Paradigm Alternatives

RouteGenie is NEMT software built for non-emergency medical transportation operations that have outgrown basic dispatch software. It combines NEMT scheduling software, dispatch, routing, billing and fleet compliance in one platform, running 600+ fleets and 20,000+ vehicles across 46 states and two countries at roughly 50,000 trips a day. NEMT dispatch software built for multi-site scale. Operators run every location in one instance with role-based access, per-location configuration and a complete audit trail on every trip change — who cancelled a trip, when, and why. DispatchGenie builds and continuously re-optimizes routes with native multiload, so a 200-vehicle schedule rebuilds in seconds instead of being maintained by hand. Subcontractor vehicles appear on the same live map as owned fleet, which matters when your network is larger than your payroll. NEMT broker software, built in. ImportGenie runs 28 live broker and payer integrations — ModivCare, MTM, Veyo, Verida, SafeRide Health, Alivi, VectorCare, New York MAS, Uber Health, transit authorities and Medicaid health plans — importing trips and returning statuses automatically, with no re-keying. BillingGenie is full non-emergency medical transportation billing software: Medicaid billing, CMS 1500, broker billing, claim scrubbing and denial management in the same system, so billing is not a second platform. Enterprise administration. SAML2 single sign-on with Microsoft Entra ID, Okta, OneLogin and Google Workspace. Single-tenant deployment with per-customer data isolation. SOC 2 Type 1 attested. HIPAA-aligned controls, BAAs, encryption in transit and at rest, role-based permissions, and four portals: staff, drivers, payers and facilities, and passengers. Open REST API. Pricing that does not punish growth. Flat per-vehicle pricing with unlimited trips and unlimited users. No per-trip fees, no per-seat licensing. Cost tracks your fleet, not your trip volume or headcount — which is why high-volume operators and large agencies model lower total cost here than on per-trip or per-user platforms. RouteGenie serves large and mid-size NEMT providers, PACE organizations, adult day programs, regional transit authorities, brokers and Medicaid health plans. Providers running 80 to 170 vehicles have migrated here from legacy paratransit and NEMT platforms. No fleet minimum. 4.6/5 across 49 reviews. 13 consecutive SourceForge Top Performer awards.

A secure, SaaS-based Medical Billing, RCM software that helps doctors to increase the collection, and receive faster payment with improved automation. Features like Seamless Insurance Eligibility Verification (IEV), Appointment scheduling, Claims scrubbing, Claim Status Inquiry (CSI),Auto Posting, and Public health clinic make the software efficient and easy to use. expEDIum SDK is available with several APIs to integrate EMR software seamlessly with expEDIum Medical Billing / RCM software.

Designed for enterprise-level non-medical Personal Care and Medicaid agencies, AxisCare's award-winning, web-based scheduling and management software allows agencies to manage and grow with confidence. AxisCare's Scheduled Reports simplify reporting by automating generation with precise specifications, ensuring accurate data for critical business decisions. AxisCare's Veterans Affairs and Medicaid billing services streamline reimbursements. VA billing experts configure your system, prevent recoupments, and manage claim submissions with direct payments. Medicaid specialists deliver accelerated payments with clean EVV processing, reduce denials through claim scrubbing, and help explore additional revenue opportunities through waivers and MCOs. With robust scheduling, GPS Mobile App, EVV, hospitalization tracking, medication reminders, payment processing, and custom reporting, AxisCare is the easiest-to-use software in Home Care.

InvisaClaim AI Revenue Cycle Management that prevents denials and wins the ones that slip through. The most advanced all-in-one platform for billing companies and RCM teams. Before claims go out, Pre-Submission Check and Pre-Check AI scrub them against NCCI edits, coding conflicts, and payer rules stopping denials at the source. When one slips through, upload or live-feed a denial letter or 835 ERA and AI extracts patient data, CARC/RARC, CPT/ICD-10, amounts, and deadlines then drafts a payer-specific appeal in 60 seconds across 30+ payers. Modules: Pre-Submission Check, Denial Workbench, NSA/IDR (eligibility, QPA, GFE & IDR letters), Prior Auth, A/R aging, NPI verification, deadline alerts, full audit trail. Connects to your clearinghouse and EHR: Change Healthcare/Optum, Waystar, Availity, Athenahealth (pipeline), plus a FHIR R4 layer for EPIC/Cerner. HIPAA Compliant · SOC 2 · 256 Encryption

HHAeXchange connects the dots between payers and providers for improved patient outcomes. Grow your business, streamline workflows, and improve patient outcomes with our enterprise homecare management software. HHAeXchange’s comprehensive homecare provider platform offers an enterprise solution for all of your agency’s needs, from referral and intake management to scheduling, billing, and compliance. Our easy-to-use system is designed specifically for Medicaid Managed Care, Commercial LTC, Consumer Directed, and Private Pay services. We are the industry leader in connecting providers and payers for successful communications, collecting confirmed visits, creating claims, and providing workflow efficiency tools to help providers optimize their operations and grow their business.

