that need your attention with predictive artificial intelligence into problem claims. Resolve errors faster, and avoid denials before submittal. Process claims more efficiently. Print and deliver primary paper claims, or add collated claims and EOBs for secondary claims. -
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AltuMED PracticeFit
AltuMED
Conducting thorough checks on the financial eligibility of the patients, running their insurance’s analysis and monitoring discrepancies, the eligibility checker covers all. If however any error does creeps in the data submitted, our scrubber working on deep AI&ML algorithms is capable of scrubbing errors be it coding errors, incomplete or wrong patient financial information. The software, at present, has 3.5 Million edits pre-loaded in its memory. To further streamline the process, automatic updates are issued by the clearing house to inform about the status of in-process claims. Covering the entire billing spectrum from verifying the patient financials to working on denied or lost claims and also has a through follow-up feature for appeals. Our intuitive systems warns if a claim could be denied, taking corrective actions to prevent it but also is capable of tracking and appealing for lost or denied claims. -
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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. -
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Veradigm Practice Management
Veradigm
Improving financial and operational workflows across your practice is a challenge. You’re working to maximize provider schedules, improve reimbursement, succeed in alternative payment models and value-based care, minimize claim errors and secure data access, all while providing the best possible patient care. It’s tough, but with the right partner with deep expertise and resources to help you drive performance, it doesn’t have to be. Practice Management enables easy scheduling and registration, with the ability to obtain real-time referrals and eligibility verification. With Practice Management, your team can more effectively manage walk-ins, cancellations and recurring appointments. Use the patient-centric ledger for one-stop account management. View service and payment history, reimbursement detail notes, rebilling and collection activity all in one place. -
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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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Silna Health
Silna Health
Silna Health’s Care Readiness Platform handles all prior authorizations, benefit checks, and insurance monitoring upfront to make sure patients are clear to receive care while providers gain capacity to focus on treatment. Its AI‑powered engine manages the entire prior authorization workflow, from tracking upcoming authorizations and sending weekly reminders to submissions and follow‑ups, automatically applying industry‑proven rules and escalating exceptions for human review. Specialty‑specific benefit checks verify coverage, accumulations, authorization requirements, and visit limits in real time, delivering accurate quotes at intake. Continuous insurance monitoring flags lost coverage, detects new plans, and safeguards against eligibility lapses. Designed for zero extra headcount, Silna ingests data directly from EMRs and practice management systems, offers configurable rule sets and strategic guidelines, and presents clear dashboards with incremental revenue insights. -
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Sentact
Sentact
Sentact’s digital, enterprise-wide rounding solutions help hospitals to create safer environments, increase patient engagement, and improve overall quality of care. Our industry leading platform drives improved patient and caregiver satisfaction, safety and quality with a comprehensive set of tools that automate rounding, deliver patient experience improvements, facilitate instantaneous feedback and provide enterprise-wide reporting. Sentact helps health systems take control of patient engagement to deliver improved patient outcomes, while simultaneously reducing costs and increasing reimbursement. -
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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. -
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symplr Provider
symplr
symplr Provider credentialing software helps create a single source of provider data, shrinks turnaround times, and shortens revenue cycles, all while prioritizing patient safety. symplr Provider credentialing software makes data gathering, secure access, reporting, and ongoing compliance less burdensome for providers, credentialing staff, and internal approval committees. Our customers report a 20% reduction in credentialing timelines, including a 50% reduction in committee review meetings. Collect, verify, store, and share provider lifecycle data and documents in one automated, user-friendly hub, resulting in time savings and cost containment. With a built-in payer enrollment module, you can enroll providers with payers and easily track applications step-by-step, to get reimbursed faster. Leverage automation to gather data from hundreds of primary sources and auto-check for expired/suspended licenses, NPDB, DEA, SAM, and more. -
