Best Healthcare Claims Management Software for Nonprofit

Service Center by Office Ally is trusted by more than 80,000 healthcare providers and health services organizations to help them take complete control of their revenue cycle. Service Center can verify patient eligibility and benefits, submit, correct, and check claims status 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.

Over 25 years ago, one of our founders was working as the IT Director of a large behavioural health and residential services agency in New York. Sensing a need for a better way to track and report on their services, he developed a case management system for his agency. Over time, two other agencies joined in and helped expand the software so that it could serve the needs of virtually any human services agency in the country. Today, Foothold’s team and our software support hundreds of agencies across the nation, in Guam, and in Puerto Rico. With our technology expertise and roots in human services, we continue to empower agencies to focus on their missions.

To ensure the well-being of both patients and providers, independent practices require comprehensive solutions. Each product offered by Tebra is specifically designed to enhance and streamline the entire patient-practice experience, and when integrated into a unified platform, it functions as a complete operating system that benefits both providers and patients. By utilizing this connected system, practices can effectively attract new patients while retaining existing ones through enhanced digital visibility. Furthermore, patients are empowered at every communication point, fostering a seamless experience that promotes trust and contributes to a healthier practice environment. A state-of-the-art, certified EHR solution tailored to meet the demands of today’s healthcare providers is also included, equipping practices with essential features such as advanced charting, efficient documentation processes, a holistic view of patient histories, electronic prescriptions, lab integrations, telehealth capabilities, and much more, enabling providers to maintain control over their care delivery methods. With these innovative tools at their disposal, practices can thrive in an increasingly competitive healthcare landscape.

Effective collaboration in patient care hinges on continuous connectivity and access to the latest information. It has become increasingly crucial to streamline the exchange of this information with insurers. Availity simplifies the process of working with payers, guiding you from the initial verification of a patient's eligibility to the final resolution of reimbursements. Clinicians desire quick and straightforward access to health plan details. With Availity Essentials, a complimentary solution backed by health plans, providers can benefit from real-time data exchanges with numerous payers they frequently engage with. Additionally, Availity offers a premium option known as Availity Essentials Pro, which aims to improve revenue cycle performance, minimize claim denials, and secure patient payments more effectively. By relying on Availity as your trusted source for payer information, you can dedicate your attention to delivering quality patient care. Their electronic data interchange (EDI) clearinghouse and API solutions enable providers to seamlessly integrate HIPAA transactions along with other essential functionalities into their practice management systems, ultimately enhancing operational efficiency. This comprehensive approach ensures that healthcare providers can maintain focus on their primary mission: patient well-being.

RXNT's cloud-based integrated Electronic Health Records (EHR), software with E-Prescribing and Patient Portal optimizes patient treatment and streamlines workflows in practices of all sizes and specialties. Providers have access to the most current patient health information and prescription history from one database, accessible from any device. Integrated communications allows providers to share real-time clinical information with patients and clinicians, allowing for better care coordination. The use of "smart keys" and intake forms allows for customization and eliminates redundancy. Your practice will enjoy the Patient Check-In feature and integrated Electronic Prescribing. HIPAA compliant, ONC certified, EPCS-certified and meets MACRA/MIPS requirements. RXNT also offers Practice Management (PM), which includes Medical Billing, Scheduling, and standalone E-Prescribing. You can choose a solution by the piece with predictable pricing or you can implement our Full Suite for one, integrated platform.

Waystar offers market-leading technology that streamlines and unifies revenue cycle. Their cloud-based platform streamlines workflows, improves financials for all healthcare providers and provides more transparency to the patient's financial experience. Waystar has been ranked best in KLAS for Claims & Clearinghouse every year since 2010. It has also received #1 rankings in Black Book™, surveys since 2012, and the Frost & Sullivan North America Customer Valu Leadership Award for ambulatory RCM service in 2019. Waystar is used by over 450,000 providers, 750 hospitals and 5,000 plans. It integrates with all major HIS/PM systems. Waystar.com and @waystar on Twitter provide more information.