Insurance companies run AI to review, adjust, and deny claims. Most practices still work them by hand. Altair closes that gap: an AI-native, done-for-you medical billing service that runs your full revenue cycle, from eligibility and prior authorization to claims, denials, and appeals, backed by a US-based team of expert billers. It is a service that does the work, not software your staff operates. Altair scrubs claims against payer edits and medical-necessity policies, works denials to root cause, files appeals, and learns how each payer behaves. It also runs patient billing and collections for you: statements, payment reminders, payment plans, follow-up on unpaid balances, and aged patient A/R, so the patient share is collected in full. Coding and charge capture stay with your practice; Altair runs everything else. It works with every EHR, and a live view shows what is billed, paid, and at risk. Payers built their AI to pay you less. Altair gets you paid in full.

CureAR is an AI-powered medical billing and revenue cycle management software designed for in-house billers, billing companies managed-service providers and DME companies. The software consolidates eligibility verification, charge capture, AI-assisted coding suggestions, claim scrubbing, electronic claim submission, ERA ingestion, and automated payment posting into a single cloud-hosted system. It is configurable for specialty billing rules and supports multi-tenant operations for practices that handle multiple client accounts. Key Features: AI-assisted coding and claim scrubbing: Machine learning highlights likely coding errors and applies payer-specific validation rules before submission. Real-time claim status and alerts: Tracks claims from submission to adjudication and surfaces exceptions for prioritized follow-up. ERA ingestion and automated posting: Electronic remittance advice handling with configurable reconciliation workflows reduces manual posting effort.

Automate your workflow and integrations, and put an end to the repetitive manual work associated with revenue cycle management. ESO Billing frees your team to focus on what they do best. In today’s reimbursement world, efficiency counts. ESO Billing was built to save you time at every possible point in the billing process. Even its interface has been freshly redesigned for the ultimate in speed and ease of use. Customize your workflow based on your business process, task-based workflow moves each claim through its stages with minimal touches. It even alerts you automatically when payments aren’t on time, for the ultimate peace of mind. Our payer-specific proprietary audit process ensures that each claim contains all critical billing information prior to claim submission. The result? The lowest clearinghouse and payer rejection rate in the industry. Pair billing with ESO Health Data Exchange (HDE) and ESO Payer Insights to tap into hospital-generated billing information with one click.

Anomaly is an AI-powered payer management platform built for healthcare revenue teams to “know your payers as well as they know you.” It surfaces hidden payer behaviors by decoding complex rules and detecting payment patterns across hundreds of millions of healthcare encounters. The core engine, Smart Response, continuously analyzes payer logic, adapts to shifting policies, and embeds learnings directly into existing revenue cycle workflows to provide real-time denial prediction, assisted claims correction, and alerts to revenue risks. By integrating payer-specific insights into existing systems, users can anticipate revenue loss, negotiate payer contracts from a stronger position, and proactively correct or reverse denials before they impact cash flow. The system helps level the playing field between providers and payers by turning opaque billing logic into actionable intelligence and embedding it into day-to-day financial operations.

BillingBench is an independent denial management and payer intelligence platform for medical billing and revenue cycle teams. It tracks published payer requirements and longitudinal adjuster patterns by combining a citation-audited policy dataset with aggregate denial data. Free core tools streamline daily billing workflows. The Denial Code Decoder translates CARC codes into plain-language definitions and root-cause analyses. To accelerate recoveries, the Appeal Letter Builder generates structured arguments with statutory citations tailored by denial type, specialty, and payer. Daily operations are supported by a Modifier Matrix with verified rulings, prior authorization checklists, a Timely Filing Calculator, and an 835 ERA Parser. A dedicated Chrome extension provides real-time support alongside major payer portals. Citations are verified against primary sources, each with a transparent changelog.

