Best Healthcare Claims Management Software

How Many Healthcare Claims Management Software Products Does G2 Track?

Total Products under this Category: 165

Category Stats (Oct 2026)

  • Average Rating: 4.34/5 (↑0.02 vs Sep 2026) The average rating of products in this category, based on all submitted ratings
  • Top Trending Product: Inovalon Claims Management Medicare Pro (+14.29%) - Among all products in this category, Inovalon Claims Management Medicare Pro recorded the largest rating increase compared to last month

Last updated: October 08, 2026

How Does G2 Rank Healthcare Claims Management Software Products?

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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

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

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

ModMed

At ModMed®, we empower our customers with an integrated, AI-powered suite of software and services designed to support the clinical, operational, and financial aspects of their practice. Our on-staff physicians collaborate closely with our software engineers to develop intelligent, specialty-specific solutions for allergy, dermatology, gastroenterology, OBGYN, ophthalmology, orthopedics, otolaryngology, pain management, plastic surgery, podiatry, and urology practices—as well as ambulatory surgery centers for ophthalmology and gastroenterology. This physician-led approach allows us to embed deep medical domain expertise into our technology, helping address the specific challenges practices face across a wide range of specialties. Our flagship product EMA®, a cloud-based electronic health records system, adapts to each doctor’s style of practice, remembering preferences and automatically suggesting exam notes and suggested billing codes. When used on a tablet, EMA offers special touch and swipe gestures to rapidly build patient profiles, diagnoses, treatment programs and billing. EMA integrates seamlessly with our full range of products and services—including Practice Management, Revenue Cycle Management, Telehealth, Inventory Management, and patient engagement tools such as online payments and scheduling. Together, these solutions form an intelligent, all-in-one system that helps eliminate departmental silos, enhances team collaboration, and improves visibility across the entire practice. The Result With our AI-powered, cloud-based platform and mobile touch-screen capabilities, ModMed’s intuitive end-to-end system helps physicians save time on administrative tasks and focus more on what matters most—delivering better patient outcomes.

Average Rating: 4.5/5.0

Total Reviews: 362

How Do G2 Users Rate ModMed?

  • Has the product been a good partner in doing business?: 8.8/10 (Category avg: 8.4/10)

Who Is the Company Behind ModMed?

  • Seller: ModMed
  • Company Website:
  • Year Founded: 2010
  • HQ Location: Boca Raton, Florida
  • Twitter: @modmed
    4,166 Twitter followers
  • LinkedIn® Page: www.linkedin.com
    2,477 employees on LinkedIn®

Who Uses This Product?

  • Who Uses This: Practice Manager, Medical Assistant
  • Top Industries: Medical Practice, Hospital & Health Care
  • Company Size: 46% Small, 28% Medium

What Do G2 Reviewers Say About ModMed?

AI-generated summary from verified user reviews

Pros
  • Users appreciate the ease of use of ModMed, facilitating efficient documentation and streamlined workflows in dermatology practices.
  • Users value ModMed for its efficiency, simplifying tasks and enhancing workflow across dermatology practices.
  • Users commend ModMed for its workflow efficiency, thanks to seamless integration of EMR, billing, and patient engagement.
  • Users value ModMed for its tailored solutions for dermatology, enhancing workflow and overall satisfaction in clinical practice.
  • Users appreciate the easy setup of ModMed, enabling a seamless transition and minimal disruption to workflows.
Cons
  • Users report poor system functionality in ModMed, encountering issues with accessioning and delayed data analytics.
  • Users highlight the missing features in ModMed, such as limited customization and absence of essential functionalities.
  • Users find the difficult setup of ModMed to be overwhelming, especially for new users navigating complex workflows.
  • Users find the limited features of ModMed restrict functionality and customization options for specific needs.
  • Users find the inadequate reporting in ModMed frustrating due to inconsistencies and inefficiencies in data presentation.

What Are Recent G2 Reviews of ModMed?