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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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Axora
Axora.AI
Axora AI is an intelligent, end-to-end claims engine that blends AI-powered automation with billing expertise - managing everything from eligibility to payment posting. But it’s more than automation. Axora AI prevents denials before they happen, adapts to payer rule changes, and prioritizes what matters - so you recover more revenue with less effort. 1. Manages your full claims cycle from start to finish 2. Flags denial risks before submission 3. Prioritizes actions that improve cash flow 4. Seamlessly fits into your EHR, payer, and finance systems 5. No migrations. No disruption. Just faster, cleaner paymentsStarting Price: $30/month -
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NaviNet Open
NantHealth
As an organization that prioritizes value-based care, your ability to communicate across a flexible, extensible platform is critical. NaviNet Open is one of America’s leading payer-provider collaboration platforms, facilitating provider engagement and generating trustworthy, actionable data throughout the continuum of care delivery. A secure multi-payer platform, NaviNet Open enhances communication, boosts operating efficiency, cuts costs, and improves provider satisfaction. It lets payers and providers exchange vital administrative, financial, and clinical information in real time. For NantHealth, security is a priority. HIPAA compliant and steadfast in our values, our demonstrated commitment has led us to hold EHNAC HNAP accreditation since 2006. NaviNet Open is HITRUST certified, having met key regulations and industry-defined requirements. It appropriately manages risk regarding third-party privacy, security and compliance. -
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Experity
Experity
Use the EMR built for urgent care. Simplified charting and easy-to-use templates drive quick, accurate documentation, streamlined workflow, seamless integration, and a better experience for patients (and everyone on your staff). Get the urgent care EMR software that provides the tools you need to navigate center visits efficiently. With an intuitive interface and documentation templates made for urgent care, clinicians can chart an urgent care visit with confidence. With fast registration, real-time insurance verification, integrated EMR/PM database, and workflow-driven scheduling queues, patients go from the front desk to discharge as quickly as possible, boosting satisfaction. Precise CPT autocoding and smart E/M code suggestions ensure full documentation of each visit and more accurate claims. With a library of relevant standard reports to inform decision-making, it’s easy to monitor and improve your clinic performance. -
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Experian Health
Experian Health
Patient access is the starting point for your entire revenue cycle process. Ensuring correct patient information on the front end reduces the errors that cause rework in the back office. 10 to 20 percent of a health system's revenue is forced to remediate denied medical claims and 30 to 50 percent of those occur during patient access. By adopting an automated, data-driven workflow—not only are you reducing the errors that lead to claim denials, you’re also improving access to care for your patients through capabilities like online scheduling options that are available 24/7. Access is further improved by reducing the friction around patient billing by leveraging real-time eligibility verification to deliver accurate patient estimates at registration. Increase staff efficiencies by improving registration accuracy. Correct discrepancies and errors in real time to avoid costly denials and rework. -
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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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QuickCap
MedVision
MedVision Solutions' QuickCap is an administrative and clinical data process management solution that lets users focus on business and not the paperwork. With QuickCap, users have scalable control over their workflow and information to work smarter. QuickCap features a customizable dashboard for ease and gives them automation of their process for speed. QuickCap also streamlines claims work that makes users' work easier. QuickCap also allows users to easily determine profitability for individual providers with analytics. -
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pMD
pMD
End-to-end practice management and revenue cycle solutions. From patient intake to getting paid, pMD has all the software and services you need to run your medical practice. With fewer systems involved, there's less room for errors and inefficiencies. Use all of the features pMD has to offer, or we can integrate seamlessly with your existing systems. A comprehensive and secure communication strategy means fewer gaps in care and a better patient experience. Delivering the best possible care means having a standardized communication channel to connect about and with your patients. We make sure all the important patient information is accessible in one place, saving you valuable time when you need to access it. pMD offers the comprehensive, integrated, and HIPAA-compliant telemedicine platform solution health care providers need to provide unparalleled patient care. Explore all the easy-to-use telehealth software app offers and get pMD telemedicine for your practice and patients.Starting Price: Free -
