# Best Healthcare Claims Management Software

## How Many Healthcare Claims Management Software Products Does G2 Track?

**Total Products under this Category:** 140

### Category Stats (Jul 2026)

- **Average Rating:** 4.34/5 (↑0.01 vs Jun 2026) The average rating of products in this category, based on all submitted ratings
- **Top Trending Product:** Zelis (+1.5%) - Among all products in this category, Zelis recorded the largest rating increase compared to last month

_Last updated: July 26, 2026_

## How Does G2 Rank Healthcare Claims Management Software Products?

**Why You Can Trust G2's Software Rankings:**

- 30 Analysts and Data Experts
- 1,600+ Authentic Reviews
- 140+ Products
- Unbiased Rankings

G2's software rankings are built on verified user reviews, rigorous moderation, and a consistent research methodology maintained by a team of analysts and data experts. Each product is measured using the same transparent criteria, with no paid placement or vendor influence. While reviews reflect real user experiences, which can be subjective, they offer valuable insight into how software performs in the hands of professionals. Together, these inputs power the G2 Score, a standardized way to compare tools within every category.

## G2 Grid® for Healthcare Claims Management Software
 ![G2 Grid® for Healthcare Claims Management Software plotting products by satisfaction and market presence](https://www.g2.com/categories/healthcare-claims-management/grids.png?focus%5B%5D=167022&focus%5B%5D=44719&focus%5B%5D=1333287&focus%5B%5D=166670&focus%5B%5D=65001&focus%5B%5D=1335611&focus%5B%5D=72881&focus%5B%5D=71280)

Highlighted products: Service Center by Office Ally, EHRYourWay, Inovalon Claims Management Pro, SPRY, TriZetto Facets, Silna Health, TriZetto QNXT, and athenaOne.

Underlying data: [Grid® JSON](https://www.g2.com/categories/healthcare-claims-management/grids.json?focus%5B%5D=service-center-by-office-ally&focus%5B%5D=ehryourway&focus%5B%5D=inovalon-claims-management-pro&focus%5B%5D=spry-spry&focus%5B%5D=trizetto-facets&focus%5B%5D=silna-health&focus%5B%5D=trizetto-qnxt&focus%5B%5D=athenaone)

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### [Service Center by Office Ally](https://www.g2.com/products/service-center-by-office-ally/reviews)

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.

**Average Rating:** 4.6/5.0

**Total Reviews:** 45

#### How Do G2 Users Rate Service Center by Office Ally?

- **Has the product been a good partner in doing business?:** 9.6/10 (Category avg: 8.6/10)
- **Clearinghouse Integration - Healthcare Claims Management:** 9.2/10 (Category avg: 8.4/10)
- **Claims Data Automation - Healthcare Claims Management:** 8.8/10 (Category avg: 8.6/10)
- **Patient Data Security - Healthcare Claims Management:** 9.5/10 (Category avg: 8.7/10)

#### Who Is the Company Behind Service Center by Office Ally?

- **Seller:** [Office Ally](https://www.g2.com/sellers/office-ally)
- **Company Website:** https://cms.officeally.com/
- **Year Founded:** 2000
- **HQ Location:** Vancouver, WA
- **Twitter:** @Office\_Ally (655 Twitter followers)
- **LinkedIn® Page:** https://www.linkedin.com/company/1464667/ (323 employees on LinkedIn®)

#### Who Uses This Product?

- **Top Industries:** Medical Practice, Mental Health Care
- **Company Size:** 80% Small, 4% Medium

#### What Are Recent G2 Reviews of Service Center by Office Ally?

**["Efficient Claims Submission Made Easy"](https://www.g2.com/survey_responses/service-center-by-office-ally-review-11961102)**

**Rating:** 5.0/5.0 stars

_— HJ L._

[Read full review](https://www.g2.com/survey_responses/service-center-by-office-ally-review-11961102)

**["Efficient and Reliable for Insurance Tasks"](https://www.g2.com/survey_responses/service-center-by-office-ally-review-11968308)**

**Rating:** 4.5/5.0 stars

_— Cross Timbers Family Chiropractic ._

[Read full review](https://www.g2.com/survey_responses/service-center-by-office-ally-review-11968308)

### [EHRYourWay](https://www.g2.com/products/ehryourway/reviews)

EHRYourWay is an end-to-end, ONC-certified electronic health record (EHR) solution specifically designed for the unique needs of behavioral health organizations. This comprehensive platform caters to outpatient and inpatient mental health clinics, addiction treatment centers, psychiatric hospitals, and Certified Community Behavioral Health Clinics (CCBHCs). By integrating all necessary functionalities—from patient intake and admissions to scheduling, clinical documentation, billing, and reporting—EHRYourWay eliminates the need for multiple vendors and disjointed systems, providing a seamless experience for users. Targeted primarily at healthcare providers in the behavioral health sector, EHRYourWay addresses the complexities of clinical workflows, compliance, and billing associated with mental health care. The platform is particularly beneficial for organizations that require a high degree of customization in their documentation and operational processes. Unlike rigid EHR systems that impose predefined workflows, EHRYourWay allows organizations to configure the platform according to their specific needs, ensuring that forms, workflows, and rules align with existing practices. This flexibility is essential for maintaining efficiency and minimizing disruption in clinical settings. One of the standout features of EHRYourWay is its robust clinical documentation capabilities. The platform enables users to create fully customized electronic replicas of their existing paper forms, allowing clinical staff to document care in a familiar format. It supports a wide range of behavioral health documentation, including psychiatric evaluations, therapy progress notes, and treatment plans. Additionally, built-in validated assessments, such as the PHQ-9 and GAD-7, automate scoring, while the integrated treatment planning module ensures continuity across patient records, linking assessments, diagnoses, and treatment goals in a comprehensive, audit-ready manner. In terms of billing and revenue cycle management, EHRYourWay streamlines the entire process from eligibility verification to claims submission. Its advanced fee schedule rules engine automates the determination of CPT codes and charge amounts, reducing manual entry and minimizing errors. The platform accommodates complex billing requirements, supporting various payers, including Medicaid, Medicare, and commercial insurers. Furthermore, EHRYourWay is equipped with compliance features, such as SOC 2 and ONC certifications, ensuring that organizations remain audit-ready while adhering to regulatory standards. EHRYourWay also excels in practice management, offering integrated solutions for scheduling, telehealth, patient portals, and intake management without the need for third-party add-ons. With a dedicated team of over 150 developers focused exclusively on behavioral health, EHRYourWay provides specialized support seven days a week, ensuring that users receive assistance tailored to their operational needs. This commitment to understanding the intricacies of behavioral health operations sets EHRYourWay apart as a comprehensive solution for organizations striving to enhance their clinical and administrative workflows.

**Average Rating:** 4.7/5.0

**Total Reviews:** 332

#### How Do G2 Users Rate EHRYourWay?

- **Has the product been a good partner in doing business?:** 9.8/10 (Category avg: 8.6/10)

#### Who Is the Company Behind EHRYourWay?

- **Seller:** [EHR Your Way](https://www.g2.com/sellers/ehr-your-way)
- **Company Website:** https://ehryourway.com/
- **Year Founded:** 2008
- **HQ Location:** San Diego, California
- **Twitter:** @ehryourway (168 Twitter followers)
- **LinkedIn® Page:** https://www.linkedin.com/company/ehr-your-way/ (33 employees on LinkedIn®)

#### Who Uses This Product?

- **Who Uses This:** Therapist, Office Manager
- **Top Industries:** Mental Health Care, Hospital & Health Care
- **Company Size:** 55% Small, 43% Medium

#### What Do G2 Reviewers Say About EHRYourWay?

_AI-generated summary from verified user reviews_

##### Pros

- Users appreciate the **ease of use** of EHR Your Way, simplifying navigation and streamlining daily tasks effectively.
- Users find EHRYourWay’s **customer support exceptional** , promptly assisting with issues and enhancing overall user experience.
- Users value the **efficiency** of EHRYourWay, enjoying streamlined workflows and quick access to necessary information.
- Users appreciate the **streamlined documentation workflow** of EHRYourWay, which enhances efficiency and reduces administrative tasks.
- Users praise the **user-friendly navigation** of EHRYourWay, making it convenient for staff and improving their experience.