What Are G2 Users Discussing About ModMed?

athenaOne

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: 114

How Do G2 Users Rate athenaOne?

  • Has the product been a good partner in doing business?: 7.2/10 (Category avg: 8.4/10)
  • 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: 8.8/10)

Who Is the Company Behind athenaOne?

  • Seller: athenahealth
  • Year Founded: 1997
  • HQ Location: Watertown, MA
  • Twitter: @athenahealth
    24,384 Twitter followers
  • LinkedIn® Page: www.linkedin.com
    9,040 employees on LinkedIn®
  • Ownership: NASDAQ: ATHN

Who Uses This Product?

  • Top Industries: Hospital & Health Care, Medical Practice
  • Company Size: 45% Small, 35% Medium

What Do G2 Reviewers Say About athenaOne?

AI-generated summary from verified user reviews

Pros
  • Users find athenaOne to be intuitive and easy to navigate, enhancing their overall experience and efficiency.
  • Users appreciate the user-driven evolution and customization of athenaOne, enhancing their workflows and reporting capabilities.
  • Users value the top-notch API integration of athenaOne, enhancing their practice's efficiency and flexibility.
  • Users commend the exceptional customer service of AthenaOne, finding support to be knowledgeable and genuinely helpful.
  • Users value the user-friendly templates of athenaOne, enhancing efficiency in scheduling and communication with colleagues.
Cons
  • Users find inadequate reporting in athenaOne that complicates tasks and hinders efficient documentation.
  • Users struggle with a high learning curve, finding the interface clunky and time-consuming for documentation tasks.
  • Users face significant billing issues, leading to frustration with documentation and overall inefficiency in the system.
  • Users find the reporting process inefficient, struggling with complexity and limited user access to necessary reports.

What Are Recent G2 Reviews of athenaOne?

What Are G2 Users Discussing About athenaOne?

TriZetto Facets

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: 8.8/10)

Who Is the Company Behind TriZetto Facets?

  • Seller: Cognizant
  • Year Founded: 1994
  • HQ Location: Teaneck, NJ
  • Twitter: @Cognizant
    707,793 Twitter followers
  • LinkedIn® Page: www.linkedin.com
    372,105 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?

What Are G2 Users Discussing About TriZetto Facets?

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Inovalon Claims Management Pro

Claims Management Pro™ helps healthcare organizations manage claims across all payers from a single platform. Built for revenue cycle teams across hospitals, health systems, physician groups, and billing organizations, it combines claims management, eligibility verification, workflow automation, and reporting to help organizations reduce system hopping, improve claim quality, and keep reimbursement moving. The solution supports a 98%+ first-pass payer acceptance rate1 by helping organizations identify and correct issues before claims are submitted. It is best suited for organizations that need enterprise claims management across Medicare, Medicaid, and commercial payers from a single platform. Managing claims often requires teams to move between multiple payer portals, monitor claim status, respond to audits and appeals, and verify patient eligibility throughout the revenue cycle. Inovalon’s most robust claims solution, Claims Management Pro brings these activities together in one application, giving organizations greater visibility into claims while helping billing teams work more efficiently and address potential issues before they affect payment. The solution is backed by Inovalon's nationwide connectivity and experience processing more than 3.3 billion provider transactions each year.2 Configurable workflows and real-time access to payer information also help organizations adapt the solution to their operational needs. Key capabilities include: Manage all payers from one platform with a customizable dashboard and a single login for Medicare, Medicaid, and commercial insurance. Catch and correct claim issues before submission using a built-in rules engine, custom claim edits, eligibility verification, and guided error correction. Automate claims workflows for audits, appeals, Additional Documentation Request (ADR) tracking, and secondary claims submissions while helping reduce timely filing write-offs. Monitor claims and payment activity through remit analytics, real-time claim status, Electronic Remittance Advice (ERA) access, and reporting that provides insight into denials and reimbursement trends. Customize staff workflows based on claim type and required actions to help teams prioritize work and manage claims more effectively. By centralizing claims management activities in one platform, the solution helps organizations improve claim quality, reduce manual effort, and strengthen revenue cycle performance. Customer experience: "BAYADA experienced an ROI of approximately $250K in the first year." — Bryan Quinn, Manager, Reimbursement Systems Analyst, BAYADA Claims Management Pro is part of Inovalon's revenue cycle management suite, which was top rated by Black Book Research. Based on evaluations from more than 1,300 hospital and health system finance and revenue cycle leaders, the suite earned recognition for its full provider cloud RCM platform breadth and eligibility, benefits verification, and real-time payer rule interpretation capabilities. 1. Inovalon internal reporting, Claims Management Pro, January 2026 2. Internal reporting, Inovalon, January 2026