MEDSYS2 Home Health Software has been designed to meet all aspects of a home health care agency operation, including back-office administration and clinical documentation. MEDSYS2 is an enterprise home health EMR platform that can handle the wider home health care spectrum, including home health, non-skilled home care, and pediatric home care. MEDSYS2 home health care software is capable of billing all payers, Commercial Insurance, and Private Pay. MEDSYS2 Home Health Software has been designed to meet all aspects of a home health care agency operation, including back-office administration and clinical documentation. MEDSYS2 is an enterprise home health EMR platform that can handle the wider home health care spectrum, including home health, non-skilled home care, and pediatric homecare. MEDSYS2 home health care software is capable of billing all payers, Commercial Insurance, and Private Pay.

eClaimStatus provides simple, practical, efficient and cost effective real time Medical Insurance Eligibility Verification system and Claim Status solutions that power value added healthcare environments. At a time when healthcare insurance companies are reducing reimbursement rates, medical practitioners must monitor their revenue closely and eliminate all possible leakages and payment risks. Inaccurate insurance eligibility verification causes more than 75% of claim rejections and denials by payers. Furthermore, refiling rejected claims cost an organization $50,000 to $250,000 in annual net revenue for every 1% of claims rejected (HFMA.org). To overcome the revenue leakages, you need a no-fuss, affordable and effective Health Insurance Verification and Claim Status software. eClaimStatus was designed to solve these specific challenges.

BHRev is a specialized revenue cycle management service and automation platform built for behavioral health providers that helps practices streamline and optimize their entire financial workflow from claims submission to payment collection with AI-powered automation, expert oversight, and industry-specific expertise. It focuses on the unique challenges behavioral health organizations face, including complex payer rules, documentation requirements, high denial rates, and evolving compliance standards, by automating up to 80% of RCM tasks while human experts handle exceptions, compliance checks, and more nuanced billing functions to ensure faster reimbursement and fewer administrative errors. It combines advanced automation with human review to handle critical steps such as insurance eligibility verification, claims processing and scrubbing, denial management and follow-up, and patient payment posting so clinics can reduce operational burden and increase cash flow.

EMCsoft’s Claims Management Ecosystem assures that healthcare providers and billing companies deliver clean claims to insurance payers for proper claim adjudication. It is the integration of our versatile claims processing software Claim Agent and comprehensive fitting process called the Four Step Methodology into your claim adjudication process. This approach enables, supports, and automates your work process to maximize claim reimbursement. Request our free online demo for a great introduction into the functionality/features of Claim Agent and how it fits into your claim adjudication process. Claim Agent scrubs and processes your claims from the provider system to the insurance payers in a efficient, cost effective, and timely manner. The software is compatible with any system making implementation process quick and simple. We provide custom edits, bridge routines, payer lists, and work flow settings that are unique to each user.

I-Med Claims provides top-tier medical billing and revenue cycle management (RCM) solutions, trusted by healthcare practices across the U.S. We handle all aspects of RCM, from eligibility verification to denial management, helping practices streamline operations and maximize reimbursements. With billing plans starting at just 2.95% of monthly collections, we offer affordable solutions that enhance financial workflows, maintain compliance, and improve cash flow. By outsourcing billing to us, practices can focus on patient care while benefiting from reduced claim denials and faster payments.

For providers, medical necessity denials cost thousands to millions of dollars every year in write-offs, plus costly staff time researching and appealing denials and responding to patient concerns. For payers, the same is true on the other end of the claim management spectrum: Paying for medically unnecessary procedures and treatments – and time spent working on denial appeals – raises costs without improving outcomes. And of course, for the patient, there can be unnecessary copays and other out-of-pocket costs, not to mention a poor patient experience involving costs and moments of care they did not need. ABN Assistant™ from Vālenz® Assurance delivers the prior authorization tools providers need to validate medical necessity, print Medicare-compliant ABNs with estimated cost, and stop over 90 percent of medical necessity denials by verifying necessity before care is delivered to the patient.

EZClaim is a medical billing and scheduling software company that provides a feature-rich practice management system specifically tailored for small to medium-sized provider office and outsourced medical billing firms. It also includes integrations with a number of EMR/EHR vendors. Whether you are a doctor, practice manager, or billing service owner, EZClaim Billing is designed with you in mind, simplifying your claims management from data entry to payment posting, and beyond. EZClaim primarily supports the following specialties, General Practice, Therapy, Vision, Surgical, Medical Specialties, Home Health Care, and Outsourced Medical Billing Services (RCM). However, the software is very adaptable and can be used for many other billing specialties. EZClaim’s billing software allows the creation of insurance payor lists for Medicare, Medicaid, Tricare, Clearinghouse payer IDs, governmental MCO’s, auto insurance, and worker compensation groups.