##### Cons

- Users often face **technical issues** , including bugs and slow performance, which hinder daily workflow and productivity.
- Users find the **limited customization** in EHRYourWay restricting for their clinical documentation needs.
- Users find **poor navigation** in EHRYourWay frustrating, impacting usability and slowing down their workflow significantly.
- Users find EHRYourWay to be **not user-friendly** , especially for older coworkers and during busy workflow times.
- Users notice a **significant learning curve** with EHRYourWay, making initial navigation challenging for new users.

#### What Are Recent G2 Reviews of EHRYourWay?

**["Extremely Helpful and Time-Saving EHR with Minimal Issues"](https://www.g2.com/survey_responses/ehryourway-review-12210651)**

**Rating:** 5.0/5.0 stars

_— Amanda J._

[Read full review](https://www.g2.com/survey_responses/ehryourway-review-12210651)

**["Consistently Excellent Support and a Smooth EHRYW Implementation"](https://www.g2.com/survey_responses/ehryourway-review-12678542)**

**Rating:** 4.0/5.0 stars

_— Kate T._

[Read full review](https://www.g2.com/survey_responses/ehryourway-review-12678542)

### [Inovalon Claims Management Pro](https://www.g2.com/products/inovalon-claims-management-pro/reviews)

Claims Management Pro is a comprehensive SaaS-based claims management solution that far outpaces the average clearinghouse. This application puts you in control of front-end claims cycle activities, with a 99% clean claims rate.1 Its combination of real-time eligibility checks, claim status tracking, audit and appeals workflows, and ease of payment posting focus your labor activities to get cash flowing. A single log-in and customizable dashboard gives access to all payers, including Medicare, Medicaid, and commercial insurance. Plus, Claims Management Pro is easy-to-use RCM software compatible with all leading web browsers. Implementation is easy, with no complicated technical requirements to get started. 1. Inovalon internal reporting, Claims Management Pro, November 2023

**Average Rating:** 4.3/5.0

**Total Reviews:** 29

#### How Do G2 Users Rate Inovalon Claims Management Pro?

- **Has the product been a good partner in doing business?:** 8.5/10 (Category avg: 8.6/10)
- **Clearinghouse Integration - Healthcare Claims Management:** 8.8/10 (Category avg: 8.4/10)
- **Claims Data Automation - Healthcare Claims Management:** 8.3/10 (Category avg: 8.6/10)
- **Patient Data Security - Healthcare Claims Management:** 9.0/10 (Category avg: 8.7/10)

#### Who Is the Company Behind Inovalon Claims Management Pro?

- **Seller:** [Inovalon](https://www.g2.com/sellers/inovalon)
- **HQ Location:** Bowie, Maryland, United States
- **Twitter:** @InovalonInc (1,521 Twitter followers)
- **LinkedIn® Page:** https://www.linkedin.com/company/inovalon/about/ (3,308 employees on LinkedIn®)

#### Who Uses This Product?

- **Top Industries:** Hospital & Health Care
- **Company Size:** 41% Small, 38% Medium

#### What Are Recent G2 Reviews of Inovalon Claims Management Pro?

**["Versatile RCM Tool with Strong MFA Security"](https://www.g2.com/survey_responses/inovalon-claims-management-pro-review-12528541)**

**Rating:** 4.0/5.0 stars

_— Vhea Nicole H._

[Read full review](https://www.g2.com/survey_responses/inovalon-claims-management-pro-review-12528541)

**["Love Inovalon Claims Management Pro"](https://www.g2.com/survey_responses/inovalon-claims-management-pro-review-11728979)**

**Rating:** 5.0/5.0 stars

_— Blair S._

[Read full review](https://www.g2.com/survey_responses/inovalon-claims-management-pro-review-11728979)

### [TriZetto Facets](https://www.g2.com/products/trizetto-facets/reviews)

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

**Average Rating:** 4.3/5.0

**Total Reviews:** 16

#### How Do G2 Users Rate TriZetto Facets?

- **Clearinghouse Integration - Healthcare Claims Management:** 10.0/10 (Category avg: 8.4/10)
- **Claims Data Automation - Healthcare Claims Management:** 10.0/10 (Category avg: 8.6/10)
- **Patient Data Security - Healthcare Claims Management:** 10.0/10 (Category avg: 8.7/10)

#### Who Is the Company Behind TriZetto Facets?

- **Seller:** [Cognizant](https://www.g2.com/sellers/cognizant)
- **Year Founded:** 1994
- **HQ Location:** Teaneck, NJ
- **Twitter:** @Cognizant (707,793 Twitter followers)
- **LinkedIn® Page:** https://www.linkedin.com/company/1680/ (362,678 employees on LinkedIn®)
- **Ownership:** NASDAQ:CTSH

#### Who Uses This Product?

- **Top Industries:** Insurance
- **Company Size:** 47% Medium, 29% Large

#### What Are Recent G2 Reviews of TriZetto Facets?

**["Facets modules are centered around the Digital 360 suite"](https://www.g2.com/survey_responses/trizetto-facets-review-8688979)**

**Rating:** 5.0/5.0 stars

_— Abhilash V._

[Read full review](https://www.g2.com/survey_responses/trizetto-facets-review-8688979)

**["It’s an excellent company"](https://www.g2.com/survey_responses/trizetto-facets-review-8876140)**

**Rating:** 5.0/5.0 stars

_— Mayank A._

[Read full review](https://www.g2.com/survey_responses/trizetto-facets-review-8876140)

### [SPRY](https://www.g2.com/products/spry-spry/reviews)

SPRY: The Fastest-Growing AI-Powered EMR & Billing Platform for Rehab Therapy SPRY isn’t just an EMR—it’s your practice partner. Built specifically for physical therapy clinics, SPRY helps reduce admin costs, increase patient visits, and maximize reimbursements. Its AI-powered, fully integrated platform is designed to enhance efficiency, minimize administrative burdens, improve patient care, and support future-proofing your practice. Why SPRY? Whether you're a clinic owner, physical therapist, clinic manager, billing specialist, or front desk staff, SPRY provides an end-to-end solution that simplifies everything from patient scheduling to automated billing. Our customizable workflows, intuitive interface, and real-time automation empower clinics to operate with confidence and efficiency. Most PT platforms claim to be end-to-end but lack seamless module integration, leaving clinics to deal with inefficiencies and workarounds. With the vision to eliminate these gaps, SPRY provides a truly all-in-one solution that streamlines workflows and ensures everything works effortlessly together. Key Features ✔ AI-Powered Documentation – AI Scribe enables real-time note-taking and seamlessly converts notes into structured SOAP templates. ✔ Automated Billing & Claim Management – Pre-authorization, eligibility verification, claim scrubbing, & Medicare compliance ✔ Real-Time Business Intelligence (BI) Dashboard – Data-driven insights for revenue and performance tracking, with the ability to ask queries in simple language ✔ Seamless Patient Engagement – Online scheduling, digital onboarding, Kiosk check-in & HIPAA-compliant patient portal ✔ Operational Efficiency – AI Fax, automated alerts & co-sign functionality for compliance Powering the Future of Physical Therapy SPRY is backed by industry experts, innovative technology, and deep clinical insights, making it the go-to platform for rehab therapy clinics looking to grow, optimize operations, and improve patient outcomes.

