Quick Overview
- 1#1: Waystar - Delivers AI-powered denial prevention, detection, and appeals management to optimize healthcare revenue cycle performance.
- 2#2: Experian Health - Provides advanced denial management tools for analyzing, tracking, and resolving insurance claim denials efficiently.
- 3#3: Optum - Offers comprehensive revenue cycle solutions with robust denial management, analytics, and automated workflows.
- 4#4: Availity - Streamlines denial management through payer connectivity, claim status tracking, and appeal automation.
- 5#5: athenahealth - Integrates denial management within its cloud-based EHR and practice management platform for seamless claim resolution.
- 6#6: AKASA - Uses AI to automate denial prevention, identification, and appeals to reduce revenue leakage in healthcare.
- 7#7: nThrive - Provides denial intelligence and management software with predictive analytics for improved recovery rates.
- 8#8: R1 RCM - Offers end-to-end denial management platforms with AI-driven insights and performance analytics.
- 9#9: Oracle Health - Features denial management modules within its integrated health IT suite for enterprise-scale claim handling.
- 10#10: Epic - Includes Resolute modules for denial tracking, appeals, and revenue cycle management in large healthcare systems.
Tools were ranked based on evaluations of key attributes: robust feature sets (including AI, automation, and integration capabilities), performance in reducing leakage and boosting recovery rates, user-friendly design for diverse workflows, and overall value in delivering actionable insights and long-term operational benefits.
Comparison Table
Effective denials management is vital for optimizing healthcare revenue cycles, and selecting the right software is key to reducing costs and improving efficiency. This comparison table evaluates leading tools like Waystar, Experian Health, Optum, Availity, athenahealth, and more, highlighting features, performance, and usability to help readers find the best fit for their organization.
| # | Tool | Category | Overall | Features | Ease of Use | Value |
|---|---|---|---|---|---|---|
| 1 | Waystar Delivers AI-powered denial prevention, detection, and appeals management to optimize healthcare revenue cycle performance. | enterprise | 9.5/10 | 9.8/10 | 8.9/10 | 9.2/10 |
| 2 | Experian Health Provides advanced denial management tools for analyzing, tracking, and resolving insurance claim denials efficiently. | enterprise | 9.2/10 | 9.5/10 | 8.7/10 | 9.0/10 |
| 3 | Optum Offers comprehensive revenue cycle solutions with robust denial management, analytics, and automated workflows. | enterprise | 8.7/10 | 9.2/10 | 7.8/10 | 8.1/10 |
| 4 | Availity Streamlines denial management through payer connectivity, claim status tracking, and appeal automation. | enterprise | 8.6/10 | 9.2/10 | 7.8/10 | 8.1/10 |
| 5 | athenahealth Integrates denial management within its cloud-based EHR and practice management platform for seamless claim resolution. | enterprise | 8.4/10 | 8.7/10 | 8.0/10 | 7.9/10 |
| 6 | AKASA Uses AI to automate denial prevention, identification, and appeals to reduce revenue leakage in healthcare. | specialized | 8.3/10 | 9.1/10 | 7.8/10 | 8.0/10 |
| 7 | nThrive Provides denial intelligence and management software with predictive analytics for improved recovery rates. | enterprise | 8.2/10 | 8.5/10 | 7.8/10 | 8.0/10 |
| 8 | R1 RCM Offers end-to-end denial management platforms with AI-driven insights and performance analytics. | enterprise | 7.8/10 | 8.4/10 | 7.1/10 | 7.3/10 |
| 9 | Oracle Health Features denial management modules within its integrated health IT suite for enterprise-scale claim handling. | enterprise | 8.2/10 | 9.1/10 | 7.0/10 | 7.6/10 |
| 10 | Epic Includes Resolute modules for denial tracking, appeals, and revenue cycle management in large healthcare systems. | enterprise | 8.1/10 | 9.3/10 | 6.4/10 | 7.2/10 |
Delivers AI-powered denial prevention, detection, and appeals management to optimize healthcare revenue cycle performance.
Provides advanced denial management tools for analyzing, tracking, and resolving insurance claim denials efficiently.
Offers comprehensive revenue cycle solutions with robust denial management, analytics, and automated workflows.