Average Rating: 4.3/5.0

Total Reviews: 36

How Do G2 Users Rate Inovalon Claims Management Pro?

  • Has the product been a good partner in doing business?: 8.7/10 (Category avg: 8.4/10)
  • Clearinghouse Integration - Healthcare Claims Management: 8.9/10 (Category avg: 8.4/10)
  • Claims Data Automation - Healthcare Claims Management: 8.4/10 (Category avg: 8.6/10)
  • Patient Data Security - Healthcare Claims Management: 9.1/10 (Category avg: 8.8/10)

Who Is the Company Behind Inovalon Claims Management Pro?

  • Seller: Inovalon
  • Company Website:
  • Year Founded: 1998
  • HQ Location: Bowie, Maryland, United States
  • Twitter: @InovalonInc
    1,521 Twitter followers
  • LinkedIn® Page: www.linkedin.com
    3,336 employees on LinkedIn®

Who Uses This Product?

  • Top Industries: Hospital & Health Care
  • Company Size: 44% Small, 33% Medium

What Are Recent G2 Reviews of Inovalon Claims Management Pro?

What Are G2 Users Discussing About Inovalon Claims Management Pro?

SPRY

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: 93

How Do G2 Users Rate SPRY?

  • Has the product been a good partner in doing business?: 9.7/10 (Category avg: 8.4/10)
  • 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: 8.8/10)

Who Is the Company Behind SPRY?

  • Seller: SPRY
  • Year Founded: 2021
  • HQ Location: Wilmington, US
  • LinkedIn® Page: www.linkedin.com
    247 employees on LinkedIn®

Who Uses This Product?

  • Who Uses This: Physical Therapist, Owner
  • Top Industries: Health, Wellness and Fitness, Hospital & Health Care
  • Company Size: 87% Small, 13% Medium

What Do G2 Reviewers Say About SPRY?

AI-generated summary from verified user reviews

Pros
  • Users commend the ease of use of Spry, benefiting from its intuitive features and efficient functionality.
  • Users commend exceptional customer support from Spry, enhancing usability and customization for their practices.
  • Users praise Spry's exceptional efficiency, noting significant time savings in medical documentation and overall user-friendliness.
  • Users commend Spry for its exceptional customer support, which significantly enhances their overall experience and practice efficiency.
  • Users value the high level of customizability in Spry, allowing personalized solutions that enhance their experience significantly.
Cons
  • Users face frequent technical issues with SPRY, including glitches and slow AI performance affecting their productivity.
  • Users experience slow performance with SPRY, finding delays in AI note generation and frequent loading issues.
  • Users occasionally face software bugs and slow loading times, though support is helpful in resolving issues.
  • Users report data management issues with SPRY, particularly in tracking claims and kiosk form populating.
  • Users highlight the limited features of SPRY, particularly in tracking and follow-up workflows for claims and authorizations.

What Are Recent G2 Reviews of SPRY?

Service Center by Office Ally

Service Center by Office Ally is a trusted Revenue Cycle Management and patient payments platform used by more than 80,000 healthcare providers and health services organizations, which process more than 950 million transactions annually. Service Center is a cost-effective solution enabling providers to control their revenue cycle. With a user-friendly interface, Service Center helps providers check and verify patients’ eligibility and benefits, submit, correct, and check the status of their claims online, and receive remittance advice. Accepting standard ANSI formats, data entry and pipe-delimited formats, Service Center helps streamline administrative tasks and create more efficient workflows for providers.