Our comprehensive range of solutions is tailor-made for surgical centers, distinguishing us as more than just a software provider for ASCs; we are specialized experts equipped with carefully crafted software designed specifically for your needs. By collaborating with HST, you will implement the finest software solutions in your facilities, enhancing profitability effectively. Regardless of whether your client base consists of 2 or 200, our offerings are designed to boost revenue, deliver insightful data, and facilitate improved management of your locations. By choosing HST as your partner, you set the stage for success. Moreover, our solutions extend to hospitals and HOPDs, ensuring seamless and accurate communication with patients throughout all stages of care. It is crucial that your practice aligns closely with the ASCs where your physicians conduct procedures, but without advanced technology tailored for this partnership, you may face a barrage of paperwork, faxes, missed calls, and inefficient manual processes. HST can streamline these operations, transforming the way you manage your workflow and improve patient interactions. Embracing our solutions means embracing a future where efficiency and patient care go hand in hand.

You deserve to spend your time on more important tasks than being glued to your phone. That's why our real-time eligibility tool enables you to swiftly confirm your patients' benefits, no matter their insurance plan. The era of incurring transaction fees for claims, attachments, and eligibility checks is over! Our comprehensive plan offers all features for a single monthly payment. By subscribing to Vyne Trellis™, you will benefit from the expertise of our dedicated industry professionals. With our platform, you can track claims that contribute to your firm's revenue. Whether your practice is large or small, our system is equipped to manage any volume of claims seamlessly. Vyne Trellis™ is designed to work with the claims administrators and clearinghouses you rely on. Our user-friendly dashboard provides rejection reasons, status updates, and smart notifications, ensuring your claims keep progressing smoothly. Should you encounter any challenges with a claim, our support team is always ready to assist you! Forget about juggling multiple tabs or windows; now you can conveniently access a wealth of data and documents, including ERAs and attachments, all in one place. Embrace the efficiency and ease that Vyne Trellis™ brings to your practice.

With over 30 years’ experience, Hi-Tech Health has the expertise to service payers of all types and sizes, including TPAs, Carriers, Insurtech, Provider Sponsored Plans, and Medicare Advantage plans. Series 3000 is a cloud-based claims administration solution for businesses within the healthcare industry. No matter what your adjudication, reporting, or plan needs are, this platform reduces time processing claims and increases productivity as it assists with: •Client management •Benefits input •Electronic claim submissions •Claims processing With an implementation timeframe of 3-4 months, you can quickly get started with Series 3000. Our professional services and back office support teams are here to guide you through customization and training. With experts available at your fingertips, we’ll be able to support you so outside consultants won’t be needed. As your business grows, we’ll work with you to scale your software system to continue to meet your needs.

Eligible offers robust APIs that seamlessly integrate insurance billing functionalities into your applications. Our certifications provide reassurance to patients and healthcare providers that Eligible adheres to the highest standards of privacy and security while managing millions of healthcare cases monthly. We recognize the importance of a well-established information security framework in fulfilling both Eligible's and our clients' objectives. We are pleased to share that we have successfully completed our Type II SOC2 audit, which reinforces our commitment to safeguarding protected health information. This achievement not only underscores our dedication to security but also builds trust with our customers and partners regarding our obligations to protect sensitive data. With our APIs, you can effortlessly enhance the patient insurance billing experience for your users, allowing you to run estimates, verify insurance, and submit claims for patients seamlessly. Experience the ease and efficiency that our technology brings to healthcare billing processes.

The Ahshay Platform, developed by DataCare, serves as an extensive repository of various software solutions designed for medical management. This platform features tools such as a medical process manager, nurse care management software, utilization review software, and auto case management software, among others. It is tailored to meet the diverse requirements of entities including insurance providers, self-insured groups, managed care organizations, and individual nurse case managers. By consolidating these resources, the platform enhances efficiency and effectiveness in medical management practices.