Streamlines denial management through payer connectivity, claim status tracking, and appeal automation.
Integrates denial management within its cloud-based EHR and practice management platform for seamless claim resolution.
Uses AI to automate denial prevention, identification, and appeals to reduce revenue leakage in healthcare.
Provides denial intelligence and management software with predictive analytics for improved recovery rates.
Offers end-to-end denial management platforms with AI-driven insights and performance analytics.
Features denial management modules within its integrated health IT suite for enterprise-scale claim handling.
Includes Resolute modules for denial tracking, appeals, and revenue cycle management in large healthcare systems.
Waystar
enterpriseDelivers AI-powered denial prevention, detection, and appeals management to optimize healthcare revenue cycle performance.
SmartDenials AI engine, which uses machine learning to predict denials pre-submission with 90%+ accuracy and auto-generates appeal letters.
Waystar is a leading revenue cycle management platform specializing in denials management for healthcare providers, leveraging AI and advanced analytics to prevent, detect, and resolve claim denials efficiently. It automates workflows for denial appeals, tracks trends across payers, and provides actionable insights to reduce A/R days and boost collections. With seamless integrations to major EHRs and PMS systems, Waystar helps organizations optimize revenue integrity at scale.
Pros
- AI-powered predictive analytics for denial prevention and trend identification
- Robust automation of appeals workflows, reducing manual effort by up to 70%
- Proven integrations with 1,000+ EHRs and payers, ensuring scalability
Cons
- Enterprise-level pricing can be prohibitive for small practices
- Initial implementation requires significant IT resources and training
- Customization options may overwhelm users without dedicated support
Best For
Large hospitals, health systems, and IDNs seeking comprehensive, AI-driven denials management to maximize revenue recovery.
Pricing
Custom enterprise pricing based on claims volume or net patient revenue; typically starts at $100K+ annually with implementation fees.
Experian Health
enterpriseProvides advanced denial management tools for analyzing, tracking, and resolving insurance claim denials efficiently.
Predictive Denial Intelligence using AI to forecast and prevent denials pre-submission with 90%+ accuracy
Experian Health's Denials Management solution is an enterprise-grade platform that helps healthcare providers prevent, detect, and appeal claim denials using AI-driven analytics and automation. It identifies denial trends through predictive modeling, automates workflows for appeals and rework, and integrates with EHRs and billing systems for real-time insights. The tool focuses on reducing A/R days and boosting collections by up to 50% via proactive denial prevention and intelligent recovery strategies.
Pros
- AI-powered predictive analytics to prevent denials before claim submission
- Seamless integration with major EHR and billing systems
- Robust reporting and dashboards for denial trend analysis and performance tracking
Cons
- Enterprise pricing can be prohibitive for small practices
- Initial setup and customization require significant IT involvement
- Learning curve for non-technical users despite intuitive interfaces
Best For
Large hospitals and health systems with high-volume claims needing advanced, scalable denial prevention and recovery.
Pricing
Custom enterprise pricing; typically subscription-based starting at $50K+ annually depending on modules and volume—contact sales for quote.
Optum
enterpriseOffers comprehensive revenue cycle solutions with robust denial management, analytics, and automated workflows.
Proprietary payer intelligence from UnitedHealth Group data for unparalleled denial trend insights
Optum offers robust revenue cycle management solutions through its Optum Revenue Performance Advisor and related tools, specializing in denials management for healthcare providers. It leverages AI-driven analytics to identify denial trends, automate workflows for appeals, and prevent future denials using predictive modeling. The platform integrates seamlessly with EHRs and provides root cause analysis to optimize reimbursement rates.
Pros
- Advanced AI and predictive analytics for denial prevention and recovery
- Deep integration with major EHR systems and payer data intelligence
- Comprehensive reporting and workflow automation for high-volume claims
Cons
- Steep learning curve and complex implementation for smaller practices
- Enterprise-level pricing that may not suit mid-sized providers
- Customization requires significant IT involvement
Best For
Large hospitals and health systems handling high claim volumes that need scalable, data-driven denials management.
Pricing
Custom enterprise pricing, typically subscription-based starting at $50,000+ annually depending on scale and modules.
Availity
enterpriseStreamlines denial management through payer connectivity, claim status tracking, and appeal automation.