**Average Rating:** 4.6/5.0

**Total Reviews:** 79

#### How Do G2 Users Rate SPRY?

- **Has the product been a good partner in doing business?:** 9.6/10 (Category avg: 8.6/10)
- **Clearinghouse Integration - Healthcare Claims Management:** 10.0/10 (Category avg: 8.4/10)
- **Claims Data Automation - Healthcare Claims Management:** 10.0/10 (Category avg: 8.6/10)
- **Patient Data Security - Healthcare Claims Management:** 10.0/10 (Category avg: 8.7/10)

#### Who Is the Company Behind SPRY?

- **Seller:** [SPRY](https://www.g2.com/sellers/spry)
- **Year Founded:** 2021
- **HQ Location:** Wilmington, US
- **LinkedIn® Page:** https://www.linkedin.com/company/sprypt/ (240 employees on LinkedIn®)

#### Who Uses This Product?

- **Who Uses This:** Physical Therapist, Owner
- **Top Industries:** Health, Wellness and Fitness, Hospital & Health Care
- **Company Size:** 84% Small, 16% Medium

#### What Do G2 Reviewers Say About SPRY?

_AI-generated summary from verified user reviews_

##### Pros

- Users find SPRY incredibly **easy to use** , appreciating its customization and seamless navigation across devices.
- Users commend the **exceptional customer support** from Spry, enhancing their overall experience and platform customization.
- Users value the **enhanced efficiency** of Spry, allowing for quicker documentation and improved workflow across teams.
- Users appreciate the **exceptional customer support** of Spry, ensuring a smooth and efficient experience across their practice.
- Users value the **ease and automation in billing** , significantly improving their practice efficiency and customer service experience.

##### Cons

- Users report frequent **technical issues** like glitches and slow note-generation, impacting their overall experience with SPRY.
- Users experience **slow performance** with SPRY, particularly during AI note generation and page loading, affecting efficiency.
- Users struggle with **data management issues** like inconsistent chart population and lack of follow-up workflow for claims.
- Users highlight the **limited features** of SPRY, particularly lacking follow-up workflows and tracking for authorizations.
- Users experience **occasional software bugs** with Spry but appreciate the support in resolving these issues promptly.

#### What Are Recent G2 Reviews of SPRY?

**["Clean UI and Fast, Efficient Billing That Helps Close Claims Faster"](https://www.g2.com/survey_responses/spry-review-12647308)**

**Rating:** 4.5/5.0 stars

_— Brady J._

[Read full review](https://www.g2.com/survey_responses/spry-review-12647308)

**["Spry’s Intuitive Design and Hands-On Support Transformed Our Clinic Workflow"](https://www.g2.com/survey_responses/spry-review-12543807)**

**Rating:** 5.0/5.0 stars

_— Trina S._

[Read full review](https://www.g2.com/survey_responses/spry-review-12543807)

### [Silna Health](https://www.g2.com/products/silna-health/reviews)

Silna Health automates front-end RCM for healthcare providers, so care can start in hours, not weeks. From prior authorizations to benefit checks, insurance monitoring, and discovery, our AI-powered Care Readiness Platform streamlines all front-end insurance workflows across every payor in the country. By combining automation with built-in payor communication, Silna cuts pre-visit administration by 95% and has accelerated care for over 50,000 patients. With Silna, your patients get faster treatment, staff reclaim time, and revenue flows without friction. We manage the full authorization process for your specialty, deliver real-time patient cost estimates, send proactive expiration alerts, and integrate with any EHR.

**Average Rating:** 4.8/5.0

**Total Reviews:** 66

#### How Do G2 Users Rate Silna Health?

- **Has the product been a good partner in doing business?:** 9.6/10 (Category avg: 8.6/10)
- **Clearinghouse Integration - Healthcare Claims Management:** 8.3/10 (Category avg: 8.4/10)
- **Claims Data Automation - Healthcare Claims Management:** 8.1/10 (Category avg: 8.6/10)
- **Patient Data Security - Healthcare Claims Management:** 9.7/10 (Category avg: 8.7/10)

#### Who Is the Company Behind Silna Health?

- **Seller:** [Silna Health](https://www.g2.com/sellers/silna-health)
- **Company Website:** https://www.silnahealth.com/
- **Year Founded:** 2023
- **HQ Location:** New York, US
- **LinkedIn® Page:** https://www.linkedin.com/company/silna-health/ (53 employees on LinkedIn®)

#### Who Uses This Product?

- **Top Industries:** Medical Practice, Mental Health Care
- **Company Size:** 70% Small, 24% Medium

#### What Are Recent G2 Reviews of Silna Health?

**["An Invaluable Support for Our Agency"](https://www.g2.com/survey_responses/silna-health-review-10326774)**

**Rating:** 5.0/5.0 stars

_— Becci H._

[Read full review](https://www.g2.com/survey_responses/silna-health-review-10326774)

**["Silna's team is exceptional. They've given us back hours every week."](https://www.g2.com/survey_responses/silna-health-review-12551748)**

**Rating:** 5.0/5.0 stars

_— Jenny L._

[Read full review](https://www.g2.com/survey_responses/silna-health-review-12551748)

### [TriZetto QNXT](https://www.g2.com/products/trizetto-qnxt/reviews)

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.

**Average Rating:** 4.3/5.0

**Total Reviews:** 11

#### How Do G2 Users Rate TriZetto QNXT?

- **Has the product been a good partner in doing business?:** 8.3/10 (Category avg: 8.6/10)
- **Clearinghouse Integration - Healthcare Claims Management:** 9.2/10 (Category avg: 8.4/10)
- **Claims Data Automation - Healthcare Claims Management:** 8.3/10 (Category avg: 8.6/10)
- **Patient Data Security - Healthcare Claims Management:** 9.4/10 (Category avg: 8.7/10)

#### Who Is the Company Behind TriZetto QNXT?

- **Seller:** [Cognizant](https://www.g2.com/sellers/cognizant)
- **Year Founded:** 1994
- **HQ Location:** Teaneck, NJ
- **Twitter:** @Cognizant (707,793 Twitter followers)
- **LinkedIn® Page:** https://www.linkedin.com/company/1680/ (362,678 employees on LinkedIn®)
- **Ownership:** NASDAQ:CTSH

#### Who Uses This Product?

- **Company Size:** 46% Large, 38% Medium

#### What Are Recent G2 Reviews of TriZetto QNXT?

**["Modern interface with sleek look"](https://www.g2.com/survey_responses/trizetto-qnxt-review-4428010)**

**Rating:** 4.0/5.0 stars

_— Verified User in Hospital & Health Care_

[Read full review](https://www.g2.com/survey_responses/trizetto-qnxt-review-4428010)

**["US helathcare care web based total payer solution"](https://www.g2.com/survey_responses/trizetto-qnxt-review-8785617)**

**Rating:** 4.5/5.0 stars

_— Omkar G._

[Read full review](https://www.g2.com/survey_responses/trizetto-qnxt-review-8785617)

### [athenaOne](https://www.g2.com/products/athenaone/reviews)

athenahealth is providing cloud-based services for electronic health records (EHR), revenue cycle management & 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 athenahealth EHR offers a homepage that allows users to review the daily schedule and patient information, manage orders, and view incoming lab results. The billing module can be used in tandem with the EHR or on its own, and features a patented and continuously updated rules engine. Medical practice management tools include visibility into daily responsibilities, custom benchmarking, proactive trends analysis, and more. Patients can utilize a patient portal to review history, pay bills, sign forms, and schedule appointments. Reminders can be delivered via phone, email, or text message; patients can even be alerted when test results are waiting in the patient portal.