Collaborating for patient care requires constant connectivity and up-to-date information. Simplifying how you exchange that information with your payers is more important than ever. Availity makes it easy to work with payers, from the first check of a patient’s eligibility through final resolution of your reimbursement. You want fast, easy access to health plan information. With Availity Essentials, a free, health-plan-sponsored solution, providers can enjoy real-time information exchange with many of the payers they work with every day. Availity also offers providers a premium, all-payer solution called Availity Essentials Pro. Essentials Pro can help enhance revenue cycle performance, reduce claim denials, and capture patient payments. Availity remains your trusted source of payer information, so you can focus on patient care. Our electronic data interchange (EDI) clearinghouse and API products allow providers to integrate HIPAA transactions and other features into their PMS.

Patient cost estimates and upfront collection. Understand patient responsibility instantly with automatic eligibility and benefit verification checks. Hyper-accurate estimates based on your own practice data, creating better care and a healthier business. Send estimates via HIPAA-compliant text or email. It's time to treat 2020 like 2020. Collect more than ever with upfront mobile patient payments. Ditch the write offs and decrease patient AR. Run eligibility checks and provide accurate cost estimates, even for multiple payers, treatments, facilities or providers. Collect payment up front via HIPAA-compliant text or email. Reduce A/R days, collect more revenue and increase patient satisfaction all at once. Identify, analyze and resolve denials, as well as track ROI from reworked claims. Automate denial assignments to team members via Rivet, and leave notes and links along the way to resolve future denials even faster.

Arrow is a healthcare revenue cycle management platform that modernizes and streamlines healthcare payments by automating billing, claim operations, and predictive analytics to help providers and payers reduce administrative burden, minimize denials, and accelerate collections. It brings workflows, data, and AI together so teams can detect errors in claims before submission, manage denials with root-cause analysis and one-click fixes, and get detailed real-time claim status updates directly from payers. It simplifies the ingestion of Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) data into a centralized, user-friendly format, provides revenue intelligence with actionable insights into the revenue cycle, and monitors payment integrity to highlight underpayments or overpayments according to payer contracts.

Approved Admissions is a secure platform that automates tracking of coverage changes for Medicare, Medicaid, and commercial payers bundled with real-time eligibility verification and coverage discovery. The platform's primary goal is to help providers minimize the number of claim denials due to a missed insurance coverage change and accelerate the billing cycle. Approved Admissions is using the innovative RPA (Robotic Process Automation) Bridge solution to ensure patient data consistency across multiple systems, and benefit coverage search. Key Features: - Automated eligibility verifications and re-verifications - Email or API notifications if any coverage changes are detected - Real-time verifications - Batch eligibility verification - Seamless integration with RCM, EHR platforms (PointClickCare, MatrixCare, SigmaCare, DKS/Census, FacilitEase, and many others) - RPA-powered cross/platform synchronization

VoiceCare AI is an agentic AI platform that automates the entire healthcare revenue cycle (RCM) from patient intake to claims across payer portals, voice, SMS, web chat, and legacy systems, with native EHR integration. One AI agent, Joy, orchestrates benefit verification, prior authorization, and claims & denials management by talking to patients and payers directly and navigating payer portals autonomously. The platform is built for specialist medical practices, dental groups and DSOs, RCM enterprises, and integrated delivery networks (IDNs) and health systems. Every agent action is logged, audit-ready, and transparent, with a human-in-the-loop safety net for complex clinical exceptions. VoiceCare AI is HIPAA-compliant and SOC 2 Type II attested.

Designed specifically to mirror the typical patient journey from pre-admission to post-discharge, yet flexible enough to adjust to your unique processes, every staff member is guided to push workflows forward effortlessly and capture the information needed to ensure clean claims and maximum reimbursements. From patient intake and benefit verification, across every Utilization Review, marking attendance and getting claims out the door, working denials and collecting payment, we’ve got you covered. It has never been more critical to work smarter and not harder in the industry. We’ve raised the bar when it comes to liberating your teams from the burden of manual processes and workarounds with our automation and powerful claim rules engines. Managing your revenue cycle is like watching dominoes fall in a harmonious pattern. Continuous industry changes, new payer rules, declining reimbursements, tighter margins.