Experience seamless accessibility and top-notch security without any trade-offs. Work from anywhere, consult with patients, and maintain connectivity through an all-inclusive cloud suite that encompasses both office and remote care technologies. Since its inception in 1999, our medical office software has remained unique as the only solution built entirely on a 100% cloud framework. We are excited to provide our complete range of software and data storage on the Amazon Web Services (AWS) cloud hosting infrastructure. The collaboration between AdvancedMD and AWS results in an unparalleled experience characterized by swift and dependable access to your information, steadfast data security, and effortless storage with automatic backup features. No other ambulatory software solution matches this level of hosting quality, ensuring that starting or expanding your practice in the cloud is both simple and budget-friendly. With our software being hosted and managed on AWS, your monthly subscription includes exceptional reliability, security, and performance. Furthermore, our cloud platform facilitates easy access to our software across various devices and operating systems, enhancing the convenience of your practice even further. This combination of cutting-edge technology and user-friendly design sets a new standard in the medical software industry.

Remedly offers a comprehensive software solution tailored for medical clinics, practices, and medspas, all seamlessly integrated into one platform. This innovative and future-ready system not only automates tedious tasks but also enhances overall workflow efficiency, allowing you to focus on what truly matters. When you need assistance, a dedicated Customer Success Manager is readily available to support you, and you won’t incur any additional charges for training or help. Being a cloud-based service, Remedly ensures you always have access to the latest updates and features with just a simple click, making it compatible with any device, whether it’s a Mac, PC, or smartphone. With just an internet connection, you can connect with both your staff and patients from virtually anywhere, at any time. Our subscription-based monthly plan is designed to provide peace of mind and substantial savings, making it ideal for both solo practitioners and larger groups. This means you can lower your stress levels while keeping more money in your wallet as you streamline your practice. Furthermore, Remedly's commitment to continuous improvement guarantees that your clinic will always be equipped with cutting-edge tools to enhance patient care.

Establish a collaborative effort to set up the EDI connection between your organization and each trading partner by determining the specific types of transactions to be exchanged. Additionally, include machine-readable EDI specifications that Stedi will utilize for the validation, reading, and writing of files. Set up one or multiple secure connections for file exchange with your trading partners, utilizing Stedi's comprehensive SFTP/FTPS and AS2 options, or by linking to external SFTP servers. Stedi will take care of processing incoming EDI files from your partners and will send the generated EDI files back to them through the established connection. You will also be able to create and send EDI files that meet your own needs or those of your partner, ensuring that they come with automatically generated envelopes and control numbers. Furthermore, an HTTP request containing the outputted transaction will be dispatched to your system for seamless integration, enhancing the efficiency of your operations and ensuring a streamlined workflow. This proactive approach not only simplifies the EDI process but also fosters stronger relationships with your trading partners through clear and effective communication.

Improve the quality of patient care, streamline office operations, and boost profitability with ChartLogic, a comprehensive Electronic Health Record (EHR) software solution tailored for private medical practices. This software is crafted to seamlessly align with a practice's workflow, catering to various specialties and individual preferences, enabling physicians to efficiently document patient interactions while securely and affordably managing data. The ChartLogic EHR suite encompasses tools for Electronic Medical Records (EMR), practice management, and medical billing, ensuring a holistic approach to healthcare administration. With its user-friendly interface, ChartLogic empowers physicians to enhance their productivity and focus more on patient outcomes.

Expand your practice using CareCloud, the top-rated cloud-based EHR and practice management software. CareCloud provides a full range of resources designed for healthcare professionals and organizations of varying sizes. Among these offerings are Concierge, a thorough revenue cycle management system; Central, an intuitive practice management application; Charts, a straightforward electronic health records platform; Community, tools for patient engagement and social interaction; and Companion, a mobile application for both clinical and administrative tasks. By utilizing these tools, practices can streamline operations and enhance patient care effectively.