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: 8.4/10)
  • 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: 8.8/10)

Who Is the Company Behind Service Center by Office Ally?

  • Seller: Office Ally
  • Company Website:
  • Year Founded: 2000
  • HQ Location: Vancouver, WA
  • Twitter: @Office_Ally
    655 Twitter followers
  • LinkedIn® Page: www.linkedin.com
    332 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?

TriZetto QNXT

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: 8.4/10)
  • 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: 8.8/10)

Who Is the Company Behind TriZetto QNXT?

  • Seller: Cognizant
  • Year Founded: 1994
  • HQ Location: Teaneck, NJ
  • Twitter: @Cognizant
    707,793 Twitter followers
  • LinkedIn® Page: www.linkedin.com
    372,105 employees on LinkedIn®
  • Ownership: NASDAQ:CTSH

Who Uses This Product?

  • Company Size: 46% Large, 38% Medium

What Are Recent G2 Reviews of TriZetto QNXT?

EHRYourWay

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: 8.4/10)

Who Is the Company Behind EHRYourWay?

  • Seller: EHR Your Way
  • Company Website:
  • Year Founded: 2008
  • HQ Location: San Diego, California
  • Twitter: @ehryourway
    168 Twitter followers
  • LinkedIn® Page: www.linkedin.com
    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 value the ease of use of EHR Your Way, appreciating its intuitive design and streamlined workflows.
  • Users value the efficiency of EHRYourWay, enjoying easy appointment management and streamlined workflows for enhanced productivity.
  • Users value the responsive customer support from EHRYourWay, enhancing their overall experience with the system.
  • Users value the extensive customization of EHRYourWay, making it adaptable and user-friendly for their organization.
  • Users appreciate the streamlined documentation workflow of EHRYourWay, enhancing efficiency and accuracy in managing client records.
Cons
  • Users often face technical issues like bugs and slow performance, hindering daily workflow and productivity.
  • Users are frustrated by the limited customization of forms and templates, hindering their ability to meet specific clinical needs.
  • Users find the time consumption in getting information and generating reports frustrating, impacting their overall efficiency.
  • Users face file management issues with EHRYourWay, including manual saving, session timeouts, and limited chart access.

What Are Recent G2 Reviews of EHRYourWay?

What Are G2 Users Discussing About EHRYourWay?

Inovalon Eligibility Verification

Eligibility Verification™ provides real-time eligibility and benefits verification for commercial and government payers. Built for healthcare providers, revenue cycle teams, billing specialists, and admissions and patient access staff, it automates routine eligibility verification tasks while giving organizations fast access to coverage and benefit information from Medicare, Medicaid, commercial health plans, Medicare Advantage, and Medicare supplement plans. Keeping eligibility information current can require teams to check multiple payer sources, monitor coverage changes, and resolve exceptions before claims move forward. Eligibility Verification helps organizations automate these routine activities through recurring batch processing, real-time eligibility inquiries, and configurable workflows that reduce manual effort while helping staff focus on more complex cases. With more than 2,300 payer connections1 and direct Medicare access, the solution gives organizations fast access to current eligibility information across a broad range of payers. Eligibility transaction history also provides a record of prior eligibility responses to support denial management and appeals when needed. Key capabilities include: Verify eligibility and benefits across commercial and government payers with access to coverage details, service type code benefits, co-pays, deductibles, coinsurance, and termination dates. Monitor coverage changes automatically using recurring batch processing, change reports, and bulk eligibility requests that help keep information current. Manage exceptions more efficiently through exception reporting, task reassignment, and Medicare Beneficiary Identifier (MBI) retrieval to resolve missing or invalid MBIs, so work continues without unnecessary delays. Integrate eligibility verification into existing workflows using CAQH CORE-compliant APIs and SFTP-based batch file exchange that connect with Electronic Health Records (EHRs), practice management, billing systems, and other supported data formats. Retain eligibility transaction history to support claims research, denial management, and appeals. By automating routine eligibility verification tasks and providing greater visibility into coverage information, the solution helps teams verify coverage more efficiently, reduce manual verification work, and improve eligibility accuracy before claims are submitted. Customer experience: "Running the batches is a big timesaver. You can run them all at the same time and see everything." — Jill Jacobson, Billing Supervisor, Lakeland Mental Health Center Eligibility Verification is part of Inovalon's revenue cycle management suite, which was top rated by Black Book Research. Based on evaluations from more than 1,300 hospital and health system finance and revenue cycle leaders, the suite earned recognition for its full provider cloud RCM platform breadth and eligibility, benefits verification, and real-time payer rule interpretation capabilities. 1. Internal reporting, Inovalon, July 2026

