Quick Overview
- 1#1: Waystar - Provides AI-powered revenue cycle management that automates claims processing, scrubbing, submission, and denial management to maximize reimbursements.
- 2#2: Availity - Offers a secure healthcare connectivity platform for real-time claims status, eligibility verification, and electronic submission across payers.
- 3#3: Change Healthcare - Delivers comprehensive claims processing and clearinghouse services with advanced analytics for efficient adjudication and payment acceleration.
- 4#4: Athenahealth - Integrates claims management within its cloud-based EHR and practice management system for seamless submission and revenue cycle optimization.
- 5#5: Experian Health - Specializes in patient access and claims solutions with robust verification, scrubbing, and denial prevention tools for healthcare providers.
- 6#6: Quadax - Supports end-to-end revenue cycle management with automated claims editing, multi-payer submission, and AR follow-up capabilities.
- 7#7: Kareo - Streamlines medical billing and claims management for independent practices with intelligent scrubbing and one-click submission features.
- 8#8: AdvancedMD - Offers practice management software with integrated claims clearinghouse services for error-free submissions and faster payments.
- 9#9: OfficeAlly - Provides a cost-effective web-based clearinghouse for electronic claims filing, tracking, and ERA posting without monthly fees.
- 10#10: PracticeSuite - Delivers cloud-based RCM software focused on claims processing, denial management, and analytics for specialty practices.
These tools were selected and ranked based on key metrics including automation capabilities, integration flexibility, user experience, denial management effectiveness, and overall value, ensuring a curated list of industry-leading solutions.
Comparison Table
Healthcare claims management software is vital for optimizing workflows, and this comparison table explores top tools like Waystar, Availity, Change Healthcare, Athenahealth, Experian Health, and more. It guides readers through key features and capabilities, helping them identify the right solution for their organization's needs.
| # | Tool | Category | Overall | Features | Ease of Use | Value |
|---|---|---|---|---|---|---|
| 1 | Waystar Provides AI-powered revenue cycle management that automates claims processing, scrubbing, submission, and denial management to maximize reimbursements. | enterprise | 9.6/10 | 9.8/10 | 9.2/10 | 9.4/10 |
| 2 | Availity Offers a secure healthcare connectivity platform for real-time claims status, eligibility verification, and electronic submission across payers. | enterprise | 9.2/10 | 9.5/10 | 8.4/10 | 8.9/10 |
| 3 | Change Healthcare Delivers comprehensive claims processing and clearinghouse services with advanced analytics for efficient adjudication and payment acceleration. | enterprise | 8.8/10 | 9.2/10 | 7.6/10 | 8.4/10 |
| 4 | Athenahealth Integrates claims management within its cloud-based EHR and practice management system for seamless submission and revenue cycle optimization. | enterprise | 8.7/10 | 9.2/10 | 7.8/10 | 8.0/10 |
| 5 | Experian Health Specializes in patient access and claims solutions with robust verification, scrubbing, and denial prevention tools for healthcare providers. | enterprise | 8.7/10 | 9.2/10 | 8.0/10 | 8.4/10 |
| 6 | Quadax Supports end-to-end revenue cycle management with automated claims editing, multi-payer submission, and AR follow-up capabilities. | enterprise | 8.2/10 | 8.7/10 | 7.4/10 | 7.9/10 |
| 7 | Kareo Streamlines medical billing and claims management for independent practices with intelligent scrubbing and one-click submission features. | specialized | 8.2/10 | 8.6/10 | 8.0/10 | 7.7/10 |
| 8 | AdvancedMD Offers practice management software with integrated claims clearinghouse services for error-free submissions and faster payments. | enterprise | 8.3/10 | 8.8/10 | 7.6/10 | 7.9/10 |
| 9 | OfficeAlly Provides a cost-effective web-based clearinghouse for electronic claims filing, tracking, and ERA posting without monthly fees. | specialized | 8.1/10 | 8.4/10 | 7.6/10 | 9.2/10 |
| 10 | PracticeSuite Delivers cloud-based RCM software focused on claims processing, denial management, and analytics for specialty practices. | specialized | 7.9/10 | 8.4/10 | 7.4/10 | 7.7/10 |
Provides AI-powered revenue cycle management that automates claims processing, scrubbing, submission, and denial management to maximize reimbursements.
