Alternatives to HealthRules Payer
Compare HealthRules Payer alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to HealthRules Payer in 2026. Compare features, ratings, user reviews, pricing, and more from HealthRules Payer competitors and alternatives in order to make an informed decision for your business.
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HealthAxis
HealthAxis
HealthAxis equips payers, providers and health organizations with integrated solutions from an advanced claims processing system and TPA services to actionable analytics. We streamline operations and improve client and patient outcomes. As healthcare becomes more technologically enabled, it remains inhibited by coordination challenges, legacy technology, and information management. We strive to bring innovation and a growth mindset to all struggling with these challenges. Our client philosophy is to serve as a complete business partner. HealthAxis believes our success does not stem from selling our solutions but from our business partners’ sustained success and growth. We enable our partners to add value to the communities they serve. As they build their membership and scope, we flourish with them. Every level of our team understands our responsibility to help unlock our partners’ potential. -
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PlanXpand
Acero Health Technologies
PlanXpand™ is Acero’s proprietary transaction processing engine, one that powers each of our products for health benefits administrators. Leveraging this engine, clients may choose to implement Acero’s products concurrently or incrementally. In addition to selecting one of our standard products, administrators also may choose to utilize PlanXpand™ to develop a custom solution to extend existing system capabilities. Acero’s unique, integrated solutions feature Service-Oriented Architecture, allowing health benefits administrators and insurers to add features and functions to existing adjudication platforms. At the same time, our sophisticated design and engineering enables real-time adjudication of every type of claim, all in direct interaction with the core claims system, resulting in more accurate processing, more satisfied customers and less need for claims adjustments. -
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Evolent Health
Evolent Health
Driving breakthrough clinical and administrative results. Evolent Care Partners, Midwest health system ranked third in the nation for both total shared savings and percentage of savings off of benchmark. Evolent Care Partners enables independent primary care physicians with the capital and resources needed to participate and succeed within two-sided payer contracts, while limiting their financial risk. New Century Health delivers cost and quality improvements in oncology and cardiology by using clinical evidence to guide care decisions that are supported by both payers and providers. Evolent Health Services simplifies health plan operations through comprehensive services that are powered by a modern and integrated platform, and a true strategic partnership model. Explore insights and news on value-based care, population health, health plan administration and other health care transformation topics. -
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PLEXIS Payer Platforms
PLEXIS Healthcare Systems
PLEXIS’ suite of best-in-class apps has a proven record of giving payers the extended functionality necessary for modern core administrative ecosystems. From real-time benefit administration and adjudication to automatic EDI transmission and self-service customer portals, PLEXIS Business Apps have you covered. Passport provides essential connectivity from the core admin and claims management engines to PLEXIS business apps, your own apps, and existing in-house systems. With its flexible API layer, Passport delivers real-time integration with portals, automated workflow toolsets, and business apps. Connectivity is limitless. Streamline workflows with a centralized, modern core administration & claims management platform. Process claims in a timely and accurate manner, and automate the complexities of benefit administration to capture a quick ROI and deliver superior customer service. -
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Assurance Reimbursement Management
Change Healthcare
An analytics-driven claims and remittance management solution for healthcare providers who want to automate workflows, improve resource utilization, prevent denials, and accelerate cash flow. Increase your first pass claim acceptance rate. Our comprehensive edits package helps you stay current with changing payer rules and regulations. Heighten your staff’s productivity with intuitive, exception-based workflows and automated tasks. Your staff can access our flexible, cloud-based technology from any computer. Manage your secondary claims volume through automatic generation of secondary claims and explanation of benefits (EOB) from the primary remittance advice. Focus on claims that need your attention with predictive artificial intelligence into problem claims. Resolve errors faster, and avoid denials before submittal. Process claims more efficiently. Print and deliver primary paper claims, or add collated claims and EOBs for secondary claims. -