**Average Rating:** 3.4/5.0

**Total Reviews:** 112

#### How Do G2 Users Rate athenaOne?

- **Has the product been a good partner in doing business?:** 7.0/10 (Category avg: 8.6/10)
- **Clearinghouse Integration - Healthcare Claims Management:** 9.2/10 (Category avg: 8.4/10)
- **Claims Data Automation - Healthcare Claims Management:** 8.8/10 (Category avg: 8.6/10)
- **Patient Data Security - Healthcare Claims Management:** 9.0/10 (Category avg: 8.7/10)

#### Who Is the Company Behind athenaOne?

- **Seller:** [athenahealth](https://www.g2.com/sellers/athenahealth)
- **Year Founded:** 1997
- **HQ Location:** Watertown, MA
- **Twitter:** @athenahealth (24,384 Twitter followers)
- **LinkedIn® Page:** https://www.linkedin.com/company/athenahealth (8,948 employees on LinkedIn®)
- **Ownership:** NASDAQ: ATHN

#### Who Uses This Product?

- **Top Industries:** Hospital & Health Care, Medical Practice
- **Company Size:** 44% Small, 35% Medium

#### What Do G2 Reviewers Say About athenaOne?

_AI-generated summary from verified user reviews_

##### Pros

- Users value the **constant feature updates** and deep customization options that enhance their workflow and reporting capabilities.
- Users find athenaOne **easy to use** with friendly templates and seamless calendar integration for efficient workflows.
- Users value the **top-notch API integration** of athenaOne, allowing seamless connection of essential tools for efficient practice management.
- Users value the **exceptional customer service** from AthenaOne, enhancing their practice management experience significantly.
- Users value the **user-friendly templates** in athenaOne, enhancing their workflow and productivity significantly.

##### Cons

- Users express frustration over **inadequate reporting** , finding it clunky and time-consuming for their documentation needs.
- Users find the **high learning curve** of athenaOne frustrating, leading to inefficient documentation and complicated processes.
- Users experience **poor customer support** with athenaOne, often facing slow response times from the help desk.
- Users report severe **billing issues** with athenaOne, including price increases and frustrating customer support experiences.
- Users find the **reporting process inefficient** , requiring too much effort and limiting accessibility for the staff.

#### What Are Recent G2 Reviews of athenaOne?

**["Easy-to-Navigate EHR with Quick Access to Key Information"](https://www.g2.com/survey_responses/athenaone-review-12619892)**

**Rating:** 5.0/5.0 stars

_— kelly b._

[Read full review](https://www.g2.com/survey_responses/athenaone-review-12619892)

**["User-Friendly EMR with Excellent Scheduling Tools"](https://www.g2.com/survey_responses/athenaone-review-1482555)**

**Rating:** 4.0/5.0 stars

_— Verified User in Research_

[Read full review](https://www.g2.com/survey_responses/athenaone-review-1482555)

### [Tebra (previously Kareo + PatientPop)](https://www.g2.com/products/tebra-previously-kareo-patientpop/reviews)

Tebra is an all-in-one EHR and practice management platform designed for independent healthcare practices. The platform includes certified electronic health records, clinical charting, electronic prescribing, lab ordering, scheduling, billing, and claims management, telehealth, and patient engagement tools within a single, integrated system. Rather than relying on disconnected add-ons, Tebra provides native workflows that support care delivery, operations, and patient experience in one platform. The solution is purpose-built to help small and mid-sized practices improve efficiency, reduce administrative complexity, and manage day-to-day operations within one system.

**Average Rating:** 4.1/5.0

**Total Reviews:** 255

#### How Do G2 Users Rate Tebra (previously Kareo + PatientPop)?

- **Has the product been a good partner in doing business?:** 8.2/10 (Category avg: 8.6/10)
- **Clearinghouse Integration - Healthcare Claims Management:** 8.2/10 (Category avg: 8.4/10)
- **Claims Data Automation - Healthcare Claims Management:** 8.3/10 (Category avg: 8.6/10)
- **Patient Data Security - Healthcare Claims Management:** 8.6/10 (Category avg: 8.7/10)

#### Who Is the Company Behind Tebra (previously Kareo + PatientPop)?

- **Seller:** [Tebra](https://www.g2.com/sellers/tebra)
- **Company Website:** https://www.tebra.com/
- **HQ Location:** Corona del Mar, US
- **Twitter:** @TebraOfficial (11,001 Twitter followers)
- **LinkedIn® Page:** https://www.linkedin.com/company/tebra/ (1,054 employees on LinkedIn®)

#### Who Uses This Product?

- **Who Uses This:** Owner, Office Manager
- **Top Industries:** Medical Practice, Hospital & Health Care
- **Company Size:** 86% Small, 11% Medium

#### What Do G2 Reviewers Say About Tebra (previously Kareo + PatientPop)?

_AI-generated summary from verified user reviews_

##### Pros

- Users appreciate the **user-friendly interface** of Tebra, highlighting ease of use and simple setup.
- Users praise the **responsive customer support** of Tebra, appreciating quick resolutions and personal assistance via video chat.
- Users value Tebra's **efficiency** in managing tasks and claims seamlessly, enhancing productivity and user experience significantly.
- Users appreciate the **user-friendly app and AI note feature** , enhancing convenience and efficiency in healthcare management.
- Users appreciate the **customizability** of Tebra, benefiting from multiple templates and easy report generation.

##### Cons

- Users find the **limited features** of Tebra hinder their efficiency, especially regarding sorting and billing capabilities.
- Users face **inadequate reporting** issues, requiring manual data manipulation and experiencing duplicate reports and refresh problems.
- Users find the **inefficiency** of Tebra due to excessive clicking and lengthy report generation processes frustrating.
- Users experience **billing issues** that hinder workflow, including slow claims, limited changes post-billing, and incorrect patient coupons.
- Users find Tebra's reporting to be **inefficient** , often requiring manual data exports to meet their needs.

#### What Are Recent G2 Reviews of Tebra (previously Kareo + PatientPop)?

**["Easy Charge Capture for Accurate Coding"](https://www.g2.com/survey_responses/tebra-previously-kareo-patientpop-review-12731619)**

**Rating:** 5.0/5.0 stars

_— Belinda C._

[Read full review](https://www.g2.com/survey_responses/tebra-previously-kareo-patientpop-review-12731619)

**["Easy to use!"](https://www.g2.com/survey_responses/tebra-previously-kareo-patientpop-review-7710720)**

**Rating:** 5.0/5.0 stars

_— Dawn P._

[Read full review](https://www.g2.com/survey_responses/tebra-previously-kareo-patientpop-review-7710720)

### [SAS Fraud, Anti-Money Laundering & Security Intelligence](https://www.g2.com/products/sas-sas-fraud-anti-money-laundering-security-intelligence/reviews)

What is SAS Fraud, Anti-Money Laundering & Security Intelligence? Software solutions in the SAS Fraud, Anti-Money Laundering and Security Intelligence suite deliver fast, on-target insights through AI and analytics so organizations can address their fraud, improper payments, financial crimes, public safety and investigational challenges more productively.