Streamline revenue cycle management, care quality oversight, and workforce optimization through a unified, user-friendly portal featuring single sign-on capabilities. Over 47,000 provider locations depend on our cutting-edge tools to ease the complexities of the patient care experience. Transform the financial experience for patients while alleviating administrative and clinical challenges with the Inovalon Provider Cloud, eliminating the need for fragmented workflows. Our SaaS offerings are designed to enhance both financial and clinical results throughout the patient journey, facilitating improved revenue cycle processes for enhanced reimbursement and ensuring optimal staffing levels for high-quality care. This all-in-one portal enables your organization to elevate its performance, boosting revenue, staff satisfaction, and care standards. By enhancing operational efficiency, productivity, and overall effectiveness, you can unlock the full potential of your organization. Explore the transformative capabilities of the Provider Cloud today.

eClaimStatus offers a straightforward, practical, and efficient real-time system for Medical Insurance Eligibility Verification and Claim Status solutions that enhance healthcare delivery environments. As healthcare insurance providers continue to lower reimbursement rates, it becomes essential for medical professionals to keep a close eye on their revenue streams and minimize any potential loss and payment risks. The issue of inaccurate insurance eligibility verification is responsible for over 75% of claim denials and rejections from payers. Additionally, the costs associated with re-filing rejected claims can reach between $50,000 to $250,000 in lost annual net revenue for each 1% of claims that are denied (according to HFMA.org). To address these financial challenges, it is crucial to have a user-friendly, budget-friendly, and efficient Health Insurance Verification and Claim Status software. eClaimStatus was specifically developed to tackle these pressing issues and improve overall financial performance for healthcare providers. With its comprehensive features, eClaimStatus aims to streamline the verification process, ultimately enhancing the efficiency and profitability of healthcare practices.

Centauri Health Solutions is a company specializing in healthcare technology and services, motivated by our commitment to enhance the efficiency of the healthcare system for our clients while offering compassionate assistance to those in need. Our software, powered by advanced analytics, supports hospitals and health plans—including Medicare, Medicaid, Exchange, and Commercial sectors—in effectively managing their fluctuating revenue through a bespoke workflow platform. Moreover, our personalized support for patients and members grants them access to vital benefits that can significantly improve their quality of life. Our array of solutions encompasses Risk Adjustment (including Medical Record Retrieval, Medical Record Coding, Analytics, and RAPS/EDPS Submissions), management of HEDIS® and Stars Quality Programs, Clinical Data Exchange, Eligibility and Enrollment services, Out-of-State Medicaid Account Management, Revenue Cycle Analytics, and both Referral Management & Analytics, as well as addressing Social Determinants of Health to further bolster healthcare outcomes and accessibility. Each of these components is designed to work in harmony, ultimately creating a more effective and compassionate healthcare experience for everyone involved.

Introducing the first-ever intelligent medical billing software that caters to multiple specialties. It simplifies the billing process and enhances patient collections for over 75,000 healthcare providers nationwide. With its global data capabilities, there's no longer a need for entering information multiple times. Designed to handle large volumes and intricate data, it features a flexible data structure that meets the diverse needs of various practices and specialties. This software ensures that you receive payments more quickly. You can input payments manually or utilize electronic remittance options. Claims are automatically scanned for errors and any missing details, ensuring accuracy. Additionally, the software can automatically resubmit insurance claims based on predetermined criteria. The rapid review feature allows for swift evaluation and approval of charges. You can audit charges by various metrics, including modality, procedure, insurance, user, or date of service. The intuitive reporting system provides insights into the financial well-being of both front-end and back-end billing processes. You’ll never miss a charge again. Furthermore, it seamlessly integrates with your chosen clearinghouse or statement vendor, making it a versatile choice for healthcare billing. With its user-friendly interface and comprehensive features, this software is set to transform the way medical billing is handled in practices.