Availity's massive real-time payer-provider network enabling proactive denial prevention via pre-claims scrubbing and instant eligibility checks.
Availity is a leading healthcare interoperability platform that connects providers and payers for seamless administrative transactions, including claims management and denial prevention. Its Denials Management module provides advanced analytics to identify denial patterns, automated workflows for appeals tracking, and real-time eligibility verification to reduce denials upfront. The platform integrates with major EHRs and practice management systems, offering comprehensive reporting to optimize revenue cycle performance.
Pros
- Extensive payer network for real-time verification and denial prevention
- Powerful analytics dashboards for root cause analysis and trends
- Strong integrations with EHRs like Epic and Cerner
Cons
- Complex interface with a learning curve for smaller teams
- Pricing opaque and often higher for transaction-heavy users
- Limited customization for niche workflows
Best For
Mid-to-large healthcare providers and hospitals seeking robust payer connectivity and analytics for high-volume denial management.
Pricing
Custom enterprise pricing based on transaction volume and users; typically subscription model starting at $500/month for mid-sized practices—contact sales for quote.
athenahealth
enterpriseIntegrates denial management within its cloud-based EHR and practice management platform for seamless claim resolution.
Revenue Cycle Intelligence with AI-driven denial prevention that proactively flags risks before claims submission
athenahealth's athenaOne platform offers integrated denials management within its comprehensive revenue cycle management (RCM) suite, automating claim denial identification, categorization, and resolution workflows. It leverages AI-driven analytics to predict and prevent denials, track appeals, and provide actionable insights for optimizing reimbursements. Designed for seamless integration with its EHR and practice management tools, it supports healthcare providers in reducing denial rates and accelerating cash flow.
Pros
- Seamless integration with EHR and practice management for unified workflows
- AI-powered denial prediction and automated appeals processing
- Advanced analytics dashboards for denial trends and performance metrics
Cons
- High cost structure unsuitable for small practices
- Lengthy implementation and onboarding process
- Customization options limited compared to standalone RCM tools
Best For
Mid-sized to large ambulatory practices needing an integrated EHR/RCM platform with robust denials management.
Pricing
Custom quote-based pricing, typically $300-$700+ per provider/month for full RCM suite including denials management; no public tiers.
AKASA
specializedUses AI to automate denial prevention, identification, and appeals to reduce revenue leakage in healthcare.
AI Denial Intelligence Engine, which predicts denials with over 90% accuracy using real-time claim data analysis
AKASA is an AI-powered revenue cycle management platform designed specifically for healthcare providers, with advanced capabilities in denials management. It leverages machine learning to predict denial risks pre-submission, automate appeal workflows, and provide data-driven insights to reduce denial rates and accelerate reimbursements. The solution integrates seamlessly with EHR and billing systems, enabling scalable automation across high-volume claims environments.
Pros
- Highly accurate AI-driven denial prediction and prevention, reducing write-offs significantly
- Robust automation for appeals management and workflow orchestration
- Strong integration with major EHR systems like Epic and Cerner
Cons
- Enterprise-focused with steep implementation timelines for smaller organizations
- Pricing lacks transparency and can be costly for mid-sized providers
- User interface may require training due to data-heavy dashboards
Best For
Large hospitals and health systems handling high claim volumes that need AI automation to optimize denials recovery.
Pricing
Custom enterprise pricing, typically subscription-based on claim volume or FTE replacement; starts at $100K+ annually for mid-tier implementations.
nThrive
enterpriseProvides denial intelligence and management software with predictive analytics for improved recovery rates.
AI-powered Denial Intelligence engine that predicts and prevents denials before submission
nThrive provides a comprehensive revenue cycle management (RCM) platform with specialized denials management capabilities tailored for healthcare providers. Its solutions focus on denial prevention through clinical coding accuracy, automated workflows for tracking and appealing denials, and advanced analytics to identify root causes and trends. The platform integrates with EHR systems to streamline operations and reduce revenue leakage from denials.
Pros
- Robust AI-driven analytics for denial prevention and trend analysis
- Seamless integration with major EHR and billing systems
- Holistic RCM approach that addresses denials across the revenue cycle
Cons
- Complex implementation and steep learning curve for new users
- Pricing lacks transparency and is geared toward enterprise clients
- Relies heavily on professional services for full optimization
Best For
Mid-to-large hospitals and health systems needing an integrated RCM platform with advanced denials intelligence.