**Average Rating:** 4.2/5.0

**Total Reviews:** 74

#### How Do G2 Users Rate SAS Fraud, Anti-Money Laundering & Security Intelligence?

- **Has the product been a good partner in doing business?:** 8.2/10 (Category avg: 8.6/10)
- **Clearinghouse Integration - Healthcare Claims Management:** 8.3/10 (Category avg: 8.4/10)
- **Claims Data Automation - Healthcare Claims Management:** 7.5/10 (Category avg: 8.6/10)
- **Patient Data Security - Healthcare Claims Management:** 8.3/10 (Category avg: 8.7/10)

#### Who Is the Company Behind SAS Fraud, Anti-Money Laundering & Security Intelligence?

- **Seller:** [SAS Institute Inc.](https://www.g2.com/sellers/sas-institute-inc-df6dde22-a5e5-4913-8b21-4fa0c6c5c7c2)
- **Company Website:** https://www.sas.com/
- **Year Founded:** 1976
- **HQ Location:** Cary, NC
- **Twitter:** @SASsoftware (60,863 Twitter followers)
- **LinkedIn® Page:** https://www.linkedin.com/company/1491/ (18,638 employees on LinkedIn®)

#### Who Uses This Product?

- **Top Industries:** Banking, Financial Services
- **Company Size:** 51% Large, 32% Medium

#### What Do G2 Reviewers Say About SAS Fraud, Anti-Money Laundering & Security Intelligence?

_AI-generated summary from verified user reviews_

##### Pros

- Users find the **ease of use** of SAS AML impressive, benefiting from its intuitive design and reliable performance.
- Users value the **robust fraud detection** of SAS Fraud, enabling proactive monitoring and timely identification of suspicious activities.
- Users appreciate the **efficiency** of SAS Fraud, enabling seamless integration for real-time fraud detection and compliance.
- Users value the **advanced analytics** of SAS Fraud, enhancing efficiency in fraud detection and risk management.
- Users value the **easy data analytics** , allowing timely tracking and reporting of suspicious activities effectively.

##### Cons

- Users find the **learning difficulty** of SAS Fraud, Anti-Money Laundering & Security Intelligence a barrier to effective use.
- Users find the **complexity and difficulty** of SAS Fraud, Anti-Money Laundering & Security Intelligence a significant barrier to effective use.
- Users often face a **steep learning curve** with SAS Fraud, requiring significant time and expertise for effective integration.
- Users find the **high cost** of SAS Fraud, Anti-Money Laundering & Security Intelligence a significant barrier to accessibility.
- Users find the **limited features** frustrating, as integration and support issues hinder their overall experience with SAS Fraud.

#### What Are Recent G2 Reviews of SAS Fraud, Anti-Money Laundering & Security Intelligence?

**["SAS Fraud & AML: Clear Alerts, Stable Performance, Smarter Case Prioritization"](https://www.g2.com/survey_responses/sas-fraud-anti-money-laundering-security-intelligence-review-12980531)**

**Rating:** 4.5/5.0 stars

_— George Picado P._

[Read full review](https://www.g2.com/survey_responses/sas-fraud-anti-money-laundering-security-intelligence-review-12980531)

**["Powerful Real-Time Detection with Room for Optimization"](https://www.g2.com/survey_responses/sas-fraud-anti-money-laundering-security-intelligence-review-13060466)**

**Rating:** 5.0/5.0 stars

_— Shivam G._

[Read full review](https://www.g2.com/survey_responses/sas-fraud-anti-money-laundering-security-intelligence-review-13060466)

### [Zelis](https://www.g2.com/products/zelis/reviews)

Zelis is modernizing the business of healthcare by building something remarkable: a connected platform that bridges gaps in the financial system and aligns interests across healthcare insurers, providers, and consumers. Our platform is transforming the financial experience for more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of providers and members. We see across the financial experience to identify, optimize, and solve problems holistically with technology built by healthcare experts — driving real, measurable results for our clients.

**Average Rating:** 3.8/5.0

**Total Reviews:** 19

#### How Do G2 Users Rate Zelis?

- **Has the product been a good partner in doing business?:** 6.7/10 (Category avg: 8.6/10)
- **Clearinghouse Integration - Healthcare Claims Management:** 6.1/10 (Category avg: 8.4/10)
- **Claims Data Automation - Healthcare Claims Management:** 6.1/10 (Category avg: 8.6/10)
- **Patient Data Security - Healthcare Claims Management:** 5.6/10 (Category avg: 8.7/10)

#### Who Is the Company Behind Zelis?

- **Seller:** [Zelis](https://www.g2.com/sellers/zelis-4372baaa-6f0e-4dc5-985f-68564a568d01)
- **Year Founded:** 2016
- **HQ Location:** Bedminister, NJ
- **Twitter:** @ZelisHealthcare (456 Twitter followers)
- **LinkedIn® Page:** https://www.linkedin.com/company/zelis (2,981 employees on LinkedIn®)

#### Who Uses This Product?

- **Top Industries:** Hospital & Health Care
- **Company Size:** 42% Small, 37% Medium

#### What Do G2 Reviewers Say About Zelis?

_AI-generated summary from verified user reviews_

##### Pros

- Users commend Zelis for its **quick response speed** and knowledgeable representatives, enhancing their support experience significantly.
- Users commend the **professionalism and responsiveness** of Zelis staff, enhancing their overall experience and satisfaction.
- Users appreciate the **customization options** in Zelis, making setup and payment processing a seamless experience.
- Users find Zelis easy to use, especially valuing the **smooth setup process** and efficient payment transmissions.
- Users value the **quick and knowledgeable support** from Zelis representatives, enhancing their overall experience with the service.

##### Cons

- Users experience **scheduling issues** with Zelis, particularly noting long wait times during the enrollment process.

#### What Are Recent G2 Reviews of Zelis?

**["Excellent Customer Service"](https://www.g2.com/survey_responses/zelis-review-11126864)**

**Rating:** 5.0/5.0 stars

_— Verified User in Mental Health Care_

[Read full review](https://www.g2.com/survey_responses/zelis-review-11126864)

**["Excellent Customer Service—Congenial, Knowledgeable, and Thorough Support"](https://www.g2.com/survey_responses/zelis-review-13031860)**

**Rating:** 5.0/5.0 stars

_— victoria m._

[Read full review](https://www.g2.com/survey_responses/zelis-review-13031860)

### [RevCycle Engine](https://www.g2.com/products/revcycle-engine/reviews)

We help you make right easy by preventing denials, protecting revenue, and eliminating manual claim edits with automation that catches errors before claims go out. Our smart, customizable rules ensure accuracy at the source, so your team spends less time fixing mistakes and more time optimizing revenue. One of our health system customers cut manual claim edits by 82%, freeing staff to focus on revenue—not rework. With RevCycle Engine, you can get results as soon as your first billing cycle. With built-in intelligence, RevCycle Engine automates charge corrections, reducing denials and accelerating cash flow. It also streamlines coding reviews, ensuring your team only works the claims that truly need attention. The result? Faster payments, lower costs, and a more efficient revenue cycle. No more last-minute scrambles, lost revenue, or manual work overload. Imagine a streamlined operation with fewer denials and a higher clean claim rate—right from the start. Let us help you make right easy.

**Average Rating:** 4.6/5.0

**Total Reviews:** 26

#### How Do G2 Users Rate RevCycle Engine?

- **Has the product been a good partner in doing business?:** 10.0/10 (Category avg: 8.6/10)
- **Clearinghouse Integration - Healthcare Claims Management:** 7.5/10 (Category avg: 8.4/10)
- **Patient Data Security - Healthcare Claims Management:** 9.2/10 (Category avg: 8.7/10)

#### Who Is the Company Behind RevCycle Engine?

- **Seller:** [Aptarro](https://www.g2.com/sellers/aptarro)
- **Company Website:** https://www.aptarro.com/hcc-coding
- **HQ Location:** Tallahassee, Florida, United States
- **Twitter:** @Alpha\_II (5,482 Twitter followers)
- **LinkedIn® Page:** https://www.linkedin.com/company/aptarro (121 employees on LinkedIn®)
- **Ownership:** Aptarro, Inc.