The way you tackle the obstacles in your revenue cycle significantly influences your profitability and the overall effectiveness of your organization. The influx of patients seeking your services means little if receiving the payments for those services takes an excessive amount of time. You shouldn’t be burdened with dedicating countless hours to chase after payments that you rightfully deserve. Fortunately, there are more effective strategies to enhance healthcare reimbursement. Let Quadax assist you in developing a thorough, sustainable, and well-organized strategic plan while also helping you choose the most suitable technology solutions and services aligned with your business model. By partnering with us, you can not only attain operational efficiency but also improve your financial outcomes and elevate the patient experience. Ultimately, the aim for each claim submitted is to prevent denials and secure prompt payment. Additionally, implementing robust processes can further streamline operations and ensure financial stability for your organization.

Create, enhance, sustain, and market your network all through a single integrated platform. Utilize competitive insights to bolster your market position effectively. Standardize and refine provider information to facilitate easier searches. Evaluate network performance using metrics related to accessibility, cost, and quality. Provide engaging and feature-rich solutions for provider searches. Gain a deeper understanding of your network's financial health. Construct and improve networks that are competitive, accessible, and provide high value to capture market share and fulfill the needs of your members. Monitor competitor movements and market prospects to sharpen your network strategy, pinpoint optimal providers to stay competitive, and convey the strengths of your network. Simplify your provider directory, plan design, and benefit consulting through quicker and more dependable provider network data. Design tailored networks that align with each client's specific objectives, risk tolerance, and desired provider access, ensuring a comprehensive approach to network management. This complete suite of features not only enhances operational efficiency but also strengthens your overall market presence.

We recognize that not every piece of software needs to cater to every possible requirement, particularly when it comes to diverse fields such as specialties, practices, clinics, and hospitals. This understanding has led us to design modular systems tailored specifically to meet YOUR needs. The user interface is streamlined and user-friendly, while the underlying technology employs state-of-the-art database engines to keep your information safe and secure. This ensures that you receive your payments accurately and promptly! With over 1,200 physicians, billing agencies, and clinics of various sizes across Ontario utilizing our services, QuickClaim has gained a reputation as a meticulously crafted tool. QuickClaim serves multiple functions and seamlessly integrates with other systems, including QuickReq, QuickDOCs, and third-party solutions through HL7 and flat file formats. Moreover, QuickClaim can function as an offline alternative to HYPE Medical, ensuring continuity in the rare event of an Internet outage, operating independently without needing a connection. This flexibility makes QuickClaim a reliable choice for healthcare providers.

DrsMagic is offered in two formats: a Single Station distribution and a Network distribution, with each available in both Lite and Pro versions. The Single Station variant is designed for use on a single machine, where both the powerful database and the graphical user interface (GUI) are housed together. Users with administrative privileges can manage the system through BayViewSoft's multi-user management framework, allowing for the configuration of various users with distinct roles, yet only one individual can access the Single Station version at any given time. In contrast, the Network versions enable installation across multiple computers, facilitating simultaneous access for numerous users. The robust database of DrsMagic can either be set up on an independent server or reside alongside the "Primary" GUI on the same machine, providing flexibility for different operational needs. This dual distribution approach ensures that organizations of varying sizes can find a suitable solution for their specific requirements.

SpyGlass, our advanced software for managing health claims at the enterprise level, presents a robust and adaptable solution for efficient and accurate claims processing. The platform simplifies the setup of benefits and plans significantly. Fully integrated with SpyGlass, BenefitDriven offers eligibility verification, contribution accounting, and pension management specifically tailored for the Taft-Hartley sector, encompassing a comprehensive suite of data and processes for both Participants and Employers. Our all-encompassing EDI gateway and scheduler, HIPAA Director, functions as a central hub, enabling seamless connections with vendor partners to minimize transaction costs, streamline batch transfers, and automate the transfer process. With SpyGlass, you gain an in-depth, panoramic view of your population while also having the capability to drill down to granular details with ease. You can access an extensive selection of unique reports, fully customizable dashboards, and maintain total control over your system, ensuring that you have everything you need at your fingertips to make informed decisions and optimize your operations. In this way, SpyGlass empowers organizations to enhance their efficiency and effectiveness in managing health claims.