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
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    (44)4.5 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 by the more than 40,000 providers that trust it for their small practices. Unlike other companies that built their offering for large medical groups or hospitals, Kareo is purpose-built for the work flows and unique needs of the independent practice. The result is an affordably-priced platform without the bells and whistles that you don’t need.

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

    athenahealth is a leading provider of network-enabled services and mobile applications for medical groups and health systems.

    Maximize all sources of revenue, reduce cost and expedite payment with a simplified and unified platform that integrates payment processing across HIS, PM and EMR systems—unlocking unprecedented, actionable insights for improved revenue cycle performance. No matter the size or scope of your organization, we can help you save time and effort so you can get back to helping those who need it most.

    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.

    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.

    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

    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.

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

    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.

    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.

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

    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.

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

    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.

    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.

    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

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

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

    Quick Practice is a medical practice management software that includes electronic billing service, calendar, patient database, and more.

    Improving efficiencies within the healthcare billing process through automation and seamless integration.

    TruBridge is a service provider focused on providing business office, consulting and managed IT services to community healthcare organizations.

    AcceliCLAIM manages every step of the Medicaid claiming process, from performing Medicaid eligibility checks, to building and submitting claims, to processing remittance files. The system performs complex validation routines to ensure only eligible services are claimed and includes a suite of reporting tools designed to help you identify where additional data can drive greater reimbursement.

    AccuReg offers a full suite of all critical front-end RCM process solutions that hospital Patient Access departments need.

    Web-based medical billing, practice management and EMR software that uses artificial intelligence.

    Offers OneTouch® electronic claims processing, real-time eligibility verification, patient statements delivery, and electronic remittance advice (ERA) and tools that accelerate the patient payment collection process.

    Denials Intelligence is a denial management solution designed to generate a rich set of reports on all claim and remit activity.

    An analytics-driven claims and remittance management solution for healthcare providers who want to automate workflows, improve resource utilization, and accelerate cash flow.

    AutoMedSys EHR is a solution designed to have a scalable architecture to support large group of physicians regardless of geographical distributions.

    Rapid access to the business intelligence and comparative analytics needed to monitor, track, and respond to Electronic Data Interchange (EDI) issues impacting your organization's financial and operational performance.

    A single platform designed to enable cleaner claims, improve communication and speed up reimbursement

    The Cirius Group has transformed healthcare revenue cycle business operations for over 35 years. Cirius delivers industry leading KPI's by streamlining business office functions with highly customized automation. We remove the manual effort from claims production, remittance, and reimbursement processes, relieving workloads with our software and business services. Continual software innovation, optimized EDI services, and dedicated support helps drive client’s success and sustains their results over the long term. Providers rely on Cirius solutions for consistent results over decades of adding facilities, managing growing claim volumes and adapting to ever-changing payer requirements. Complex billing environments are our specialty; large CBOs, major academic systems and cancer centers all rely on Cirius solutions to help ensure the sustainable cash flow they need. Offering: Contract Management Software Claim Editor and 837 Submission Software Payment Processing Software Cash Reconciliation Software Denial Management Software Revenue Cycle Consulting Cirius Business Services: Fully managed hands-free direct EDI services to all payers. Includes submission, tracking, re-submissions, reconciliation management, and correcting rejections. Available to all providers.

    Claim Resolutions provides an integrated solution for medical billing, coding, and practice management.

    A clinically-based claims payment solution for payers that want to create and deploy flexible, automated rules to help improve payment accuracy, reduce appeals, and realize medical and administrative savings.

    ClaimVantage offers industry-leading software for managing life, health, and absence claims efficiently and securely, helping you deliver superior customer service for a competitive edge. Hosted on the Salesforce platform, our configurable and intuitive cloud-based software is developed and updated by industry experts. We provide regular enhancements to keep you on top of market changes and industry developments. Our best-in-class solutions are fully integrated and can be accessed anytime, anywhere, helping you minimize fraud, streamline operations and improve productivity, while saving on implementation costs.

    Analyze proposed bills to get visibility into problems and actionable insight before the problems leave the business office.

    Comindware Health Insurance Claims Management software provides for effective claims processing and enables elimination of inconvenient and error-prone paper and email-based operations taking all communications, data and processes into a unified working environment.

    The PayoIQ's payor change information provides immediate and substantial revenue management benefits to your practices as you seek to improve patient outcomes.

    DatixWeb is a web-based patient safety software for healthcare risk management applications, delivering safety, risk and governance elements through a variety of integrated software modules. DatixWeb is the first step towards improving patient safety and creating a culture of learning with a locally hosted product.

    Dental Hero helps lighten the load so you can focus on being a dental hero.

    DrsMagic is a comprehensive software package for medical clinics.

    Helps you meet pressures with a full range of BPO and turnkey healthcare administration solutions, including advanced technologies and strategic consulting services designed to help you optimize member outcomes, focus on revenues, and manage risk to remain compliant

    eClaimStatus is a Health insurance eligibility verification software that is easy to Use, comes with zero setup or maintenance hassles ,assures real-time , eligibility verification from 700+ payers, fetches benefits data for 1 or 1000 patients in seconds , HIPAA compliant.

    E-COMB is a web based solution for generating medical claims complying with the HIPAA transaction and code set standards, regulated by the US Government following the recommendations of American National Standards Institute.

    Payment Infrastructure for Healthcare. Eligible is a software suite that increases yield while decreasing cost to collect.

    Claim Agent is a claims management software designed to have an intuitive functionality that optimizes workflow, reduces errors, and accelerates cash flow.

    A web-based complete healthcare revenue cycle management solution. Check eligibility, edit, submit and retrieve claim data online.

    EzyMed Online 4 is a fully integrated Medical Practice Management software for General Practices, Radiology and Specialists Centres.EzyMed Online 4 encompasses all functions required for the Medicare Australia's Online Claiming Online process, Department of Veterans Affairs (DVA) Claims and Australian Childhood Immunisation Register (ACIR) claims.

    QuickStart Forms is a solution used to preserve the look and feel of the original paper document, while creating a faster, more accurate way of completing clinical information.