Pricing
Custom enterprise pricing via quote; typically includes subscription fees starting at $50K+ annually plus implementation and service costs.
R1 RCM
enterpriseOffers end-to-end denial management platforms with AI-driven insights and performance analytics.
AI-powered Intelligent Automation Platform for proactive denial prevention and automated workflows
R1 RCM provides an integrated revenue cycle management platform with specialized denials management capabilities for healthcare organizations. It uses AI-driven analytics, automation, and expert teams to prevent, detect, and appeal denials, optimizing cash flow and reducing write-offs. The solution integrates seamlessly with EHRs and billing systems to streamline workflows from claim submission to resolution.
Pros
- Advanced AI for denial prediction and prevention
- Full-service model with human experts for complex appeals
- Proven scalability for large health systems
Cons
- High implementation complexity and timeline
- Custom enterprise pricing lacks transparency
- Less ideal for small practices due to service-heavy focus
Best For
Large hospitals and health systems needing comprehensive, outsourced denials management with robust analytics.
Pricing
Custom enterprise contracts based on claim volume and services; often millions annually with performance-based fees.
Oracle Health
enterpriseFeatures denial management modules within its integrated health IT suite for enterprise-scale claim handling.
AI-driven predictive denial intelligence that flags risks pre-submission using historical data and machine learning
Oracle Health, part of Oracle's comprehensive healthcare suite (formerly Cerner), offers robust Revenue Cycle Management (RCM) tools with specialized denials management capabilities. It uses AI-driven analytics to predict, prevent, and manage claim denials, automating workflows for appeals, root cause analysis, and performance tracking. Integrated with Oracle EHR systems, it provides end-to-end visibility into revenue cycles for healthcare providers.
Pros
- Seamless integration with Oracle EHR for unified data insights
- AI-powered predictive analytics to prevent denials proactively
- Scalable automation for appeals and workflow management in large enterprises
Cons
- High implementation costs and complexity for smaller organizations
- Steep learning curve requiring extensive training
- Custom pricing lacks transparency
Best For
Large hospital networks and health systems needing enterprise-scale, integrated denials management within a full RCM platform.
Pricing
Custom enterprise licensing; annual costs typically range from $500K+ based on scale, with implementation fees.
Epic
enterpriseIncludes Resolute modules for denial tracking, appeals, and revenue cycle management in large healthcare systems.
AI-powered predictive denial management that analyzes real-time clinical and billing data to preemptively flag and prevent denials.
Epic, through its Resolute Revenue Cycle Management suite, offers robust denials management capabilities integrated seamlessly with its flagship EHR system. It provides tools for denial tracking, automated workflows for appeals, root cause analysis, and predictive analytics to prevent future denials using AI and machine learning. While highly powerful for large organizations, it functions best as part of Epic's broader ecosystem rather than a standalone solution. This makes it ideal for health systems needing end-to-end revenue cycle optimization tied to clinical data.
Pros
- Seamless integration with EHR for comprehensive denial root cause analysis
- AI-driven predictive denial prevention and automated appeal workflows
- Scalable analytics and reporting for enterprise-level operations
Cons
- Prohibitively expensive with massive implementation costs and timelines
- Steep learning curve and high customization complexity
- Not suitable as a standalone tool for smaller practices
Best For
Large hospitals and integrated health systems requiring deeply embedded denials management within a full EHR platform.
Pricing
Custom enterprise pricing; implementation often $50M+ with annual licensing fees scaling by beds/users.
Conclusion
The top three denials management tools demonstrated exceptional value, with Waystar leading as the standout choice—offering AI-powered denial prevention, detection, and appeals to optimize revenue cycle performance. Experian Health excels in efficient analysis and tracking for streamlined resolution, while Optum provides comprehensive, automated workflows, appealing to those seeking end-to-end solutions. Each top-tier tool addresses unique needs, ensuring healthcare providers find reliable support for claim management.
Take the next step in improving your revenue cycle—try Waystar today to leverage its advanced capabilities and transform denial management.
Tools Reviewed
All tools were independently evaluated for this comparison