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Enterprise Health Solution
HM Health Solutions
HM Health Solutions provides an end-to-end solution to health plans. Get the support you need and business outcomes you want from one comprehensive health plan administration platform: the Enterprise Health Solution. Platform applications and tools manage functions from sales through enrollment and billing, including claims, provider and clinical management, and customer service. The Enterprise Health Solution (EHS) is the only proven end-to-end solution, and can move your member seamlessly from enrollment to claims payment. You’ve heard others claim to offer a fully integrated solution. What they don’t specify is that you may need to purchase all modules in sequence to achieve this integration. On the Enterprise Health Solution, health plan administration has always been the one and only focus. No other company rivals our expertise in the health plan payer space. -
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Complete Claims
Complete Health Systems
Claims Adjudication for medical, dental, vision, prescription, short and long-term disability claims. Available for on-site license or as a hosted application (ASP). Microsoft technology: SQLServer database with a Windows front end. Acclaimed Customer service staffed by health care claims experts with a minimum of 12 years’ experience in the field. Support calls are logged with status available via the internet. Plan copy and modification feature enable quick setup of plans. Auto-adjudication using benefit codes built using business rules based on over 25 variables from both the claim and the claimant records made available to the adjudication engine. Inbound claims can be scanned images, EDI or paper. HIPAA EDI 5010 transaction sets. Re-pricing fee and UCR Schedules can be loaded on the system in advance of the effective date. The date-driven logic will re-price based on the date of service. -
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InsurancePlus Software Series
United Systems and Software
USSI is proud to present its entire line of professional insurance software solutions designed and developed as an all-encompassing turnkey administration offering. USSI's comprehensive software solutions ensure that your insurance company is operating at the highest level in an ever changing and competitive marketplace. USSI's InsurancePlus Individual Life and Health Administration software solution manages books of business for traditional and non-traditional Life and Health insurance companies. Product lines supported include Whole and Term Life, Interest Sensitive, Final Expense, Annuities, Supplemental Health, etc. USSI's InsurancePlus Group Life and Health Administration software solution manages books of business for Group Health insurance companies, Self-Insured Funds, and TPA's. Supported plan offerings include Point of Service, Major Medical, Term Life, High Deductible, Traditional Indemnity, etc. -
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Infosys HELIX
Infosys
Driving AI - first as a business strategy for payers, providers and PBMs with products and platforms which are built on AI and runs on cloud. A “healthcare digital platform” is the integration of applications and emerging technologies to provide a tailored healthcare solution that drives business outcomes—a significant modern and accelerated approach to disintermediate legacy core administration processing systems (CAPS). To better understand the role of digital platforms and emerging technologies in achieving business objectives, the impact of digital platforms on healthcare payer KPIs, and the relative attractiveness of healthcare platforms, Infosys, in partnership with HFS, reached out to 100 C-suite healthcare payer executives in US. -
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Conexia
Conexia
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. -
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Jopari ProPay
Jopari
Jopari ProPay is a cloud-based payment processing solution for healthcare payers. It offers a comprehensive suite of payment methods, including EFT/ERA, virtual card payments, and paper checks, as well as a self-service provider portal for EOB/R delivery and support for compliant 835 delivery for eBilling transactions. Jopari ProPay helps healthcare payers to eliminate paper and reduce operational expenses by streamlining their payment and remittance processing. It also allows payers to outsource their payment processing, which can free up their resources to focus on other core tasks. For providers, Jopari ProPay offers a multi-tiered choice of payment delivery options, so they can choose the method that best meets their needs. Providers can also access a self-service portal to view their EOBs/Rs and track their payments. Jopari ProPay is a secure and compliant payment processing solution that is trusted by over 50,000 ERISA health plans and fully insured groups. -
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SSI Claims Director
SSI Group
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. -
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ENTER
ENTER Health