Offers a secure healthcare connectivity platform for real-time claims status, eligibility verification, and electronic submission across payers.
Delivers comprehensive claims processing and clearinghouse services with advanced analytics for efficient adjudication and payment acceleration.
Integrates claims management within its cloud-based EHR and practice management system for seamless submission and revenue cycle optimization.
Specializes in patient access and claims solutions with robust verification, scrubbing, and denial prevention tools for healthcare providers.
Supports end-to-end revenue cycle management with automated claims editing, multi-payer submission, and AR follow-up capabilities.
Streamlines medical billing and claims management for independent practices with intelligent scrubbing and one-click submission features.
Offers practice management software with integrated claims clearinghouse services for error-free submissions and faster payments.
Provides a cost-effective web-based clearinghouse for electronic claims filing, tracking, and ERA posting without monthly fees.
Delivers cloud-based RCM software focused on claims processing, denial management, and analytics for specialty practices.
Waystar
enterpriseProvides AI-powered revenue cycle management that automates claims processing, scrubbing, submission, and denial management to maximize reimbursements.
RevView AI platform for predictive denial intelligence and automated workflows that proactively prevents revenue leakage.
Waystar is a leading cloud-based revenue cycle management platform designed specifically for healthcare providers, focusing on end-to-end claims management. It automates claims submission, scrubbing, tracking, and adjudication across payers, while integrating denial management, patient payments, and analytics to maximize revenue capture. With AI-powered tools and extensive payer connectivity, it streamlines workflows for hospitals, health systems, and physician practices, achieving industry-leading first-pass resolution rates.
Pros
- Superior automation and AI for claims scrubbing and denial prevention, boasting 98%+ clean claims rates
- Seamless integrations with major EHRs like Epic and Cerner, plus 2,000+ payer connections
- Robust analytics dashboard with real-time revenue insights and benchmarking
Cons
- Enterprise pricing can be steep for smaller practices
- Initial implementation requires significant IT involvement and customization
- Advanced features have a learning curve despite intuitive UI
Best For
Large hospitals, health systems, and multi-specialty groups needing scalable, high-volume claims processing with advanced analytics.
Pricing
Custom enterprise pricing, typically subscription-based with per-claim fees or revenue share models starting at $50K+ annually based on volume.
Availity
enterpriseOffers a secure healthcare connectivity platform for real-time claims status, eligibility verification, and electronic submission across payers.
Availity Network, the largest U.S. healthcare connectivity hub enabling real-time data exchange with virtually all major payers.
Availity is a leading healthcare platform that serves as a secure network for providers and payers to exchange administrative and clinical data, with a strong focus on claims management. It enables electronic claims submission, real-time eligibility verification, remittance processing, and denial management to optimize revenue cycles. The solution integrates with EHRs and practice management systems, supporting end-to-end billing workflows for healthcare organizations.
Pros
- Extensive payer network connecting to over 3,000 payers including 90%+ of U.S. market
- Comprehensive tools for claims submission, tracking, ERA processing, and analytics
- Robust HIPAA-compliant security and seamless EHR integrations
Cons
- Steep learning curve for smaller practices without dedicated IT support
- Custom pricing lacks transparency and can be costly for low-volume users
- Customer support response times can vary during peak periods
Best For
Mid-to-large healthcare providers, hospitals, and billing companies needing scalable, high-volume claims processing with broad payer connectivity.
Pricing
Custom enterprise pricing based on transaction volume and features; typically subscription tiers starting at $500/month for basics, with per-claim fees; contact sales for quotes.
Change Healthcare
enterpriseDelivers comprehensive claims processing and clearinghouse services with advanced analytics for efficient adjudication and payment acceleration.
