Best Healthcare Claims Management Software

    Healthcare claims management software is used to streamline the medical claims process, which eases the relationship between provider and insurance company and efficiently speeds up the patient’s payment lifecycle. These solutions leverage automation features so hospitals and clinics can resolve or prevent any hurdles that can potentially disrupt the claims processing and billing workflow. Healthcare claims management software are sold either as standalone products or bundled within medical billing software, revenue cycle management software, or comprehensive medical practice management software. Users of healthcare claims management software include payers, health care providers, and insurance providers.

    To qualify for inclusion in the Healthcare Claims Management category, a product must:

    Digitize the submission of claims
    Streamline interaction between health care providers and health insurance agencies
    Mine the databases that maintain patient medical data
    Comply with regulatory and industry standards like HIPAA

    Top 9 Healthcare Claims Management Software

    • Kareo
    • Waystar
    • TriZetto QNXT
    • athenaCollector
    • NextGen Office
    • Availity
    • eClinicalWorks RCM
    • NextGen Enterprise
    • AdvancedBilling

    Compare Healthcare Claims Management Software

    G2 takes pride in showing unbiased reviews on user satisfaction in our ratings and reports. We do not allow paid placements in any of our ratings, rankings, or reports. Learn about our scoring methodologies.
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    (105)4.1 out of 5
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    Kareo makes it easier and more rewarding for you to run an independent medical practice. We offer the only cloud-based, clinical and business management technology platform dedicated to serving the unique needs of independent practices. Our software helps you find and engage with patients, run a smarter business, provide better care, and get paid faster. From the front office to your back-end billing, Kareo Practice Management streamlines the way you work. It’s easy to use and proven powerful

    (68)4.6 out of 5
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    Waystar provides market-leading technology that simplifies and unifies the revenue cycle. Their cloud-based platform streamlines workflows and improves financials for healthcare providers of all kinds and brings more transparency to the patient financial experience. Waystar has been ranked Best in KLAS for the Claims & Clearinghouse segment every year since 2010, earned #1 rankings in Black Book™ surveys since 2012 and received the Frost & Sullivan North America Customer Value Leadership

    (12)4.3 out of 5

    TriZetto offers consulting, IT, and business process solutions to streamline the deployment and adoption of technologies and improve operations for payers and providers in the health care industry. TriZetto solutions are designed to improve efficiency, accuracy, compliance, and results throughout the health care system.

    (29)3.8 out of 5

    athenahealth is providing cloud-based services for electronic health records (EHR), revenue cycle management and medical billing, patient engagement, care coordination, and population health management, as well as Epocrates and other point-of-care mobile apps. Our suite of integrated, network-enabled services works to deliver measurable financial and clinical results for providers. The billing module can be used in tandem with the EHR or on its own, and features a patented and continuously upd

    (55)3.6 out of 5
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    NextGen Healthcare’s private practice solution, NextGen®️ Office, helps practices simplify, automate, and unify clinical care—in person and virtually—so practices can save time and focus on what matters most: patient outcomes. As a HIPAA compliant, cloud-based EHR, patient data is accessible from any device with an internet connection; virtual visits are embedded directly into clinical workflows; revenue cycle management tools facilitate optimal reimbursement; and a state-of-the-art patient port

    (24)4.2 out of 5

    Availity solves the communication challenges between healthcare stakeholders, creating a more transparent exchange of information between health plans, providers, and technology partners.

    (16)3.9 out of 5

    eClinicalWorks Revenue Cycle Management (RCM) Services provides an alternative by allowing our staff of expert billers to handle back-office operations directly through the eClinicalWorks application, securely and accurately. Dashboards provide authorized users with transparency into the process and visibility into your practice’s financial performance in real time.

    (47)3.1 out of 5
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    NextGen Healthcare delivers a comprehensive, integrated technology and services platform tailored to fit the needs of ambulatory and specialty practices of all sizes. The company powers national interoperability that lets users easily exchange patient data across disparate systems, access health information regardless of where patients are treated, and personalize and streamline patient communications. The company’s analytics offerings enable population health management and risk stratification

    (14)4.0 out of 5

    AdvancedBilling: Drive revenue with ease. All the tools you need to manage your A/R and claims processes in one database. Our robust clearinghouse automates manual processes and improves workflow. ClaimsCenter gives you auto-generated worklists, claims tracking & centralized billing. Easily identify issues with ClaimInspector that automatically scrubs claims for potential errors. Results are astonishing with nearly 100% first-pass claim acceptance. Healthier practice = healthier patients.

    (9)3.4 out of 5

    Optum360 sits at the center of the health care financial exchange. It combines technology, methodology and expertise to help payers and providers collaborate. Its seamless, transparent revenue cycle capabilities strengthen and sustain the payer and provider relationship.