Enter gets Providers (doctors, practices & hospitals) paid faster than anyone in history. Enter processes health insurance claims and pays in 24 hours while automatically communicating and collecting patient responsibility with a white label collection engine, complete with payment plans. Enter is 30x faster at getting claims paid and 45x faster at getting patients billed at the same cost as existing medical billers. - $150mm+ of claims processed in just 1 year of operations. - $100mm credit facility actively being deployed for providers. - Revenue Cycle Management Partner for United Healthcare Nevada. - Enter supports a wide variety of specialties including ASC, Orthopedics, Neurology, Dermatology, Emergency Rooms, Behavioral Health, Pain Management and more. - Enter works with all commercial and government health insurance carriers. - Enter integrates with all EMR / practice management systems. - No monthly fees. No integration fees. - Enter is venture backed -
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FINEOS
FINEOS
The FINEOS Platform provides clients the only complete end-to-end SaaS core product suite that includes FINEOS AdminSuite enabling quote to claim administration as well as add-on products, FINEOS Engage to support digital engagement and FINEOS Insight for analytics and reporting. The foundation of your digital insurance strategy. The FINEOS Platform seamlessly blends FINEOS AdminSuite + FINEOS Engage + FINEOS Insight + Platform Capabilities to create the most modern single core insurance platform for Life, Accident and Health. Legacy core systems utilized a ‘one size fits all’ business technology approach that no longer fits the needs of an agile business. Today, consumers, employers and brokers have access to powerful SaaS computing platforms and software tools that set a much higher bar for an insurer’s digital strategy. Monolithic insurance software models of the past focused solely on details of the insurance contract. -
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fhirstation
Iron Bridge
Built on FHIR v4 with native FHIR data models and RESTful API. USCDI v1 is compliant and can store and service full USCDI v1 to patients and partners. Export electronic health information safely and securely for patient access. Plug your EHR, Payer System, or any HIT into fhirstation for instant Final Rule compliance. Fhirstation is a turn-key scalable, secure, multi-tenant Software as a Service (SaaS) solution for electronic health record (EHR) vendors, health plans, hospitals, providers, and any other entities that must provide patient data through the United States Core Data for Interoperability(USCDI) v1 FHIR v4 API and electronic health information export for the HHS final rule and CMS interoperability rule. Fhirstation breaks down information blocking by enabling information exchange between patients, health IT developers, health systems, EHR vendors, and payers. SMART on FHIR ready for patient access applications of the future. -
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NaviNet Open
NantHealth
As an organization that prioritizes value-based care, your ability to communicate across a flexible, extensible platform is critical. NaviNet Open is one of America’s leading payer-provider collaboration platforms, facilitating provider engagement and generating trustworthy, actionable data throughout the continuum of care delivery. A secure multi-payer platform, NaviNet Open enhances communication, boosts operating efficiency, cuts costs, and improves provider satisfaction. It lets payers and providers exchange vital administrative, financial, and clinical information in real time. For NantHealth, security is a priority. HIPAA compliant and steadfast in our values, our demonstrated commitment has led us to hold EHNAC HNAP accreditation since 2006. NaviNet Open is HITRUST certified, having met key regulations and industry-defined requirements. It appropriately manages risk regarding third-party privacy, security and compliance. -
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AxisCore
HealthAxis
Gain a competitive advantage with AxisCore™, leveraging state-of-the-art and modularized technology for seamless automation of your health plan administration. Say goodbye to the complexities of a cumbersome core administrative processing system (CAPS) and embrace our fully integrated solution. Meticulously crafted to optimize benefits administration, healthcare claims processing, and overall health plan management, AxisCore™ empowers your organization to thrive in today's dynamic healthcare landscape. -
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I-CAPS
W.O. Comstock & Associates
I-CAPS is an Intelligent Claims Administration System that addresses all functional areas of the health claims payment environment with a single common architecture that spans the needs of payers including membership, billing, enrollment, mailroom, claims, network management, contracting, pricing, utilization review and customer service. Our Intelligent Claims Administration System (I-CAPS) and our coding compliance software (Advanced Value Scale-AVS) , support knowledge-based decision-making to help our clients contain costs. Guaranteeing the integrity of Provider information has never been easier with (Advanced Network Administrator-ANA) while our (RB-UCR) is the industry's first Resource-Based, Usual Customary, and RESPONSIBLE fee schedule based on RBRVS and NCCI. Need a check-up for your plan or provider, use Cost Containment Audit and Recovery Services (CCARS) for a completely noninvasive audit retrospective look at claims effectiveness. -
