HIPAA eCommerce

21 Options for Healthcare Claim Management Software (and what to look for)

Published  |  9 min read
Key Takeaways
  • Claims processing software is a digital program designed to make life easier for healthcare professionals when it comes to managing their billing and administrative operations.
  • This type of software can help save time by automating processes such as eligibility checks, patient statement generation, insurance payment tracking, posting payments to accounts, and more.
  • Claims processing software provides greater accuracy in the billing process by reducing manual data entry mistakes. It can also be integrated into almost any ERP or CRM you currently use.
A claims processing solution will reduce the amount of fraudulent claims.

It's essential for healthcare providers to select the right healthcare claims management software. With the help of a quality billing software, you can experience improved processes and increased revenue. On the other hand, an inadequate one could cause revenue losses and compliance issues.

In this guide, we'll provide you with all the knowledge necessary to choose the perfect claims-processing software for your practice. We'll also review some of the most popular healthcare claim management options available on the market today. Finally, we'll discuss how to integrate your ERP, CRM, or EHR systems into this process.

Claims processing is made easy with a claim integration system.

Factors to Consider when Choosing a Medical Billing System

Choosing the right claims processing software for your practice is an important decision. Here are some factors to consider when selecting a system:

  • Features and Functionality: It's essential to consider the features and functionality you need, such as electronic claims submission, automated patient payment processing, financial reporting, appointment scheduling, and EHR/medical claims integration.
  • Pricing: The pricing of medical billing software can vary significantly, so it's important to consider your budget and ensure that the software you choose is cost-effective for your practice.
  • Compliance: Medical billing software must comply with various regulations including HIPAA eCommerce standards. Look for a provider that prioritizes compliance and data security.
  • Customer Support: Good customer support is key to successful medical billing. Choose a provider that offers phone and email support, as well as training resources and implementation assistance.
Claims processing software deals with primary and secondary claims.

How to Choose the Best Medical Billing Software

Finding the best claims processing software for your practice can be a challenging task. Here are some tips to help you make the right choice:

Define Your Requirements

Before you start your search, make a list of key features that you need in claims processing software, such as electronic claims submission, automated patient payment processing, financial reporting, appointment scheduling, and integration with EHRs.

Consider Your Budget

The cost of claims processing software can vary significantly depending on the provider and the features offered. Carefully evaluate your budget and choose a software provider that offers flexible payment options.

Research Software Providers

Compare the features, pricing, compliance, and customer support of different providers to find one that meets your requirements. Look for providers that offer excellent customer support and have a good reputation in the industry.

Read Customer Reviews

Reading customer reviews will give you an idea of how well the medical claims software works in real-world situations. Look for feedback from healthcare providers that have similar needs and practice sizes as yours.

Request a Demo

Request a demo to see how the system works and if it meets your requirements. Ask the provider about their implementation process, training resources, and customer support during this time.

Make Your Decision

After researching and evaluating different claims processing software providers, choose one that meets your requirements and fits your budget while offering excellent customer support.

The right software will help reduce claim denials.

Questions to Ask Claims Processing Software Vendors

When investigating healthcare claims management software, it's important to ask some questions of your developer or integration partner. Here are a few of the most vital:

What features does this software provide?

Does the software have features and capabilities to help manage healthcare claims processes efficiently, securely, and effectively? Ask about secure data storage, automated workflow business processes to further streamline claims management workflows, integrated billing for accurate and timely claims processing, and customizable

Does this software integrate with existing systems?

The claims processing software should integrate with existing systems such as ERP and CRM platforms to ensure seamless integration with existing business systems.

Is training and support available for the claims management software?

Ask about professional training and support, and if it is available from the provider to ensure users are getting the most out of their product.

Is client data secure and compliant with HIPAA requirements?

All client data needs to be stored securely in accordance with HIPAA requirements for privacy and security. This includes any EMR transfer or electronic data interchange accepted via a HIPAA-compliant website.

What about data analysis and metrics?

Ask if detailed reports can be generated to help analyze performance metrics, trends over time, costs associated with claims processing activities, and other important business insights.

How much will the claims processing software cost?

Of course, you'll need to know about costs—both implementation and maintenance. Setup fees, subscription fees, installation costs, and ongoing maintenance costs will vary depending on the provider and package selected.

Electronic data interchange (EDI) will facilitate claims processing.

The Top Medical Billing Software to Investigate

Finding the right claims processing software for your practice is an important decision. Here are some popular software tools to consider:

ModMed

ModMed is popular among healthcare providers for claims management.

ModMed assists physicians in managing their practice operations efficiently by consolidating multiple applications into one system accessible from any internet device or browser window anytime anywhere.