Veritable accelerates patient insurance eligibility verification and claims-status checks by providing instantaneous results in a clean, intuitive interface. It supports real-time, batch uploading of patient lists to verify eligibility across more than 1,000 payers (including national Medicare and all state Medicaid) and multiple service types. It also enables tracking of claims status, from submission through reimbursement, so practices and billing companies can proactively identify issues to reduce payment delays and denials. Key benefits include automating eligibility and claims workflows to reduce manual entry and phone calls, improving front-desk patient experience by validating coverage and copayments at check-in, and offering seamless integration for both technical and non-technical users with strong data-security controls. It includes a “Code Explorer” for instant lookup of ICD-10-CM, ICD-10-PCS, HCPCS Level II, and CPT codes.

Axora AI is an intelligent, end-to-end claims engine that blends AI-powered automation with billing expertise - managing everything from eligibility to payment posting. But it’s more than automation. Axora AI prevents denials before they happen, adapts to payer rule changes, and prioritizes what matters - so you recover more revenue with less effort. 1. Manages your full claims cycle from start to finish 2. Flags denial risks before submission 3. Prioritizes actions that improve cash flow 4. Seamlessly fits into your EHR, payer, and finance systems 5. No migrations. No disruption. Just faster, cleaner payments

More compensation from payers means more services for your clients, patients, and community. Outsourced billing services through SMART Health Claims or EmpowerMax Billing provide you with all the benefits of our technology while we do most of the work to increase your funds. Designed for behavioral and mental health, EmpowerMax Billing enables your organization to eliminate common issues with in-house billing, like key personnel absence or loss, under- or over-staffing, disorganization in the department, and inadequate billing supervision. EmpowerMax Billing provides a team of billing experts to handle medical claims billing, cash application, corrections, and follow up for you.

Alora Home Health Care is a web-based solution that empowers home health agencies by allowing them to go paperless and to automate their workflow for increased accuracy, efficiency, and compliance. As an all-in-one platform for agencies that provide both skilled and non-skilled care services, Alora Home Health Care has the capability to manage multiple offices or business lines in one integrated system. Core features include electronic visit verification (EVV), integrated electronic one-click faxing, integrated telephony and workflow automation, billing for all payers, scheduling, Plan of Care (485), Point of Care, e-signature, automatic 485 generation from OASIS, and more.

Elevate your claims management process and decrease denials through unmatched edits and an industry-leading clean claim rate. Health systems require access to technology that facilitates accurate claim submission and rapid reimbursement. Claims Director, SSI’s claims management solution, streamlines billing practices and provides visibility by guiding users through the electronic claim submission and reconciliation process from beginning to end. As payers change or modify reimbursement criteria for services, the system actively monitors and incorporates these changes and requirements. And with a comprehensive mix of edits at the industry, payer and provider levels, the solution aids organizations in making the most of reimbursement efforts.

Seamlessly integrating with, our cloud-based Practice Management solution allows for quick and easy billing management, which enables your practice to quickly identify and confirm patient insurance benefit eligibility level and copay. Work with many different clearinghouses. Efficiently manage your accounting books. Easily reconcile patient accounting and insurance billing. Quick and easy online patient payments and EOB/ERA processing. Our healthcare practice management system has a very robust tasking system. You can quickly find and assign claims to work on using a filter-based search function. You can filter and search outstanding claims by around 100 different parameters, including patient vs. insurance responsibility, primary/secondary/tertiary payer or payer grouping, provider, date of service, aging bucket, and denial reason. Filters can be saved and reused later.

We're on a mission to make behavioral health more available and accessible. At Camber, we build software for behavioral health clinicians to improve the quality of care. We streamline and replace manual efforts so clinicians can focus on what they do best. Camber is a software platform designed to streamline administrative tasks for behavioral health clinicians, enabling them to focus on providing high-quality care. It automates daily claim validations and submissions, incorporating pre-submission error detection and payer-specific claim formatting to enhance accuracy and efficiency. By leveraging AI-driven workflows, Camber has achieved first-pass collection rates of approximately 93%, significantly improving financial outcomes for healthcare providers. The system also offers data-driven insights, assisting clinics in identifying optimal locations for expansion and facilitating payor contract negotiations.