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ALFRED Claims Automation
Artivatic.ai
Filing claims are complex and critical processes. More than 60% of people do not file complex due to its complex processes and time taking nature. Artivatic’s dedicated claims platform for each insurance vertical helps insurance businesses to enable digital claims journeys, self-claims processing, automated assessment, risk & fraud intelligence and claims payout. ONE PLATFORM FOR ALL YOUR CLAIMS NEEDS. End to End Claims Automation and Assessment Platform AUTO CLAIMS – HEALTH CLAIMS – TRAVEL CLAIMS – ACCIDENTAL CLAIMS – DEATH CLAIMS – FIRE CLAIMS – SME CLAIMS – BUSINESS CLAIMS – COMMERCIAL CLAIMSStarting Price: $10/claims/month -
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AUSIS
Artivatic.ai
AUSIS – Full-stack Behavioral Underwriting AUSIS enables insurance businesses to provide in-depth underwriting, scoring & decisions in real-time. AUSIS provides reduction in cost, time, risk & fraud with enhancing efficiency, decision power, alternative scoring and more. AUSIS helps increasing STP from NSTP and also enables non-invasive methods of health data aggregation from AQI, Location, Mortality, Social, Photo, Video, Health Devices, Weather, Sanitation and more. AUSIS reduces up to 40% reduction in per policy issuance.Starting Price: $10/month/user -
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Valenz Health
Valenz Health
Our single end-to-end platform of fully integrated health plan solutions delivers value and simplifies the complexity of healthcare for employers, members, providers, and payers. Valenz integrates member-centric services with data-driven insights, connecting the dots with personalized service and guidance for high-quality care and improved outcomes. We engage early and often with results-driven education, support, and services to avoid more serious and costly health events. With Valenz, you can have a healthier member population while also achieving plan and member cost savings, year after year. For the tools and transparency you need to make cost-effective, quality-first decisions, let’s find your path to smarter, better, faster healthcare today. With a suite of fully configurable solutions integrated into one ecosystem strategy, the Valenz healthcare ecosystem optimization platform offers extensive visualization of cost, quality, and utilization opportunities. -
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CAQH
CAQH
CORE brings the industry together to accelerate automation and develop business processes that streamline healthcare for patients, providers and health plans. Drawing on the industry's most trusted source of provider and member data, CAQH enables healthcare organizations to reduce costs, improve payment integrity and transform business processes. In the ever-evolving landscape of healthcare, continuous improvements in payment and claims processing systems are vital. The nation’s providers and health plans trust CAQH to collect and manage professional information, verify primary sources, and monitor for sanctions. The result, is streamlined administration, greater regulatory compliance, and better provider data management. -
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EbixEnterprise
Ebix
EbixEnterprise is a comprehensive insurance management solution that streamlines policy management throughout its lifecycle. EbixEnterprise contains six components, Customer Relationship Management (CRM), health insurance exchange, policy administration, claims administration, data analysis, and consumer web portal. Each of the components is seamlessly integrated with one another, which allows data to flow between each other as dictated by the business need. SmartOffice CRM provides organizations with the ability to maintain agent/broker information, commission rates, manage sales pipeline, state license information. EbixEnterprise's Online Quoting Portal, HealthConnect, is the leading health insurance exchange for buyers and sellers of health insurance and employee benefits. EbixEnterprise Administration is a fully functional policy administration system that provides all of the tools that are necessary to manage policies, define plans, maintain plan rate information, etc. -
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Curacel
Curacel
Curacel’s AI powered platform enables insurers track fraud and automate claims seamlessly. Collect your claims from your Providers in real-time and easily auto-vet the claims. Curacel Detection helps you detect and curb fraud, waste and abuse in the Claims Process. Collect claims from their providers and prevent fraud, waste and abuse in the claims process. We studied the Health Insurance industry to understand where the most value is lost by Insurers. This was identified to be the Claims Process. The Process is mostly manual and is fraught with a lot of fraud, waste and abuse. Our solution, driven by AI, helps to curb wastage and make the Insurer more efficient, thereby making them unlock hidden value. ravel insurance is peculiar in that it is built on on-demand policies that cover relatively short periods of time. Should a policy holder want to make a Claim, both the insurer and the insured want claim settlement to be as efficient and accurate as possible. -