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symplr Payer
symplr
Save on costs, eliminate data silos, and deliver better outcomes for your members with a unified, automated provider data solution. symplr Payer provides a single source of truth for provider data that is consistently reconciled and validated against primary sources. It improves data quality, access, and transparency. Further, it eliminates duplicate requests for information, reducing provider frustration. Using symplr Payer as the enterprise-wide hub for provider data, payers can feed timely, accurate information to other downstream systems. Our highly configurable, end-to-end provider data management solution manages all pre-contract and renewal contract negotiations. Standardize and streamline your contracting processes, while capturing contract details such as sentinel events, trigger dates, configuration efforts, process steps, fee schedule info, and more. symplr Payer’s unique design allows your organization to consolidate contracting and credentialing. -
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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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Medallion
Medallion
Medallion is the first solution for healthcare companies to fully offload their clinician operations—state license management, payor enrollment, credentialing, and more—in one modern management platform. By empowering digital health companies, hospitals, payers, and other organizations to credential, license, and monitor their providers with ease from one modern platform, they eliminate time-consuming and laborious tasks that ultimately increases accessibility of care to millions of patients nationwide. Since inception in 2020, Medallion has saved over 100,000 administrative hours for leading healthcare companies like Cerebral, Ginger, MedExpress, Oak Street Health, and hundreds more, and has raised $50M from leading investors like Sequoia Capital, Spark Capital, Optum Ventures, Elad Gil, and Peter Reinhardt. -
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ClearGage
ClearGage
Technology-enabled patient billing and payments. Accept PCI compliant payments through online and point-of-care payment methods including POS systems, Google pay, Apple pay, online payment portals and text to pay. Eliminate A/R with automated post-care payments pre-authorized up to a specific amount with patient consent. Send receipts instead of statements with digital-first text and email statements with secure payment options. Accept full or partial payments or enable patients to set up payment plans at their convenience with a fully customizable practice branded portal. Estimate your patients’ out-of-pocket expenses with greater accuracy for a more transparent patient experience and assist patients in financial management to improve treatment acceptance.Starting Price: $89.00 -
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HealthEC
HealthEC
HealthEC’s best population health management platform, comprising our care management module CareConnect™ and our analytics module 3D Analytics™ - is designed to elevate quality of care and patient experience by overcoming the healthcare industry's toughest data challenges. Conquer system chaos with a universal data warehouse of normalized claims, clinical, and SDoH data, from any source. CMS certified for reuse. Eliminate workflow disruption with integrated, customizable care plans, decision-support tools and robust care management support. Deliver patient-centric care by seamlessly coordinating with community resources and addressing social determinants of health. Inform strategies with actionable insights at the diagnosis, provider, practice, and organizational levels, presented in clear dashboards or at the point of care. Enhanced MCO performance reviews and CMS interoperability rule compliance. -
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Veritable
314e Corporation
Veritable accelerates patient insurance eligibility verification and claims-status checks by providing instantaneous results in a clean, intuitive interface. It supports real-time, batch uploading of patient lists to verify eligibility across more than 1,000 payers (including national Medicare and all state Medicaid) and multiple service types. It also enables tracking of claims status, from submission through reimbursement, so practices and billing companies can proactively identify issues to reduce payment delays and denials. Key benefits include automating eligibility and claims workflows to reduce manual entry and phone calls, improving front-desk patient experience by validating coverage and copayments at check-in, and offering seamless integration for both technical and non-technical users with strong data-security controls. It includes a “Code Explorer” for instant lookup of ICD-10-CM, ICD-10-PCS, HCPCS Level II, and CPT codes.Starting Price: $50 per month -
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Inovalon Insurance Discovery
Inovalon