DoctorMGT is a healthcare revenue cycle and practice support company that helps medical providers improve billing performance, reduce denials, and accelerate payments. The company supports solo providers, specialty clinics, hospitals, and medical groups with services such as medical billing, coding, claims management, AR follow-up, and compliance-focused revenue support. DoctorMGT works with complex claims across areas such as pain management, orthopedics, surgery, chiropractic care, durable medical equipment, personal injury, and lien-based billing. Its services are designed to reduce administrative workload while helping providers keep cash flow steady and claims moving efficiently. DoctorMGT also offers virtual medical assistants, virtual medical scribes, appointment scheduling, credentialing, medlegal support, and lien negotiation services.

MDaudit is a cloud-based platform that unifies billing compliance, coding audits, and revenue-integrity workflows for healthcare providers, hospitals, physician networks, ambulatory surgical centers, and the like. It supports all types of audits, scheduled, risk-based, retrospective, and denial-focused. MDaudit automates data ingestion from pre-bill charges, claims, and remittance data; triggers audit workflows; flags anomalies and high-risk patterns; and delivers real-time dashboards and drill-down analytics revealing root causes of billing errors, denials, and revenue leakage. Its modules, including a “Denials Predictor” for pre-submission claim validation and a “Revenue Optimizer” for continuous risk monitoring, help organizations prevent claim denials, reduce recoupments, and capture more legitimate revenue. MDaudit also provides payer-audit management: a secure, centralized workflow to respond to external audit requests and manage documentation exchange.

NeuralRev is an AI-powered Revenue Cycle Management (RCM) platform that automates and accelerates end-to-end financial workflows in healthcare, reducing manual effort and errors while improving cash flow and operational efficiency. It automates insurance eligibility verification by connecting to clearinghouse networks in real time so patient intake and coverage checks happen instantly, and it handles prior authorization by assembling clinical and payer requirements, submitting requests electronically, and tracking approvals to reduce denials and delays. It also delivers real-time patient cost estimates by combining eligibility data with payer rules to improve transparency and upfront collections, and it streamlines medical coding, claim submission, claims processing, post-claim follow-up, and recovery, so teams spend less time chasing paperwork.

Patient access is the starting point for your entire revenue cycle process. Ensuring correct patient information on the front end reduces the errors that cause rework in the back office. 10 to 20 percent of a health system's revenue is forced to remediate denied medical claims and 30 to 50 percent of those occur during patient access. By adopting an automated, data-driven workflow—not only are you reducing the errors that lead to claim denials, you’re also improving access to care for your patients through capabilities like online scheduling options that are available 24/7. Access is further improved by reducing the friction around patient billing by leveraging real-time eligibility verification to deliver accurate patient estimates at registration. Increase staff efficiencies by improving registration accuracy. Correct discrepancies and errors in real time to avoid costly denials and rework.

Hospice Tools is a hospice EMR and billing software platform built specifically for independent hospice and palliative care agencies. The system includes eDocs EMR, TimeKeeper, eBilling, web access, and mobile apps to support clinical documentation, care planning, IDG workflows, payroll, mileage tracking, claims, and compliance. Hospice Tools is designed by hospice professionals and focuses on workflows such as point-of-care charting, smart care plans, SNF room and board billing, HIS dashboards, and real-time claim status. Agencies can use the platform to chart from virtually any device, customize forms and reports, validate documentation, track staff activity, and manage billing across Medicare, Medicaid, and other payers. Its mobile apps give care teams secure real-time access to patient information, document signing, scanning, uploading, and chart updates from the field.

EDI Compatible Medical Billing (E-COMB) is a web based solution for generating medical claims complying with the HIPAA transaction and code set standards, regulated by the US Government following the recommendations of American National Standards Institute (ANSI). The application is designed to generate, submit and reconcile the claims to the insurance carriers, guarantors and/or patients. This is one of the most important tools for doctors in realizing their revenue by reducing the turnaround time in the claims reimbursement. All the information related to environment of the Doctor’s Office/Hospital is grouped together as Master Data. This information is frequently used for claims processing and is less likely to change quite often. Master Data contains details of the Procedures, Diagnoses, Doctors, Payers, and Billing Providers etc. This data is created as part of the initial set up and can be updated easily at any time.