Average Rating: 4.5/5.0

Total Reviews: 16

How Do G2 Users Rate Inovalon Eligibility Verification?

  • Has the product been a good partner in doing business?: 10.0/10 (Category avg: 8.4/10)

Who Is the Company Behind Inovalon Eligibility Verification?

  • Seller: Inovalon
  • Company Website:
  • Year Founded: 1998
  • HQ Location: Bowie, Maryland, United States
  • Twitter: @InovalonInc
    1,521 Twitter followers
  • LinkedIn® Page: www.linkedin.com
    3,336 employees on LinkedIn®

Who Uses This Product?

  • Top Industries: Hospital & Health Care
  • Company Size: 56% Medium, 25% Large

What Are Recent G2 Reviews of Inovalon Eligibility Verification?

What Are G2 Users Discussing About Inovalon Eligibility Verification?

Silna Health

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: 8.4/10)
  • 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: 8.8/10)

Who Is the Company Behind Silna Health?

  • Seller: Silna Health
  • Company Website:
  • Year Founded: 2023
  • HQ Location: New York, US
  • LinkedIn® Page: www.linkedin.com
    66 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?

RCx

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 RCx, you can get results as soon as your first billing cycle. With built-in intelligence, RCx 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: 35

How Do G2 Users Rate RCx?

  • Has the product been a good partner in doing business?: 9.6/10 (Category avg: 8.4/10)
  • Clearinghouse Integration - Healthcare Claims Management: 7.5/10 (Category avg: 8.4/10)
  • Patient Data Security - Healthcare Claims Management: 9.2/10 (Category avg: 8.8/10)

Who Is the Company Behind RCx?

  • Seller: Aptarro
  • Company Website:
  • HQ Location: Tallahassee, Florida, United States
  • Twitter: @Alpha_II
    5,482 Twitter followers
  • LinkedIn® Page: www.linkedin.com
    127 employees on LinkedIn®
  • Ownership: Aptarro, Inc.

Who Uses This Product?

  • Top Industries: Hospital & Health Care, Medical Practice
  • Company Size: 51% Medium, 26% Small

What Are Recent G2 Reviews of RCx?

SAS Fraud, Anti-Money Laundering & Security Intelligence

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: 75

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: 8.4/10)
  • 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: 8.8/10)

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

  • Seller: SAS Institute
  • Company Website:
  • Year Founded: 1976
  • HQ Location: Cary, NC
  • Twitter: @SASsoftware
    60,863 Twitter followers
  • LinkedIn® Page: www.linkedin.com
    15,122 employees on LinkedIn®

Who Uses This Product?