Insurance Discovery reduces uncompensated care and underpayments by identifying active billable coverage previously unknown to the provider. Using sophisticated search capabilities, this solution identifies if patients have multiple active payers to help boost reimbursement opportunities. Prevent reimbursement delays and increase the speed of revenue capture by sending claims to the right payers on the first submission, enabled by more accurate coverage information. Run Insurance Discovery with verified patient demographic data to get accurate coverage and eligibility information. Replace manual insurance discovery methods with one quick, comprehensive search that inquires numerous databases in seconds to deliver detailed, accurate coverage information. Improve the patient/resident experience and estimate accurate out-of-pocket costs to improve their financial experience. -
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Valenz Health
Valenz Health
Our single end-to-end platform of fully integrated health plan solutions delivers value and simplifies the complexity of healthcare for employers, members, providers, and payers. Valenz integrates member-centric services with data-driven insights, connecting the dots with personalized service and guidance for high-quality care and improved outcomes. We engage early and often with results-driven education, support, and services to avoid more serious and costly health events. With Valenz, you can have a healthier member population while also achieving plan and member cost savings, year after year. For the tools and transparency you need to make cost-effective, quality-first decisions, let’s find your path to smarter, better, faster healthcare today. With a suite of fully configurable solutions integrated into one ecosystem strategy, the Valenz healthcare ecosystem optimization platform offers extensive visualization of cost, quality, and utilization opportunities. -
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BHRev
BHRev
BHRev is a specialized revenue cycle management service and automation platform built for behavioral health providers that helps practices streamline and optimize their entire financial workflow from claims submission to payment collection with AI-powered automation, expert oversight, and industry-specific expertise. It focuses on the unique challenges behavioral health organizations face, including complex payer rules, documentation requirements, high denial rates, and evolving compliance standards, by automating up to 80% of RCM tasks while human experts handle exceptions, compliance checks, and more nuanced billing functions to ensure faster reimbursement and fewer administrative errors. It combines advanced automation with human review to handle critical steps such as insurance eligibility verification, claims processing and scrubbing, denial management and follow-up, and patient payment posting so clinics can reduce operational burden and increase cash flow. -
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ThoroughCare
ThoroughCare
ThoroughCare is a comprehensive care coordination software platform designed to enhance care delivery across various healthcare services, including chronic care management, remote patient monitoring, behavioral health integration, transitional care management, annual wellness visits, and advance care planning. The platform enables providers to meet all service requirements, leverage evidence-based standards, and capture new revenue while closing gaps in care. ThoroughCare supports a comprehensive care management approach by tracking quality and performance, aggregating data across clinical sites to monitor engagement and performance, patient risk stratification reports, claims details, missed revenue, encounters, and call metrics. ThoroughCare Analytics informs decision-makers by visualizing operational, financial, and patient-related data. The platform integrates with electronic health records (EHRs), health information exchanges (HIEs), remote monitoring devices, etc. -
42
Madaket
Madaket Health
Get hours back in your day and millions back in your pocket with our automated solutions. Access the key players—providers, payers, and partners—and the real-time, accurate data you need to never miss a beat in care delivery. We handle all the complex connections across thousands of payers. All you need to know is fast and easy enrollments to any payer starts here. The cloud has never looked this good. Central command to manage, store, and share provider data in real-time—connected everywhere it needs to be. Provider verification made simple. You request it, our platform processes it fast. -
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CheckinAsyst
HealthAsyst
CheckinAsyst is an end-to-end digital platform for patient intake, payments, and communication. CheckinAsyst enhances your patient experience and improves your practice efficiency, allowing you to dedicate your attention to patient care. -
44
Inovalon Claims Management Pro
Inovalon
Keep revenue flowing with a powerful tool that speeds up reimbursements with eligibility checks, claims status tracking, audits and appeals, and remittance management for government and commercial claims, all in a single system. Leverage an advanced rules engine that immediately scrubs claims against the most up-to-date CMS and commercial payer rules, allowing you to correct errors before claims go out the door. Verify eligibility across all payers during claim upload and see flagged errors so claims can be edited before submission. Decrease days in A/R with automated workflows for audit responses, appeal submissions, and ADR tracking. Customize staff workflow assignments based on the type of claim and action needed. Automate secondary claims submissions to stop timely filing write-offs. Increase claims revenue with automated workflows for faster, more successful audits and appeals. -