Amazing Charts Practice Management is a comprehensive solution designed to streamline administrative tasks and enhance the efficiency of independent medical practices. Developed by a practicing physician, this system automates processes such as capturing patient demographics, scheduling appointments, pre-registering patients with insurance eligibility checks, and generating analytical reports. It also determines patient financial responsibilities at the point of care, maintains insurance payer lists, and ensures prompt and accurate billing to assist in payment collection efforts. Key features include the ability to view unpaid claims to ensure timely resolution, a claims manager who reviews submissions to reduce denials, and an integrated secure connect clearinghouse for high-level support and quick responses to payer changes. The system offers intelligent, interactive role-based dashboards that automatically prioritize work lists across all office areas.

PayerLenz is a reimbursement benchmarking and eligibility verification platform for behavioral health providers, billing companies and RCM firms. It answers a question standard verification cannot: not whether a patient is covered, but what the payer is likely to allow. The benchmarks are built from more than 500,000 adjudicated claims covering 260+ payer groups across 21 states, and every figure carries its sample size and recency so users can judge how much weight it holds. The platform also provides real-time eligibility checks and full worked verifications, and gives billing teams a live view of accounts receivable. PayerLenz is the first product from Revenue Logic, a behavioral health billing firm. A benchmark is a distribution of what comparable claims have paid; it is not a prediction or guarantee for any individual claim.

CareSmartz360 is an AI-powered, all-in-one home care management and electronic visit verification platform built for large and multi-location home care agencies operating at scale. The platform helps organizations maintain visibility, control & compliance across locations. CareSmartz360 centralizes scheduling, EVV, multi-payer billing, payroll, care plans, custom forms, reporting, caregiver training and retention, and point-of-care documentation in a single system. These capabilities enable agencies to standardize operations, reduce administrative effort, and manage the workforce. Agencies can schedule caregiver visits across locations, monitor clock-ins & late shifts through real-time alerts. The platform is supported by a GPS-enabled caregiver mobile app & an agency mobile app that provides on-the-go operational control. Built on secure, HIPAA-compliant cloud infrastructure with role-based access controls, CareSmartz360 protects sensitive data while ensuring audit readiness.

Provide authorizations, claims processing and payment in real-time at the point of care. Enhance care coordination and improved outcomes to lower medical cost while streamlining administrative processes. Engage providers at the point of care to capture and share data in real-time resulting in an unparalleled exchange of health information. We partner with our clients to implement risk management strategies that result in better outcomes with lower costs. We strive to improve the user experience for everyone involved in the ecosystem. We deliver a minimum 3:1 ROI for our clients to allow them to optimize their resources. Conexia has developed a core technology platform (ONE) that is customizable to meet the diverse regulatory requirements and operational processes for each client in each geography. In most cases, our initial implementation is an overlay on the payer’s existing technology ecosystem to create real-time processes.

AveeCare is a cloud-based home care agency management platform that serves agencies across all 50 US states. The platform covers scheduling, patient management, caregiver coordination, billing, compliance, real-time visit tracking, and more. AveeCare's scheduling module uses AI to match caregivers to visits based on availability, geographic proximity, skill requirements, and patient preferences, with drag-and-drop editing and recurring visit support. Caregivers use a dedicated iOS and Android mobile app to clock in and out with GPS verification, view schedules, document visits, capture signatures, and receive push notifications. For billing, AveeCare supports private pay invoicing, Medicare, and long-term care insurance. The platform generates CMS-1500 forms and ANSI X12 837P/837I EDI files for claims, with support for 270/271 eligibility verification, 276/277CA claim status inquiries, and 835 ERA remittance processing. 180+ additional features .

Built for usability and power—CareTime is a cloud-based desktop and mobile software solution for home health, home care, and consumer-directed care markets. Find the best fit based on client requirements, preferences, distance, hours worked, and caregiver availability. Invite caregivers to accept a shift through text message or email. Shifts are filled on a first-come-first-serve basis. Track visits and automatically create billing and payroll data from check ins and check outs. Record visit notes and questions. Admins have the ability to see caregivers and visits on a map. Alerts notify if visits are missed, caregivers are late, authorized hours are running out and more. Create and send electronic claims to get paid by insurance, Medicaid, Medicare, and more. Batch claims can be created in an instant from all of your visit data.

Droidal is an AI-powered revenue cycle management platform that helps healthcare organizations reduce costs, increase revenue, and improve patient experiences. By leveraging Generative AI and large language models (LLMs), Droidal automates complex billing, claims, and payment workflows with precision and speed. The platform processes over 2 million claims monthly across 1,800+ locations while maintaining coverage for 3,500+ payers. Its AI agents streamline operations for hospitals, clinics, and care providers — cutting denials, accelerating payments, and boosting cash flow. Designed for seamless integration, Droidal enhances productivity without replacing existing systems or workflows. With enterprise-grade compliance and a subscription-based model, Droidal delivers measurable ROI while freeing up staff to focus on patient care.