#### Who Uses This Product?

- **Top Industries:** Hospital & Health Care, Medical Practice
- **Company Size:** 62% Medium, 27% Large

#### What Are Recent G2 Reviews of RevCycle Engine?

**["User-Friendly and Easy to Navigate, with Helpful Automatic Billing"](https://www.g2.com/survey_responses/revcycle-engine-review-13154459)**

**Rating:** 5.0/5.0 stars

_— Lanetris W._

[Read full review](https://www.g2.com/survey_responses/revcycle-engine-review-13154459)

**["Phenomenal System with Top-Notch Customization"](https://www.g2.com/survey_responses/revcycle-engine-review-12355295)**

**Rating:** 5.0/5.0 stars

_— Ioannes C._

[Read full review](https://www.g2.com/survey_responses/revcycle-engine-review-12355295)

### [Essentials](https://www.g2.com/products/essentials/reviews)

From the first phone call with a new patient through final claim reconciliation and payment, you need a simpler way to collect, submit, and track the administrative, clinical, and financial data that make healthcare possible. Availity Essentials is the place to connect with your payers—at no cost to providers. Availity works with hundreds of payers nationwide to give providers a one-stop-portal where they can check eligibility, submit claims, collect patient payments and track ERAs, and even sign up for EFT. Your Essentials account gets you access to all this and more, with one password. You can also update your provider profiles, manage quality-of-care paperwork, and get detailed reporting about your office’s standard HIPAA and other payer transactions.

**Average Rating:** 4.0/5.0

**Total Reviews:** 42

#### How Do G2 Users Rate Essentials?

- **Has the product been a good partner in doing business?:** 7.2/10 (Category avg: 8.6/10)
- **Clearinghouse Integration - Healthcare Claims Management:** 8.8/10 (Category avg: 8.4/10)
- **Claims Data Automation - Healthcare Claims Management:** 8.6/10 (Category avg: 8.6/10)
- **Patient Data Security - Healthcare Claims Management:** 9.3/10 (Category avg: 8.7/10)

#### Who Is the Company Behind Essentials?

- **Seller:** [Availity](https://www.g2.com/sellers/availity)
- **Year Founded:** 2001
- **HQ Location:** Jacksonville, FL
- **Twitter:** @Availity (2,154 Twitter followers)
- **LinkedIn® Page:** https://www.linkedin.com/company/34624/ (1,845 employees on LinkedIn®)

#### Who Uses This Product?

- **Top Industries:** Medical Practice, Hospital & Health Care
- **Company Size:** 62% Small, 24% Medium

#### What Are Recent G2 Reviews of Essentials?

**["Easily accessible with many plans"](https://www.g2.com/survey_responses/essentials-review-7745188)**

**Rating:** 4.0/5.0 stars

_— Dawn P._

[Read full review](https://www.g2.com/survey_responses/essentials-review-7745188)

**["Easy Insurance Benefits Lookup with Helpful Tutorials"](https://www.g2.com/survey_responses/essentials-review-12654929)**

**Rating:** 4.0/5.0 stars

_— Christina M._

[Read full review](https://www.g2.com/survey_responses/essentials-review-12654929)

### [Waystar](https://www.g2.com/products/waystar/reviews)

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 Award for ambulatory RCM services in 2019. The Waystar platform is used by more than 500,000 providers, 1,000 health systems and hospitals and 5,000 health plans and integrates with all major HIS and PM systems. For more information, visit waystar.com or follow @waystar on Twitter.

**Average Rating:** 4.4/5.0

**Total Reviews:** 116

#### How Do G2 Users Rate Waystar?

- **Has the product been a good partner in doing business?:** 8.0/10 (Category avg: 8.6/10)
- **Clearinghouse Integration - Healthcare Claims Management:** 9.1/10 (Category avg: 8.4/10)
- **Claims Data Automation - Healthcare Claims Management:** 9.2/10 (Category avg: 8.6/10)
- **Patient Data Security - Healthcare Claims Management:** 9.3/10 (Category avg: 8.7/10)

#### Who Is the Company Behind Waystar?

- **Seller:** [Waystar](https://www.g2.com/sellers/waystar)
- **HQ Location:** Louisville, Kentucky
- **Twitter:** @Waystar (2,039 Twitter followers)
- **LinkedIn® Page:** https://www.linkedin.com/company/11444741/ (1,741 employees on LinkedIn®)

#### Who Uses This Product?

- **Who Uses This:** Billing Manager, Office Manager
- **Top Industries:** Hospital & Health Care, Medical Practice
- **Company Size:** 61% Small, 32% Medium

#### What Are Recent G2 Reviews of Waystar?

**["Best for quick billing and managing business"](https://www.g2.com/survey_responses/waystar-review-5262731)**

**Rating:** 5.0/5.0 stars

_— Sandeep A._

[Read full review](https://www.g2.com/survey_responses/waystar-review-5262731)

**["Helpful Insurance and Patient Payment Search"](https://www.g2.com/survey_responses/waystar-review-12713685)**

**Rating:** 5.0/5.0 stars

_— Verified User in Insurance_

[Read full review](https://www.g2.com/survey_responses/waystar-review-12713685)

### [MicroMD PM](https://www.g2.com/products/micromd-pm/reviews)

MicroMD PM is a comprehensive practice management software designed to streamline administrative and financial operations for medical practices of all sizes. It offers a suite of tools that automate billing processes, enhance patient scheduling, and improve overall practice efficiency. By integrating various functionalities into a single platform, MicroMD PM enables healthcare providers to focus more on patient care and less on administrative tasks. Key Features and Functionality: - Patient Scheduling and Management: Facilitates intuitive scheduling with template-based displays, color-coded views, and intelligent patient waiting lists. Supports online patient scheduling through the Secure Chart Patient Portal, allowing patients to book appointments at their convenience. - Automated Billing and Claims Processing: Streamlines billing operations with robust billing features, integrated claims submission, and management capabilities through preferred clearinghouse partners. Includes automatic insurance eligibility verification to ensure accurate billing. - Financial Management and Reporting: Provides comprehensive management, financial, and administrative reporting tools to monitor key performance indicators, manage accounts receivable, and enhance revenue cycle management. - Digital Patient Intake: Automates the patient intake process from scheduling through registration and check-in, reducing wait times and improving the patient experience. - Patient Engagement Tools: Enhances patient communication with automated appointment reminders via email, text, and voice, as well as notifications for past due balances and follow-up care instructions. Primary Value and Solutions Provided: MicroMD PM addresses the critical need for efficient practice management by automating and integrating key administrative functions. It reduces manual errors, accelerates billing and claims processing, and provides actionable insights through advanced reporting. This leads to improved cash flow, enhanced patient satisfaction, and increased operational efficiency, allowing healthcare providers to focus more on delivering quality patient care.

**Average Rating:** 4.2/5.0

**Total Reviews:** 26

#### How Do G2 Users Rate MicroMD PM?

- **Has the product been a good partner in doing business?:** 8.1/10 (Category avg: 8.6/10)
- **Clearinghouse Integration - Healthcare Claims Management:** 8.3/10 (Category avg: 8.4/10)
- **Claims Data Automation - Healthcare Claims Management:** 8.5/10 (Category avg: 8.6/10)
- **Patient Data Security - Healthcare Claims Management:** 8.8/10 (Category avg: 8.7/10)

#### Who Is the Company Behind MicroMD PM?

- **Seller:** [Henry Schein One](https://www.g2.com/sellers/henry-schein-one-c2b2b9e0-09c0-490c-9b70-33bd380468f0)
- **Year Founded:** 2018
- **HQ Location:** American Fork, UTAH
- **Twitter:** @Henryscheinone (157 Twitter followers)
- **LinkedIn® Page:** https://www.linkedin.com/company/henry-schein-one/ (1,388 employees on LinkedIn®)
- **Ownership:** NASDAQ:HSIC

#### Who Uses This Product?

- **Top Industries:** Hospital & Health Care
- **Company Size:** 62% Small, 27% Medium

#### What Do G2 Reviewers Say About MicroMD PM?

_AI-generated summary from verified user reviews_

##### Pros

- Users appreciate the **efficiency in billing** with MicroMD PM, simplifying daily tasks for better practice management.
- Users appreciate the **efficiency of claims management** in MicroMD PM, as it simplifies daily tasks in their practice.
- Users commend the **responsive customer support** of MicroMD PM, enhancing their overall experience with the system.
- Users appreciate the **customization options** of MicroMD PM, allowing adjustments to better fit workflow and enhance efficiency.
- Users appreciate the **customization options** of MicroMD PM, allowing adjustments to better fit their workflow and improve efficiency.

