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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    (40)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.

    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.

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

    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.

    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.

    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.

    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

    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.

    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.

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

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

    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.

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

    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 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.

    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.

    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

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

    FINEOS Claims is a best in class, customer-centric, web-based claims processing software solution.

    GeBBS Healthcare Solutions provides tailored revenue cycle management solutions that cut through the complexity with expertise, operational excellence, and a sophisticated approach.

    HEALTHsuite is a comprehensive benefit administration system and claims processing software solution designed for health plans administering Medicaid and / or Medicare Advantage benefits. HEALTHsuite is a rules-based auto adjudication software solution designed to automate all aspects of enrollment/eligibility, benefit administration, provider contracting/reimbursement, premium billing, medical management, care management, claims adjudication, customer service, reporting and more.

    Revenue cycle management services for hospitals and health systems that want to increase cash flow and achieve sustainable financial performance.

    Healthcare organizations of every size face common bottom-line challenges, including payer requirements, regulatory rules, and the need to manage your own financial process. The key to achieving great end results is strengthening your cash flow and patient billing process.

    Thrive holistically re-engineers the revenue cycle throughout the patient's journey, from patient access to accurate clinical documentation and coding to proper reimbursement.

    OSP Labs’ first-class healthcare claims management software solutions play a vital role in countering the rising medical claims denial rate and stringent federal regulations. OSP Labs’ medical claims processing software solutions are outfitted with intelligent integration capabilities that work in perfect synergy with existing administration systems, other OSP Labs’ healthcare software solutions, and future cloud-based innovations.

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

    PLEXIS comprehensive enterprise platform is the premier claims adjudication and benefit administration software solution on the market.

    PokitDok's Healthcare Claims Management suite allows you to quickly and easily automate your claims processing so that you can increase clean claim rates, minimize revenue leakage, and drive down unproductive manual procedures.

    ProtoMED™ Practice Management Software tool offers the nation’s first Web-based electronic claims product that automatically links insurance claims with Medicare and BCBS payors who offers direct claims processing – There are no clearing house fees associated with this electronic processing! This scalable desktop solution provides complete medical management, sophisticated Claims Management Tools and Real-Time Billing solutions to your practice or facility.

    RevenueXL offers a suite of revenue cycle management services from coding and billing of encounters to the more tedious tasks of following up and collecting from payers and patients.

    Anytime, anywhere information access. Get patient information quickly and reliably. As a web-based patient access software platform, SCI provides a single, integrated view into all electronic, EHR, and fax-based communications that can be accessed across all your devices, anytime and anywhere you have a data connection.

    Streamline Health Denials Management offers workflow and analysis tools to successfully appeal denials, recoup lost revenue and address the issues driving the denials.

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

    A cloud-based application that helps regulatory and legal compliance professionals manage the product claims journey from initial request, through substantiation, review, and approval, to tracking usage in marketing materials and assets.