DrChrono

DrChrono is a popular tool for claims management.

DrChrono allows healthcare organizations to streamline their workflow through automated business processes for patient documentation, appointment scheduling, payments, and analytics. It also features integrated e-prescribing and direct messaging capabilities.

Kareo Billing

Kareo Billing is a popular choice of claims processing software.

This robust platform provides time-saving billing tools to maximize revenue and minimize paperwork. It allows you to track payments in real-time, send electronic claims, and manage authorizations all in one place.

NextGen Office

NextGen Office is a great choic in healthcare claims management.

This cloud-based EMR platform helps practices save time on administrative tasks with automated efficiency through its easy-to-use workflows that integrate both clinical data and financials into one unified system.

athenahealth

athenahealthmakes claims management easier.

This electronic medical billing software simplifies the complexity of managing a healthcare business and provides comprehensive tools such as billing and revenue cycle management, patient scheduling, and financial reporting.

ChartLogic

ChartLogic EHR enables clinicians to streamline their workflow through its intuitive interface design paired with powerful functionality for managing patient information quickly and accurately. The system includes features such as e-prescribing, lab integrations, and order sets built specifically for OBGYN practices.

Compulink Healthcare Solutions

Compulink Healthcare Solutions is a well-known claims processing software.

Compulink provides a suite of tools designed to improve the efficiency of medical practices with integrated practice management software and EHR systems connected by a simple patient portal. With Compulink’s integrated payment processing module, users can get paid faster while eliminating manual data entry errors in the payment posting process.

RXNT

RXNT is a popular claims processing software.

RXNT is a user-friendly practice management system for outpatient care providers with features such as automated insurance eligibility verification, claims processing, patient statements, collections tracking, integrated SMS reminders, and more.

Practice EHR

Practice EHR helps get the right medical codes to reduce rejected claims.

This advanced electronic health record (EHR) system combines comprehensive clinical records with powerful administrative components like appointment scheduling and practice management tools in one intuitive platform.

DocVilla

DocVilla is a popular way to deal with claims adjudication.

DocVilla features automated billing operations along with self-service patient portals for securely accessing medical records from any device or location worldwide. Additionally, it includes an inbuilt analytics suite for better insights into how healthcare businesses are performing over time.

CentralReach

CentralReach helps medical providers with claim processing.

CentralReach is an advanced electronic medical billing system that helps streamline the processes of submitting insurance claims electronically. It facilitates faster claims filing by automating processes like data entry and check writing, enabling health providers to collect payments in a timely manner. CentralReach' intelligent medical software also enables care providers to track how much they’ve been reimbursed during each payment cycle so they can manage their businesses better.

CharmHealth

CharmHealth is a popular claim processing option.

CharmHealth provides deep data analytics capabilities from within its comprehensive Cloud-based platform which shares information between various stakeholders within the healthcare industry.

Azalea Health

Azalea Health is popular for claim processing.

Azalea Health offers next-generation cloud-based electronic health record (EHR) systems and services including population health management financial and accounting software plus secure messaging virtual care and telemedicine telehealth solutions all designed to help deliver value-based care.

AllegianceMD

Claims integration with an EMR system helps transfer patient data.

AllegianceMD empowers independent physicians to take control of their operations enabling individualized patient care, greater flexibility, streamlined processes, enhanced security, quicker reimbursements, and deeper insights & improved collaboration across provider networks.

Harmony

Harmony is a good choice for claim processing.

Harmony Medical is a full-featured medical billing solution that enables providers to manage multiple office locations simultaneously from one single platform leveraging real-time analytics & optimized workflows helping optimize engagement throughout the entire healthcare team.

WRS Health

WRS Health is a popular option for claim processing.

WRS Health focuses on helping small practices stay agile and competitive through its intuitive modular design and customizable clinically driven suite technology stack. This gives users unparalleled access to critical intelligence, identifying areas that need improvement.

CollaborateMD

CollaborateMD is a popular option for processing claims.

CollaborateMD makes it easier than ever before for clinics physician group practices hospitals urgent care specialty practices to quickly submit professional claims accurately track their accounts receivables manage future cash flow more easily and resolve complex coding issues.

MedEZ

MedEZ helps streamline claim management.

MedEZ assists primary care physicians groupings specialists ambulatory centers private practitioners practices nursing homes emergency rooms state correct info institutions pharmacies vendors customers regulatory agencies pharmaceutical companies insurers distributors parallel parties mass marketers employers universities through a complete set of electronic forms compliant documentation permissions payments actionable.

Nexus

Nexus can process claims after clinical outcomes are established.