##### Cons

- Users express the need for improved **appointment filtering** in MicroMD PM to save time and enhance reporting functionality.
- Users find the **reporting functionality inefficient** , noting that it lacks advanced options and modern updates.
- Users desire improvements in **reporting functionality** , citing outdated reports and a need for enhanced appointment filtering options.
- Users note **scheduling issues** with MicroMD PM, emphasizing the need for improved appointment filtering for efficiency.

#### What Are Recent G2 Reviews of MicroMD PM?

**["Easy to Use, Reliable, and Flexible Practice Management System"](https://www.g2.com/survey_responses/micromd-pm-review-11638852)**

**Rating:** 5.0/5.0 stars

_— Emily H._

[Read full review](https://www.g2.com/survey_responses/micromd-pm-review-11638852)

**["Seamless billing, coding, and collections. Efficient revenue tracking"](https://www.g2.com/survey_responses/micromd-pm-review-9189622)**

**Rating:** 5.0/5.0 stars

_— Shorya R._

[Read full review](https://www.g2.com/survey_responses/micromd-pm-review-9189622)

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[Browse Healthcare Claims Management Themes](/categories/healthcare-claims-management/themes)

 ![Emma Stein](/assets/transparent-ad5be28fbcd25b7b08d2cebe1d957125437fb5407d75ee717965ad22c8808791.gif "Emma Stein")
ES

Researched and written by [Emma Stein](https://research.g2.com/insights/author/emma-stein)

Updated October 3, 2024

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](https://www.g2.com/categories/medical-billing),[revenue cycle management software](https://www.g2.com/categories/revenue-cycle-management), or comprehensive [medical practice management software](https://www.g2.com/categories/medical-practice-management). 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

Show More

* * *

## How Do You Choose the Right Healthcare Claims Management Software?

### What You Should Know About Healthcare Claims Management Software

Any healthcare organization, whether it’s a small, specialized practice or an enterprise healthcare system, deals with invoices, payments, insurance claims, and overall finances. Efficient management of these financial processes is crucial for maintaining profitability and ensuring smooth operations. This is where **healthcare claims management software** comes into play. 

### What is healthcare claims management software?

Healthcare claims management (HCM)  software, also called medical claims software, automates a medical practice’s invoicing and claims processes. 

From initial submission to adjudication, it handles all steps to ensure [claims](https://www.g2.com/glossary/medical-claims-definition) are processed accurately and quickly, reducing the risk of errors and denials. It’s an essential tool for medical practices, hospitals, and billing companies aiming to boost efficiency in the billing process.

The solution can turn an office paperless and digital, which will optimize the process by reducing overall billing errors, time spent on monitoring and managing the claims, and lead to real-time processing of claims. 

Implementing medical claims management software will help hospitals and clinics improve financial performance with automated processes and prevent any hurdles that can potentially disrupt the claims processing and billing workflow. 

### What are the common features of healthcare claims management software?

The following are some core features within healthcare claims management that can help users manage a more effective and efficient claims process.

- **Claims submission and processing:** Electronic claims processing feature automates the submission process for insurance claims, enabling faster and more efficient processing.
- **Claims scrubbing:** HCM identifies and corrects errors or discrepancies in claims before submission. It uses validation rules to ensure accurate coding and billing, reducing the chances of denials.
- **Denial management** : A good medical claims software tracks and manages denied claims, providing tools to resubmit claims with corrected information. It offers denial analytics to help identify common denial reasons and improve the accuracy of future claim submissions.
- **Real-time eligibility verification:** This feature checks a patient’s insurance eligibility and coverage in real time before services are rendered. It prevents claim rejections due to patient ineligibility or insufficient coverage.
- **Automated coding:** This is an essential feature in HCM that incorporates medical coding standards like the International Classification of Diseases - ICD-10, and Current Procedural Terminology (CPT) in claims to ensure proper coding of procedures and diagnoses. It reduces manual coding errors and speeds up claims processing.
- **Claims tracking:** This feature provides real-time tracking of claim statuses, from initial submission to adjudication. It offers insights into claim progress and outcomes, helping users manage follow-ups efficiently.
- **Compliance management:** All healthcare claims management software ensures adherence to healthcare regulations such as the [Health Insurance Portability and Accountability Act (HIPAA)](https://www.g2.com/glossary/hipaa-definition), and ICD-10 coding. It regularly updates to align with new regulatory changes to avoid compliance risks.
- **Revenue cycle management (RCM) integration:** Best HCM software works seamlessly with broader RCM systems, electronic health records (EHR), and billing systems to streamline the entire billing and payment process. It supports end-to-end [RCM workflows](https://www.g2.com/articles/revenue-cycle-management-healthcare), improving financial outcomes for healthcare providers.
- **Customizable dashboards** : HCMs offer user-friendly visual displays of key metrics such as claim status, denial rates, and overall financial performance. 
- **Patient payment processing:** This software manages patient billing, invoicing, and payment processing for self-pay patients or out-of-pocket costs. It offers payment plans, online payment options, and reminders to improve patient collections.

### What are the benefits of healthcare claims management software?

Best healthcare claims management software does more than automate billing and invoicing, thereby reducing loads of paperwork and time usually spent on creating statements, verifying insurance coverage, and processing claims. A few other benefits of using healthcare claims management software include: 

- **Digital claims** : Automation is key to improving efficiency and accuracy in the healthcare industry because the claims process can be very manual. Implementing a digital claims process will reduce the amount of paper-based processes, increase clean claim submissions, reduce errors, and create more thorough, accurate [documentation](https://www.g2.com/articles/medical-documents).
- **Efficient processing:** The various stages of claims processing can be very time consuming due to errors. Healthcare claims management software will allow for optimized processing and collection of claims. It will also increase efficient reimbursement cycles and communications with insurance companies.
- **Patient satisfaction:** If the claims process is filled with errors and inaccuracies, patients will likely be upset and frustrated with the system. Healthcare claims management software will allow for tracking, monitoring, and reporting of patients’ finances and customization of billing according to specialized practice needs—all of which leads to improved patient engagement and satisfaction. 
- **Adjudication:** To adjudicate claims means to automate how the responsibility of the payer is determined. Auto-adjudication can be implemented in the claims process, which leads to a faster payment process for providers, more accurately processed claims, fewer pending or outstanding claims, and an improved patient experience. 
- **Compliance adherence:** There are many compliance issues, such as Medicare and Medicaid, and numerous state and federal regulations, which makes the claims process complex. The privacy and security requirements of the Health Insurance Portability and Accountability Act (HIPAA) are critical to a successful practice. HIPAA violations can lead to fines and significant damage to a provider’s reputation. Ensuring the healthcare claims processing systems are fully compliant is critical to remain compliant and maintain optimal levels of patient service.