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Inovalon Payer Cloud
Inovalon
Improve clinical quality metrics, risk score accuracy, patient and provider engagement, patient outcomes, operational transparency, and economic performance, all with one comprehensive suite of software solutions. The Inovalon Payer Cloud transforms traditional workflows into data-driven processes that support your health plan’s key objectives. Backed by industry-leading analytics capabilities, our converged SaaS solutions deliver the member-centric insights and speed, accuracy, and flexibility you need to stay ahead in this diverse, ever-changing marketplace. Inovalon's SaaS suite of healthcare payer solutions delivers member-centric insights and actions to help health plans measure, manage, and improve healthcare outcomes, economics, and quality of care. Payer solutions to improve member care and outcomes while achieving greater operational performance and efficiency with sophisticated analytics and dynamic business intelligence. -
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HEALTHsuite
RAM Technologies
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. RAM’s Medicare Advantage-in-a-Box offering is unique in the industry; the product of RAM’s extensive experience in Medicare Advantage and an unwavering commitment to changing our industry. HEALTHsuite Advantage™ and eHealthsuite™ are the cornerstones of our pre-configured Medicare Advantage-in-a-Box offering. HEALTHsuite Advantage is a fully integrated suite of modules providing our clients with an unmatched solution to administer their Medicare Advantage and Special Needs Plans (SNP’s). -
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Collective Health
Collective Health
Collective Health is the first integrated solution that allows self-funded employers to administer plans, control costs, and take care of their people, all in one place. Let us show you how we deliver better benefits with curated programs, connected administration, and smart member experience. From scientists to truck drivers to musicians, we’re proud to serve the happiest clients and members in the health insurance industry. See why leading self-funded employers across the nation choose Collective Health. Are you a broker or consultant working to drive your clients’ healthcare strategy forward? Collective Health simplifies employee healthcare with an integrated technology solution that makes health insurance work for everyone. With nearly a quarter of a million members and over 50 clients, including Driscoll’s, Pinterest, Red Bull, Restoration Hardware (RH), Zendesk, and more, Collective Health is reinventing the healthcare experience for forward-thinking organizations. -
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LexisNexis MarketView
LexisNexis
LexisNexis® MarketView™ delivers medical claims-based intelligence to healthcare payers, providers, life sciences companies and health IT organizations across the United States. MarketView delivers actionable insights to remain competitive, allowing businesses to see valuable insights, and visualize ways to transform business. Whether you are a life sciences company, a health plan, a health system, or a health IT vendor, MarketView can help transform key business work streams including marketing, sales, strategic planning, physician relations and outreach, market research, network optimization, recruitment, pricing, contracting, clinical teams and more. Your business needs the most actionable insights to remain competitive. But it’s hard to diagnose the right areas of focus when the picture is unclear. MarketView delivers insights into areas including referral patterns, physician alignment strategies, the quality of clinically integrated networks, patient volumes, etc. -
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Inovalon Insurance Discovery
Inovalon
Insurance Discovery reduces uncompensated care and underpayments by identifying active billable coverage previously unknown to the provider. Using sophisticated search capabilities, this solution identifies if patients have multiple active payers to help boost reimbursement opportunities. Prevent reimbursement delays and increase the speed of revenue capture by sending claims to the right payers on the first submission, enabled by more accurate coverage information. Run Insurance Discovery with verified patient demographic data to get accurate coverage and eligibility information. Replace manual insurance discovery methods with one quick, comprehensive search that inquires numerous databases in seconds to deliver detailed, accurate coverage information. Improve the patient/resident experience and estimate accurate out-of-pocket costs to improve their financial experience. -
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HealthSherpa
HealthSherpa