Increase your organization’s cash flow by processing claims from Medicare, Medicaid and all other commercial payers. Automated processing of all payer claims in real time from anywhere at anytime ensures your claims get processed and get paid faster. Automatically submit and track your claims from anywhere at any time with real-time claims status updates. You are assigned a dedicated account manager that is a certified health care claims manager. You even have their mobile phone number. Diversify your revenue sources and improve your cash flow with our automated, anytime, anywhere claims processing with complete visibility to all your electronic funds transfers (EFT) and payment projections. Process, track and fix claims in real-time to capture all your revenue while eliminating costly time-consuming processes. Automate Medicare eligibility verification and claims processing.

PMS Insight is a full-service and highly organized, medical billing service company dedicated to provide complete, custom-made, claims billing and patient accounting services. Our Medical Billing Services team are specialized in efficient and revenue generating billing practices and successfully meet with the demands of various needs of the health care industry. Our Medical Billing Services extends to Houston, Dallas, Austin, Los Angeles, New Jersey and Boston. In any organization dedicated to patient care managing medical billing can be a huge burden and a distraction from the core strength of patient care. Working with a professional medical billing service like PMS Insight guarantees that professionals are at work efficiently managing claims billing, authorization, appeals, patient billing and follow up. We at PMS Insight have streamlined our processes over the years and manage transactions through electronic processing, and integrated medical billing software.

Clients get the care they expect, when they expect it, and at the right cost. Caregivers get the information they need in one secure location. And you get unmatched visibility and control over the entire process. We simplify agency operations through smart scheduling, easy electronic visit verification, fast billing, and accurate data whenever you need it. We make billing insurers and Medicaid a snap, which lets you focus on what matters most - growing your business. We enable simple approvals, automated client billing and collection, fast timesheet approvals, and accurate caregiver reimbursement. Electronic visit verification is more than just a box to check. With the right platform, EVV is a powerful tool that can unlock efficiency, profitability and insights for your agency. AssuriCare’s EVV platform is accessible by mobile app and telephony, making it easy for clients, caregivers, and agencies to get all visit details.

Netsmart Homecare is a fully-integrated system made for any home healthcare organization to streamline everything from patient intake to documentation to scheduling to billing and beyond. Designed by industry professionals and clinicians, Homecare seamlessly combines business, clinical, scheduling, and mobile functionality for multiple lines of business, including home health, hospice, and private duty. With immediate access to vital patient data, notes, and care plans, this homecare software provides true interoperability. It enables real-time data exchange with other providers, maximizing care coordination and leading to improved outcomes. Netsmart Homecare supports your mission to provide care at home with a complete EHR that best suits your agency for today and tomorrow. We know better care requires successful relationships both within and outside of your agency among your patients, payors, staff, and other providers.

elsai RCM analytics intelligence transforms fragmented revenue cycle data into actionable operational intelligence. By connecting claim, payer, authorization, charge, and financial data, it helps teams prevent denials, identify revenue leakage, prioritize recovery, and make faster revenue decisions with explainability, governance, and human oversight built in.

MedClarity is Medusind's turnkey RCM technology. MedClarity is a robust, web-based medical billing and practice-management software. The solution comes with a range of tools to enable medical practices of all sizes to take full control of their front-office and revenue operations. In addition to offering intuitive navigation and workflows, MedClarity boasts an advanced rules engine for clean claim submission, smart scheduler, comprehensive reporting and business analytics, real-time insurance eligibility verification, denial management and claim status lookup, and integration more than 30 EMR platforms.

Nestaid, an AI Native Operating System for home care agencies with AI Employees built in. Home care agencies, non-medical, Medicaid HCBS and waiver, and private-duty agencies, use Nestaid to run their daily operations: scheduling caregivers to client visits, electronic visit verification (EVV), care plans, client and caregiver records, hiring, billing, payroll-ready timesheets and reporting.Nestaid ships a set of AI agents that do routine operational work for the office like your own staff: answering the agency's phone line, filling shifts when a caregiver calls out, following up on missed clock-ins, screening job applicants, generating care plans and compliances.