    RXNT is a fully-integrated, cloud-based healthcare software provider, offering a Practice Management (PM) solution with Medical Billing and Scheduling tools for practices and billing companies of all sizes and specialties. RXNT was founded in 1999 in Annapolis, MD; named to Inc. Magazine list of America’s 5000 Fastest-Growing Private Companies in 2019 and 2020, and a Gartner 'Software Advice FrontRunner' in 2017, 2018, and 2019. Our trusted solutions will help your practice thrive at a reasona

    (13)4.1 out of 5

    Facets is a modular system integrating consumer, care, claims and revenue management to help organizations meet their business goals.

    Practice management solutions ensure you can maximize cash flow quickly and efficiently.

    (11)3.4 out of 5
    Entry Level Price:$349 /provider/month

    CareCloud helps medical practices manage patients to payers and everything in-between. CareCloud's cloud-based platform helps high-performing medical practices grow by improving efficiency, increasing margins and optimizing the patient experience. Our comprehensive suite of tools covers patient management, revenue cycle management (RCM), electronic health records (EHR) and patient experience management. For more information, visit www.carecloud.com.

    (5)4.0 out of 5

    Delivering on the promise of health information technology, Henry Schein Medical Systems/MicroMD provides simple yet powerful EMR and practice management solutions that facilitate the delivery of superior patient care, automate incentive and quality reporting activities, and streamline operations for today's busy providers.

    (3)4.7 out of 5
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    Founded in 1996 and headquartered in Oregon, PLEXIS serves healthcare payer administrative organizations serving over 50 million people in all 50 states and 15 countries. PLEXIS provides enterprise core administration processing solutions to healthcare payers, specialty groups (dental, vision, radiology, etc.), TPAs, delegated risk groups (IPAs, ACOs, MSOs), international insurers, and government healthcare organizations/program administrators. PLEXIS Payer Platforms feature highly scalable, hi

    (2)3.5 out of 5

    The HSP Payer Suite provides a single-source database, core administrative system, web portals, and open system with web services to quickly automate current and future healthcare regulations and business processing requirements.

    (2)4.0 out of 5
    Entry Level Price:$0

    iSALUS Billing and Scheduling Services is a billing and scheduling software that has integrated clearinghouse service that allows you to get your claims paid, as well as submit e-claims, post ERA payments, verify patient insurance eligibility, and more.

    (2)2.8 out of 5

    LexisNexis MarketView delivers medical claims-based intelligence to healthcare organizations across the United States.

    (4)3.8 out of 5

    Improve efficiency and effectiveness with a claims management desktop that modernizes your underwriting environment on an enterprise scale.

    (2)1.5 out of 5

    This software is designed to help optometrists better manage and analyze their business and clinical operations.

    (1)4.0 out of 5

    ABILITY EASE All-Payer was engineered by leveraging over a decade of experience troubleshooting EDI submission pain points to create a system that reduces first-pass rejections.

    (1)4.5 out of 5

    Allscripts Payerpath® is an Internet-based suite of solutions that addresses every step in the reimbursement cycle.​

    Practice Management solution lets you manage patient records, insurance eligibility, documents, and billing in one place to maximize staff efficiency.

    (1)2.5 out of 5

    Medical, dental and vision claims, health benefits administration, and claims adjudication software in one solution.

    (1)5.0 out of 5

    ImagineBilling Practice Management Software improves cash flow, simplifies processes and provides unprecedented, real-time productivity monitoring by streamlining the billing/collections workflow to help clients achieve peak performance and measurable results.

    (1)5.0 out of 5

    As a pharmacy care services company, OptumRx goes beyond traditional pharmacy benefit management. Connecting billions of data points, we empower doctors to make informed decisions. We tackle trends and pinpoint solutions for our clients. And we work every day to simplify the system.

    Oracle Health Insurance Claims Management supports the import, processing, and release of claims for payment. Authorizations can be recorded for the procedures that require permission in advance. Claimed amounts that are a result of an accident can be recovered from third parties

    (1)4.0 out of 5

    Parascript automates the extraction of meaningful, contextual data from image and document-based information to support transactions, information governance, fraud prevention, and business processes. Parascript software processes any document with any data from any source with its easy-to-use, image-based analysis, classification, data location, and extraction technology.

    (1)5.0 out of 5

    Provation MD is a clinical documentation software. Designed by physicians for physicians, to improve efficiency and optimize reimbursement with structured procedure documentation.

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    Check out the G2 Grid® for the top Healthcare Claims Management Software products. G2 scores products and sellers based on reviews gathered from our user community, as well as data aggregated from online sources and social networks. Together, these scores are mapped on our proprietary G2 Grid®, which you can use to compare products, streamline the buying process, and quickly identify the best products based on the experiences of your peers.
    Leaders
    High Performers
    Contenders
    Niche
    NextGen Enterprise
    Kareo
    AdvancedBilling
    athenaCollector
    Waystar
    Availity
    TriZetto QNXT
    NextGen Office
    eClinicalWorks RCM
    Market Presence
    Satisfaction