### Who uses HCM or medical claims software?

Common users of healthcare claims processing software include: 

- **Healthcare providers:** Hospitals, clinics, private practices, and specialty care centers are the primary users of HCM software. They use it to streamline billing, manage insurance claims, and enhance revenue cycle management.
- **Medical billing and coding companies:** These companies rely on HCM software to handle claims processing for healthcare providers, managing everything from submission to denial resolution.
- **Health insurance companies and payers:** These parties use medical claims software to process, verify, and adjudicate claims, ensuring accurate payment and compliance.
- **Third-party administrators (TPAs):** TPAs utilize this software to provide outsourced claims management services, covering compliance, claims processing, and auditing.
- **Healthcare clearinghouses:** These companies employ HCM software to validate and process claims between healthcare providers and insurers, ensuring claims meet payer requirements and reducing rejections.
- **Patients:** Patients indirectly interact with healthcare claims management software through billing and payment processes. The software manages [patient billing](https://www.g2.com/glossary/medicaid-billing-definition), tracks out-of-pocket costs, and facilitates payment plans.

### Healthcare claims management software pricing

The cost of healthcare claims management software can vary significantly based on factors like the number of users, the complexity of features, the deployment model, and the specific vendor. 

- **Number of users:** The more users accessing the software, the higher the cost.
- **Features and functionality:** The complexity and breadth of features, such as advanced analytics, automated coding, and real-time reporting, will impact the price.
- **Deployment model:** Cloud-based solutions are generally more affordable than on-premise solutions due to lower upfront costs and reduced maintenance overhead.
- **Additional services:** Consider costs for implementation, customization, training, and ongoing support.

Here’s a look at the common pricing models of medical claims software: 

- **Subscription-based:** Many healthcare claims management systems operate on a subscription model, often charged monthly or annually. Pricing can range from a few hundred to several thousand dollars per month, depending on the software's features and the number of users. Subscription-based models typically include customer support, regular updates, and cloud hosting.
- **Per-claim pricing:** Some software solutions use a pay-per-claim model, where healthcare providers are charged based on the number of claims processed. This model is often preferred by smaller practices that handle fewer claims and want to keep costs predictable.
- **One-time license fee:** Some on-premise solutions require a one-time licensing fee, making them a significant upfront investment. This model is common for larger organizations wanting full software infrastructure control. However, ongoing costs for maintenance, updates, and support should also be considered when evaluating this pricing model.
- **Free or freemium:** Some vendors offer free basic versions of their software, with premium features and services available for an additional fee. 

Many healthcare claims management software providers offer custom pricing, tailoring their offerings to each client's specific needs. Contact vendors directly to discuss specific needs and obtain customized quotes.

### Software related to healthcare claims management software

Related solutions that can be used together with healthcare claims management software include:

- [Medical billing software](https://www.g2.com/categories/medical-billing): Medical organizations use medical billing software to create and manage invoices for the services they provide. Healthcare institutions require certain industry-specific billing features, as medical invoicing varies according to patient diagnostics, treatment, and healthcare coverage. Medical billing software includes support for compliance with health care regulations such as the HIPAA. Additionally, medical billing solutions can increase the accuracy and speed of the billing process for healthcare organizations. Some advanced solutions also provide functionality for revenue management or profitability analysis.
- [Medical practice management software](https://www.g2.com/categories/medical-practice-management): Healthcare organizations use medical practice management software to manage all aspects of their operations, including patient information management, treatment planning and scheduling, and back-office functions such as accounting. This type of software helps doctors with patient treatment management and healthcare administrative personnel with patient influx management. Scaled-down versions of medical practice management can address the needs of small clinics or private practices.
- [Revenue cycle management software](https://www.g2.com/categories/revenue-cycle-management): Revenue cycle management (RCM) software unifies the business and clinical sides of a health care practice via automation of administrative tasks, pulling of data from EHRs and other hospital information management solutions, and organization of individual RCM processes that already exist. This helps streamline and ease the overall financial processes that exist within a healthcare organization.

### Challenges with healthcare claims management software

Software solutions can come with their own set of challenges. 

- **Denial management:** The biggest challenges to claims denials include coding errors and reimbursement policies. Providers and administrators have to constantly learn new codes and adding this information can still be a manual process. There may need to be communications between the provider, insurer, and patient as not all claims will be approved and processed immediately. 
- **Training and onboarding:** Like any piece of technology, effective training and onboarding will speed up the adoption of the healthcare claims management solution. The quicker practitioners and administrators become comfortable with the software, the more empowered they will feel when utilizing and communicating about the solution. Regular training will also reduce any wrong use, insufficient documentation, or miscommunication. Training will benefit staff when it comes to everyday use, as well as reducing errors in coding.
- **Multiple systems:** Not all clinics have coexisting patient management and billing systems. These systems may or may not communicate with each other and this can lead to a less efficient claims management process. 

### How to buy healthcare claims management software

There are unique needs to consider when assessing software to purchase—size and team member count, onboarding process, software cost, vendor customer support options, mobile compatibility, and customization are some of them. Buyers must determine what set of features will help the users be more efficient and meet the needs of the claims management process. 

#### **Choose a selection team**

To choose a selection team, decision makers need to involve subject matter experts from all teams that will use the system. For any organization, this will likely involve healthcare practitioners, office staff, claims management employees, and decision makers. An IT administrator should also be present to weigh in on technical concerns with the products. The selection team should be a representation of the people who will use the system. 

#### Create a long list

An initial list of potential healthcare claims management solutions should include any products that meet the basic feature requirements. At this stage, focus on identifying options that align with your essential needs, such as claims submission, denial management, compliance, and integration capabilities. This list serves as a broad overview of potential vendors that could fit your organization.

#### **Create a short list**

After a long list has been created, it’s time to look at each product in more detail to determine if it sounds like it will meet the needs of the healthcare providers interested in purchasing this software. This involves analyzing additional features beyond the essentials, such as AI-powered automation, analytics, or enhanced compliance tools.

Consider the software’s scalability, user-friendliness, and ability to drive efficiencies and improve compliance. Select the top contenders that seem most aligned with your requirements.

#### **Conduct demos**

Demos are a great opportunity for buyers to see how the software works. Only the shortlisted vendors should be invited to demonstrate their solutions. Demos should be performed live, using the system, and not through slide decks and screenshots. 

Request a walkthrough from the perspective of all user roles—administrators, claims staff, and healthcare providers—to assess ease of use, navigation, and overall user experience. This will help you understand how the software operates in real-world scenarios.

#### **Negotiation**

After narrowing in on the preferred product, it’s time to negotiate a pricing package. Buyers must consider the software's pricing model, such as whether the seller charges a flat monthly fee or, more commonly, a fee based on how many user seats the buyer needs. Buyers should also note if they can negotiate to add more user seats to a package that would otherwise meet their needs. They might also consider negotiating a discount in exchange for signing a multi-year contract. 

#### **Final decision**

The final decision should involve feedback from all primary users. Ensure the software is user-friendly, easy to implement, and capable of improving operational efficiency. Consider its impact on the patient experience, compliance, and overall claims performance. The selected solution should align with your organization’s long-term goals and provide clear value for your investment.

### Healthcare claims management software trends

The healthcare claims management software landscape is constantly evolving, driven by technological advancements and changing industry regulations. Here are key trends shaping the industry:

- **Artificial intelligence and automation:** [AI](https://www.g2.com/articles/artificial-intelligence-in-healthcare-benefits-myths-and-limitations) can transform claims management by automating claims scrubbing, denial prediction, and error detection. By analyzing claims data in real-time, AI tools minimize errors, increase approval rates, and speed up the entire claims process, making operations more efficient. 
- **Cloud-based solutions:** Cloud-based claims management software offers flexibility, scalability, and cost efficiency. It enables providers to access real-time data, supports remote work, simplifies software updates, and ensures compliance, making it a critical choice for organizations aiming for seamless digital transformation.

**Researched and written by** [**Dominick Duda**](https://research.g2.com/insights/author/dominick-duda)