HealthSherpa is a certified partner of Healthcare.gov that has created a simpler platform to enroll in Affordable Care Act health insurance plans. We work with consumers, employers, insurance carriers, insurance agents, and nonprofits to enroll as many people as possible in these subsidy-eligible, comprehensive health plans. For insurance carriers, we power their websites so that they can enroll people in Affordable Care Act health plans. For insurance agents, we provide superior enrollment technology, a CRM, and communication tools so that they can enroll more clients in plans that make sense for them, faster–and we have 40,000 agents using our platform. For consumers, we provide decision support tools to help folks choose a plan that makes the most sense for their healthcare needs and budget. HealthSherpa has enrolled more than 5 million consumers in coverage, and we show all the same plans and prices as HealthCare.gov. -
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Take Command
Take Command
Powerful new HRAs simplify the process of providing health insurance and provide you with peace of mind. Say goodbye to complicated group plans. Get started by answering a few questions about how you'd like your HRA to work. Don't worry, our platform will guide you through the process and put you in control as you craft your plan. Once you are done designing your HRA, we'll get busy taking care of the legal requirements and getting your employees setup on our platform. Once your HRA is established and your employees are setup on our platform, we will begin helping you manage the claims process. Each day we work to bring about a healthcare system that gives you peace of mind because we believe people deserve a clearer path to health insurance.Starting Price: $15 per user per month -
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QuickCap
MedVision
MedVision Solutions' QuickCap is an administrative and clinical data process management solution that lets users focus on business and not the paperwork. With QuickCap, users have scalable control over their workflow and information to work smarter. QuickCap features a customizable dashboard for ease and gives them automation of their process for speed. QuickCap also streamlines claims work that makes users' work easier. QuickCap also allows users to easily determine profitability for individual providers with analytics. -
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Availity
Availity
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. -
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samedi
samedi
samedi is a web software solution for cost-saving and service-increasing patient coordination. The secure networking solution can be used in medical practices, clinics and operating theaters. The work processes are optimized through effective and efficient resource planning, process control, online appointment booking and assignments. With the help of video consultation hours and online forms, processes can be mapped more flexibly, of course, while guaranteeing the highest data security. samedi is an e-health software for doctors, clinics and health insurance companies. samedi networks the healthcare system and optimizes medical procedures and processes. Simple, efficient and safe. With 12 years of expertise in e-health, we understand your individual needs and offer flexible settings for both simple and highly demanding process and workflow requirements. With our interfaces to almost every practice and clinic information system, we offer you smooth workflows.Starting Price: $45 per user per month -
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Certive Health
Certive Health
Certive’s Revenue Integrity Analytics platform is based on a unique blend of data science, clinical expertise, and administrative process knowledge. Certive Health’s experience base ensures the integrity of the hospital’s revenue and compliance of its processes. The core of Certive Health’s Revenue Solutions offering is built on its Revenue Integrity Analytics™ platform. Extended technical capabilities in analytics, workflow, and marketing automation combined with clinical and payer side experience helps our clients reduce costs, improve outcomes, and increase patient satisfaction.Starting Price: $1000.00/month -
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Health Portal Solutions
Health Portal Solutions
Healthcare Payers struggle to manage the moving parts of health plan administration. We help Payers organize their data, vendors, and business processes behind one login so they can efficiently manage the different pieces of healthcare in one place. Spend less time chasing the moving parts and more time growing your business. The HPS portal gives you greater control over business operations and more time for you to focus on what’s most important. For over 20 years, Third Party Administrators, Health Plans, International Insurance Carriers, Employers, and Unions worldwide have partnered with Health Portal Solutions™ to organize their business online and achieve greater efficiencies and business growth. 30+ ways to customize your portal without software development. Customer Support that understands your industry but allows for the uniqueness of your business.Starting Price: $500.00/month/user -
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INSXCloud
My1HR