45
AdvancedMD
AdvancedMD
Enjoy ease of access and security without compromise. Work remotely, see patients and stay connected with a comprehensive cloud suite of office and remote care technologies. Since 1999 we are the only medical office software built on a 100% cloud platform. We are pleased to offer our entire suite of software and data storage on the Amazon Web Services (AWS) cloud hosting platform. Combined, AdvancedMD and AWS offer an unprecedented experience with fast, reliable access to all your information, unwavering data security, and simplified storage with automatic backup. No other ambulatory software system offers this standard of hosting, which means starting or growing your practice on the cloud is as easy and affordable as it gets. Because our software is hosted and managed on AWS, as part of your low monthly subscription you get the highest levels of reliability, security and performance. Our cloud platform makes our software simple to access across multiple devices and platforms. -
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Talix
Talix
The Talix platform powers intelligent workflow applications that enable risk-bearing healthcare organizations to succeed in the age of value-based care. Our workflow solutions for payers and providers require intelligent underlying technologies to work in unison and at scale. We’ve engineered the Talix Platform to support the needs of thousands of end-users, anywhere in the world simultaneously. Moreover, our platform architecture enables multiple SaaS application solutions in order to harness the efficiencies derived from being able to process millions of patient charts and encounter data. The Talix Platform is comprised of several technology components, intricately linked, to power software applications at scale for healthcare payers and providers. These components form the building blocks of artificial intelligence (AI). -
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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. -
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Virtuo MIS
MediSolution
By simplifying and streamlining human capital management processes, you can achieve total control of workforce-related costs and be constantly assured of employing your valuable human resources to maximum advantage. You can confidently go about your daily business knowing your financial, statistical and accounts receivable information is complete, accurate, and effortlessly assembled and distributed to authorized stakeholders with minimal intervention. Total control of the entire source-to-settlement process is yours with a comprehensive suite of integrated and ecommerce enabled supply chain management software that significantly reduces work and errors while improving efficiency to make a dramatic impact on the bottom line. -
49
Amazing Charts Practice Management
Amazing Charts
Amazing Charts Practice Management is a comprehensive solution designed to streamline administrative tasks and enhance the efficiency of independent medical practices. Developed by a practicing physician, this system automates processes such as capturing patient demographics, scheduling appointments, pre-registering patients with insurance eligibility checks, and generating analytical reports. It also determines patient financial responsibilities at the point of care, maintains insurance payer lists, and ensures prompt and accurate billing to assist in payment collection efforts. Key features include the ability to view unpaid claims to ensure timely resolution, a claims manager who reviews submissions to reduce denials, and an integrated secure connect clearinghouse for high-level support and quick responses to payer changes. The system offers intelligent, interactive role-based dashboards that automatically prioritize work lists across all office areas.Starting Price: $229 per month -
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Certify
Certify
Certify delivers API-first credentialing, licensing, and enrollment to payors, health systems, and rapidly-scaling digital health companies. We unlock insights and power performance for clinicians, teams, and organizations. Build best-in-class provider networks with our one-click credentialing solution. Real-time, automated NCQA-compliant credentialing to scale provider networks. Automated ongoing monitoring to ensure your provider networks remain compliant. We take the guesswork (and paperwork) out of licensing–so you can scale to new markets, seamlessly. Get in the network and get reimbursed faster, so you can get back to care. Streamlined processes for cross-state licensure in all 50 states for any license category. Streamlined payor enrollment process to get providers in-network in new markets. Track enrollment progress with our individualized dashboards. Leverage our best-in-class methodology to clean, normalize, and enhance your provider data.