  • Top Industries: Banking, Financial Services
  • Company Size: 49% 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 appreciate the ease of use of SAS Fraud, enjoying seamless data integration and a user-friendly experience.
  • Users appreciate the comprehensive and adaptable fraud prevention capabilities of SAS, enhancing their decision-making process effectively.
  • Users value the efficiency of SAS Fraud, enhancing fraud detection through advanced analytics and real-time insights.
  • Users value the advanced analytics of SAS Fraud, enhancing efficiency in fraud detection and risk management.
  • Users appreciate the immediate response to fraud patterns, enabling effective analysis and decision-making in security intelligence.
Cons
  • Users find the learning difficulty of SAS Fraud, Anti-Money Laundering & Security Intelligence challenging, especially without prior experience.
  • Users face significant difficulties with complex configuration and a non-intuitive interface, requiring extensive training and adaptation.
  • Users often struggle with the steep learning curve of SAS Fraud, finding the interface and configurations challenging to navigate.
  • Users find the product expensive and challenging due to high training needs and complexity for smaller organizations.
  • 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?

What Are G2 Users Discussing About SAS Fraud, Anti-Money Laundering & Security Intelligence?

Tebra (previously Kareo + PatientPop)

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: 256

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

  • Has the product been a good partner in doing business?: 8.2/10 (Category avg: 8.4/10)
  • 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: 8.8/10)

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

  • Seller: Tebra
  • Company Website:
  • HQ Location: Corona del Mar, US
  • Twitter: @TebraOfficial
    11,001 Twitter followers
  • LinkedIn® Page: www.linkedin.com
    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, 12% Medium

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

AI-generated summary from verified user reviews

Pros
  • Users praise Tebra for its user-friendly interface, enabling efficient task completion and customizable reporting.
  • Users appreciate the user-friendly interface of Tebra, enjoying seamless integration and comprehensive features like notes AI.
  • Users praise Tebra's responsive customer support, highlighting quick resolutions and helpful video chat assistance.
  • Users commend Tebra for its efficiency, enhancing the ease of managing tasks and claims across multiple practices.
  • Users find the user-friendly interface of Tebra helpful, especially with clear documentation and customizable templates.
Cons
  • Users experience inadequate reporting with Tebra, often needing to manually compile data and encountering refresh issues.
  • Users find the inefficiency in navigating tabs and lack of timely reports frustrating, slowing down their workflow.
  • Users find limited features in Tebra, especially in reporting and customization options, impacting their experience negatively.
  • Users experience billing issues with Tebra, citing frustrations with workflow, slow claims, and patient coupon discrepancies.
  • Users find the reporting inefficient, often requiring manual data stitching and lacking necessary customizations for their needs.

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

What Are G2 Users Discussing About Tebra (previously Kareo + PatientPop)?

Zelis

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: 8.4/10)
  • 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: 8.8/10)

Who Is the Company Behind Zelis?

  • Seller: Zelis
  • Year Founded: 2016
  • HQ Location: Bedminister, NJ
  • Twitter: @ZelisHealthcare
    456 Twitter followers
  • LinkedIn® Page: www.linkedin.com
    3,068 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 value the quick response time of Zelis representatives, noting their support and knowledgeable assistance.
  • Users commend the professionalism and responsiveness of Zelis staff, enhancing their overall experience and support.
  • Users value the easy customization process in Zelis, especially appreciating the smooth setup and efficient file transmission.
  • Users find Zelis easy to use, with smoother setup and integration for efficient payment processing.
  • Users appreciate the quick and knowledgeable support from Zelis representatives, enhancing their overall experience and satisfaction.
Cons
  • Users face scheduling issues due to long wait times during enrollment, which can complicate the process.

What Are Recent G2 Reviews of Zelis?

What Are G2 Users Discussing About Zelis?

Essentials

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: 8.4/10)
  • 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: 8.8/10)

Who Is the Company Behind Essentials?

  • Seller: Availity
  • Year Founded: 2001
  • HQ Location: Jacksonville, FL
  • Twitter: @Availity
    2,154 Twitter followers
  • LinkedIn® Page: www.linkedin.com
    1,814 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?

What Are G2 Users Discussing About Essentials?

Emma Stein
ES
Researched and written by Emma Stein
Updated October 3, 2024

Healthcare Claims Management Topics

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Learn More 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 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), 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, 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.
  • 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, 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.

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.