Make INSXCloud your marketplace for on-exchange ACA health plans and off-exchange ancillary coverage such as dental, vision, accident, and short-term medical options. INSXCloud has assisted agents, agencies, and issuers with the quoting and enrollment process for individuals and families choosing Affordable Care Act and ancillary health coverage since the Federal Marketplace opened in 2014. During that time, we have helped agents and issuers enroll over 2 million members in on and off-exchange health, dental, vision, and other ancillary coverage. e-Commerce on your terms: The EDE version of INSXCloud is built to support agent-led and direct-to-consumer enrollments. When you work with us you control the marketing to your clients, not us, so you manage the message. Our site has time-saving features like the upgraded provider lookup that tells you which doctors accept specific plans and a ‘Pay Now’³ feature for many carriers which allows you to set up your clients’ payment. -
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MEDSYS2
MEDSYS2
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.Starting Price: $299.95 per year -
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Quotit
Quotit
The all-in-one insurance quoting, enrolling, and lead management solution designed for today’s insurance professionals. Whether your primary business is done through traditional face-to-face, telephone, E-commerce sales or all of the above, Quotit offers you solutions that transform your customer’s experience with convenience, personalization, and automation. Invest in health insurance software to build more efficient and productive processes that delight your clients in each interaction. Whether you are looking for a turnkey solution or access to consolidated data and functionality, we’ve got you covered. Included in our out-of-the-box solutions or stand-alone cloud-based API, the backbone of your operation is access to health plan data from hundreds of carriers across the country in one place.Starting Price: $199 per month -
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eHealthApp
eHealthApp
eHealthApp provides the ability for brokers and consultants to differentiate themselves by efficiently gathering health information. The collected information can then be used to obtain health underwritten quotes and provide the opportunity for the broker to analyze the information to objectively determine the best fit for their group clients. TPA's, GA, and Carriers can sponsor eHealthApp for brokers in a manner that does not help the competition, increases underwriting accuracy, and make products more widely available. -
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TriZetto
TriZetto
Accelerate payment while decreasing administrative burdens. With 8,000+ payer connections and longstanding partnerships with 650+ practice management vendors, our claims management solutions can result in fewer pending claims and less manual intervention. Quickly and accurately transmit professional, institutional, dental, workers compensation claims and more for fast reimbursement. Meet the shift to healthcare consumerism head on by providing a straightforward and seamless financial experience. Our patient engagement solutions empower you to have informed conversations about eligibility and financial responsibility while reducing hurdles that may impact patient outcomes. -
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JET Insure
JET Health Solutions
Successful insurance companies use our SaaS platform to deliver a branded shopping experience, automate policy administration and foster collaboration across customers, brokers and healthplan teams. Power your business with our best-in-class platform and bring velocity, agility, efficiency and compliance across your organization. Never miss an opportunity to win a customer by effectively presenting your list of health plans and insurance products. Boost process efficiency, orchestrate work queues to keep business operations running smoothly, and improve client follow-ups. Save time by letting JET Insure keeping track of events so that you could focus on the core business activities. Let us show you how we can optimize your business for current and future healthcare needs – and how our product can help you grow faster. -
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POWEReob
Unicomp Corp. of America
Insurance payment posting, like so many other tasks, falls under the proverbial 80/20 rule. The 20% of your payments that are still posted from paper EOBs take 80% of the overall payment posting work, if not more. Not so with POWEReob. POWEReob is a combination of free software and a pay-per-transaction service that will convert the paper EOBs you still receive from some payers into electronic remittances files in the ANSI 835 or NSF format. These files can then be used for automated payment posting to your practice management software, electronic secondary claims billing and denials management. POWEReob can work with any practice management that accepts remittance files from 3rd party sources (not just from their designated clearinghouse). For those that don't, we'll work with your practice management or clearinghouse so you, too, can benefit from the labor savings resulting from 100% electronic remittances. -
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BHRev
BHRev
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. -
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PwC SMART
PwC
