Best Healthcare Payers' Core Administrative Processing Solutions Software

Healthcare Payer’s Core Administrative Processing Solutions support and simplify the solutions that healthcare payers use for administrative management and transactions processing.

To qualify for inclusion in the Healthcare Payer’s Core Administrative Processing Solutions category, a product must:

  • Evolve and accommodate regulatory changes and innovation in the payment sector
  • Extend the capabilities and functionalities of existing processing and provider-facing systems
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    Medisoft is a compact solution for the healthcare industry that deals with both clinical and administrative requirements of healthcare centers.

    NaviNet Open Foundation consists of a series of layers: a platform, a set of network services, a suite of reimbursement-related and clinical applications, and a set of tools that customers can use to configure and customize the system.

    Clinical Decision Support (CDS) system is a next-generation decision-support solution available to providers today.

    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.

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

    ABN Assistant is the triage medical necessity for Medicare and private payers prior to service delivery.It verifies medical necessity pre-service and generates ABN or private payer notices as necessary and provides full reporting, chargemaster, coding, and administration tools.

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

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

    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.

    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

    E-HAS is an Online / Offline Hospital Administration and Management Information System for Health Care organizations . E-HAS has a capability of data warehousing and business intelligence for consistent growth of organization and hospital system automation to significantly decrease manpower with accuracy.

    Post Discharge Software is a patient follow up care management solution that helps you connect with recently discharged patients.

    Empower your organization to adapt with a user-friendly solution, identifying and mitigating risk. While profitability improves, so will your patients experiences and outcomes.

    Health Portal Solutions is a provider of custom, integrated web portals that saves Employers and Payers time and money by consolidating insurance data, products, and business processes into a single portal.

    The Health Catalyst Data Operating System (DOS) is a breakthrough engineering approach that combines the features of data warehousing, clinical data repositories, and health information exchanges in a single, common-sense technology platform.

    Health iPASS is redefining the patient revenue cycle by improving the patient experience from appointment to payment. It helps providers promote price transparency, build trust and increase operating income by simplifying the check-in process and streamlining both time-of-service and residual patient payments.

    LexisNexis ProviderPoint is a proven, powerful hosted solution that gives payers and other health care stakeholders a systematic way to keep provider information accurate and up-to-date, while significantly reducing operating costs. It delivers unrivaled depth, breadth and quality of information in a way that's easy to integrate and use.

    MediQuire is a performance management platform designed to leverage data (clinical, claims, demographic and others) to derive powerful insights about operational and clinical performance gaps of individual clinicians and provide the tools to clinicians and patients in order to close those care gaps daily.

    MOMS Medical Billing and Practice Management software is designed to streamline physician billing processes in order to maximize reimbursement.

    PlanXpand is a platform manages real-time, shared benefit accumulators; ACA cost-sharing reduction subsidies; CDH plan designs (HRA) for payors.

    TM3 is a practice management solution that can be deployed either in the cloud-based or on-premise. It is suitable for a variety of practice types.

    Veradigm is an integrated data systems and services business that combines data-driven clinical insights with actionable tools for clinical workflow, research, analytics and media. Our solutions are designed to help key healthcare stakeholders to improve the quality, efficiency, and value of healthcare delivery - from biopharma to health plans, healthcare providers, health technology partners, and most importantly, the patients they serve. We are dedicated to simplifying the complicated healthca

    Virtuo MIS software solutions for healthcare management encompass all areas of finance, decision support, supply chain, human resources and payroll.

    Gives consumers smart healthcare recommendations, considering their life stage, preferences, and finances. Curates the experience, learning from their behaviors.

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