Nexus enables medical facilities large or small (private offices, hospital-driven satellite clinics, multi-specialty groups) the ability to go paperless via pharmacy connect integration, e-prescribing, digital forms sharing, imaging results, and communication optimization.

Nextech EMR

Nextech helps with patient claims and other medical bills.

Nextech EMR is an award-winning electronic medical billing software suite, with powerful tools and features that empower healthcare professionals to manage patient records, prescriptions, appointments, and financials. It has been designed to simplify the administrative burden of running a healthcare practice while providing the highest level of convenience, accuracy, and security.

CureMD

CureMD helps with claim managment after medical services.

CureMD is an electronic medical billing software that provides integrated revenue cycle management, patient engagement tools, and practice management solutions. It features flexible cloud-based and on-premise deployment options allowing care providers to tailor the software to fit their specific needs. Plus, it offers a range of HIPAA-compliant functionalities such as claims submission and analytics for more informed decisions.

AdvancedMD

Advanced MD can work with EHR to process intake and consent forms.

AdvancedMD is an all-in-one electronic medical records and billing platform designed for small and medium practices. It offers affordable subscription plans with easy-to-use claims processing, cost tracking, patient scheduling, and other administrative tasks. With its intuitive user interface and powerful reporting capabilities, AdvancedMD is helping make managing medical records easier than ever before.

Mahler Health

Mahler Health can transfer electronic data interchange documents

Mahler Health's end-to-end enterprise service leverages innovative technologies such as machine learning, natural language processing, artificial intelligence, robotics automation, and visual recognition. This provides intelligent digital assistant capabilities coupled with powerful dynamic algorithms for predictive prescribing, imaging orders, diagnostics extraction, radiology, etc.

FAQ

 

Claims management software is a technology solution designed to help healthcare providers and insurance companies manage the complex process of processing and tracking healthcare claims. The software streamlines the claims process by automating many of the manual tasks involved, such as verifying patient eligibility, submitting claims to insurance companies, and tracking payments.

A claims processing solution also helps reduce errors and improve accuracy by standardizing the coding and billing process. This technology solution can help healthcare providers save time and resources, as well as improve patient satisfaction by a claims processing solution providing faster claim resolution and reducing the number of denied claims.

 

The medical claims management process involves the submission, processing, and payment of healthcare claims by healthcare providers and insurance companies.

It begins when a patient receives medical treatment from a healthcare provider, who then submits a claim to the patient's insurance company for reimbursement. The insurance company then processes the claim by verifying patient eligibility, determining coverage, and calculating payment.

If there are any errors or discrepancies in the claim, it may be denied or returned for further information. Once the claim is approved, payment is made to the healthcare provider. The medical claims management process can be complex and time-consuming, which is why many healthcare providers and insurance companies use specialized software to automate and streamline the process.

 

A medical claims manager is responsible for overseeing the entire medical claims management process. They work for healthcare providers or insurance companies and are responsible for ensuring that claims are processed accurately and efficiently.

Medical claims managers review and analyze claims data to identify trends and patterns, and work to improve the claims management process to reduce errors and improve efficiency. They also work closely with healthcare providers and insurance companies to resolve any issues or disputes that arise during the claims process.

Medical claims managers must stay up to date on changing regulations and policies related to healthcare claims management and ensure that their organizations are in compliance with all relevant laws and regulations.

 

The cost of claims management software varies depending on a variety of factors, such as the size of the organization, the features, and capabilities of the software, and whether the software is purchased as a one-time license or as a subscription service.

Some basic claims management software can be purchased for a few hundred dollars, while more advanced solutions can cost several thousand dollars or more. In addition to the initial cost, there may be ongoing quality control maintenance and support fees associated with the software. Organizations should carefully evaluate their needs and budget before selecting a claims processing solution.

 

Health insurance claims are processed by insurance companies, which are responsible for determining the eligibility of the patient and the coverage of the medical service or treatment.

When a patient receives medical treatment from a healthcare provider, the provider submits a claim to the patient's insurance company for reimbursement. The insurance company then processes the claim by reviewing the medical records and verifying the patient's eligibility and the services provided. They then determine the payment amount and either approve or deny the claim.

In the event of a denial or dispute, the healthcare provider or patient may appeal the decision to the insurance company. The insurance company is ultimately responsible for paying the healthcare provider for covered medical services.

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Stephen Beer is a Content Writer at Clarity Ventures and has written about various tech industries for nearly a decade. He is determined to demystify HIPAA, integration, enterpise SEO, and eCommerce with easy-to-read, easy-to-understand articles to help businesses make the best decisions.