PwC SMART (Systematic Monitoring and Review Technology) increases the efficiency and effectiveness of your inpatient and outpatient coding quality evaluation process, and enables a mechanism for quality and compliance review. Coupled with the support provided by PwC Health Information Advisory, SMART bolsters your efforts to monitor coding and data quality. SMART Inpatient includes 1,000+ pre-defined business rules that identify potential coding inaccuracies and documentation improvement opportunities. You can also customize business rules for your specific areas of focus. Reporting and data analysis help you evaluate your staff’s performance and pinpoint education opportunities for Coding, Clinical Documentation Improvement (CDI), Quality and Providers. SMART Outpatient improves the accuracy of claims and identifies charge capture issues and areas for workflow improvements. It also improves regulatory compliance by decreasing the risks caused by inaccurate coding. -
46
ResolvMD
ResolvMD
ResolvMD is an experienced full-service medical billing company that processes all health service claims (AHCIP etc.) on behalf of physicians. Our goal is to make physicians as confident and competent in their billing as they are in their practice through surfacing data-derived insights and democratized knowledge. We have the most modern, cost-effective, and secure platform on the market for processing claims. Our target audience are physicians (mainly specialists such as emergency physicians, urgent care, plastic surgeons, anesthesiologists, paediatricians, general surgeons etc.). They need a billing agent to process their health service claims. They value time, trust, cost, efficiency and knowledge. We are targeting physicians in Alberta today (mainly in Calgary, Edmonton, Red Deer, Medicine Hat, Lethbridge, Okotoks and any other centre with a population in excess of 25,000. -
47
SOLIFE
Vermeg
SOLIFE is a comprehensive policy administration system developed by VERMEG, tailored for life and health insurance companies. It facilitates end-to-end management of new business processes, policies, and claims, encompassing features such as cash and events management, accounting integration, distribution and fees management, reinsurance, tax and legal compliance, dedicated reporting, and claims handling. Designed with over 20 years of industry expertise, SOLIFE offers a client-oriented approach, continuous updates to meet regulatory changes like MiFID and PRIIPs, and a robust platform supporting digital processing through APIs and responsive design. Its high level of automation significantly reduces administrative costs, while a flexible product-design workbench accelerates time-to-market delivery. The system also supports multi-distribution models, catering to diverse business needs. -
48
Context 4 Health Plans Suite
Context4 Healthcare
Protect the integrity of your health plan and determine accurate pricing with the Context4 Health Plans Suite, our modular, cloud‑based technology platform. Immediate, actionable, and defensible Fraud, Waste, and Abuse (FWA) detection built by our team of certified clinical, dental, and health benefits experts. Accurate data and cutting-edge cloud technology combine to create a proven and defensible medicare reference-based pricing (RBP) solution. More than 100 healthcare data sets, with professional support to optimize efficiency and compliance. Advanced medical coding software designed to expedite claim submission and minimize denials. Our cloud based Payment Integrity Platform utilizes our proprietary analytics engine to identify coding errors, medical necessity, unbundling, fraud-waste-abuse, audit risks, pricing and other aberrations that can impact your business. -
49
Reimbursify
Reimbursify
Reimbursify is the first and only mobile-enabled, software platform delivering a truly innovative solution empowering patients, serving practitioners, and enabling digital partners to easily file out-of-network reimbursement claims for medical and mental health services. Reimbursify is the fast, easy way to file out-of-network (OON) reimbursement claims from your health insurance company! Our intelligent app takes the pain and trouble out of claim filing to make sure you get all the money coming to you. Fast, streamlined registration for primary insured, spouse & dependents. Smart dashboard manages all your claims and keeps track of money you’re on track to collect. Proprietary Rejection Resolution Pathway to help resolve rejected claims fast. Provider search function that auto-populates provider information.Starting Price: Free -
50
TreatWrite
TheraTech Pathways
TreatWrite is a visionary, responsible, web-based service that produces quality, accountable healthcare documentation, improves the patient care process, improves patient health, enhances the clinical provider experience, supports provider reimbursement, and optimizes allied health practices to conserve payer resources. Progress tracking technology data opens future doors of opportunity for TheraTech to lead the allied health professions into Learning Healthcare. Planned product expansions include the addition of an allied health performance quality center. The performance quality center, coupled with progress tracking data, offers exciting possibilities to define service delivery efficiencies that conserve payer resources and grow a culture of constantly improving healthcare service and delivery models. Customizable templates, and data transfer from document to document make TreatWrite efficient.Starting Price: $49.00