Unparalleled scale with connectivity to 100% of U.S. payers for real-time eligibility checks and claims status updates
Change Healthcare provides a robust suite of tools for healthcare claims management, including electronic claims submission, advanced editing and scrubbing, eligibility verification, and remittance processing. It supports end-to-end revenue cycle management by connecting providers to a vast network of payers, handling billions of transactions annually to minimize denials and speed up payments. The platform integrates seamlessly with EHRs and practice management systems, offering analytics for denial trends and compliance reporting.
Pros
- Extensive payer connectivity covering nearly all U.S. payers
- High-volume processing capability with billions of claims handled yearly
- Advanced denial management and predictive analytics to reduce errors
Cons
- Complex interface requiring significant training for full utilization
- Custom pricing can be expensive for small practices
- Integration setup may involve lengthy onboarding
Best For
Large hospitals, health systems, and revenue cycle management firms processing high volumes of claims.
Pricing
Enterprise-level custom pricing, typically subscription-based with fees per claim, user, or transaction volume.
Athenahealth
enterpriseIntegrates claims management within its cloud-based EHR and practice management system for seamless submission and revenue cycle optimization.
AthenaCollector’s AI-driven claims intelligence for proactive denial prevention and revenue recovery
Athenahealth is a cloud-based, all-in-one healthcare platform that excels in revenue cycle management, including automated claims submission, scrubbing, eligibility verification, and denial management to optimize reimbursements. It integrates seamlessly with its EHR and practice management tools, providing real-time analytics and reporting for efficient claims processing workflows. Designed for ambulatory practices, it reduces administrative burdens through AI-driven insights and patient payment solutions.
Pros
- Advanced claims scrubbing engine with high first-pass acceptance rates (often >95%)
- Seamless EHR integration for streamlined workflows and reduced errors
- Robust analytics and denial management tools with AI-powered predictions
Cons
- High implementation costs and lengthy onboarding process
- Interface can feel dated and overwhelming for smaller practices
- Custom pricing lacks transparency and can be expensive for solo providers
Best For
Mid-sized to large medical practices needing integrated EHR and claims management with strong automation.
Pricing
Custom subscription pricing starting at ~$400/provider/month, plus setup fees; scales with practice size and modules.
Experian Health
enterpriseSpecializes in patient access and claims solutions with robust verification, scrubbing, and denial prevention tools for healthcare providers.
Health Passport identity management, using Experian's vast consumer data for accurate patient matching and fraud prevention in claims.
Experian Health provides a robust revenue cycle management platform specializing in healthcare claims management, automating EDI claims submission, scrubbing, and adjudication to minimize denials and accelerate reimbursements. The solution integrates seamlessly with EHRs and practice management systems, offering real-time eligibility verification, patient identity resolution, and advanced analytics for optimizing billing workflows. It leverages Experian's extensive data assets to enhance accuracy and compliance in claims processing across hospitals and provider networks.
Pros
- Advanced claims scrubbing and AI-driven denial prediction reduce errors and resubmissions
- Seamless integration with major EHRs and payers for efficient workflows
- Comprehensive analytics and reporting for revenue optimization
Cons
- Enterprise-level pricing may be prohibitive for small practices
- Steep learning curve and lengthy implementation for complex setups
- Limited flexibility in customization for niche payer requirements
Best For
Mid-to-large hospitals and health systems needing scalable, data-driven claims management with strong fraud prevention.
Pricing
Custom enterprise pricing based on claim volume, revenue share, or subscription tiers starting at $10,000+ annually.
Quadax
enterpriseSupports end-to-end revenue cycle management with automated claims editing, multi-payer submission, and AR follow-up capabilities.
AI-driven Intelligent Claims Scrubbing that proactively identifies and corrects errors before submission
Quadax is a comprehensive revenue cycle management platform designed specifically for healthcare providers, focusing on automating claims processing, submission, and denial management. It offers an integrated EDI clearinghouse, advanced claims scrubbing, and analytics to optimize reimbursements and reduce denials. The solution supports hospitals, laboratories, and physician groups with seamless integration into existing EHR systems.
Pros
- Advanced claims scrubbing and editing reduce denials and improve first-pass acceptance rates
- Robust denial management with root cause analysis and automated workflows
- Comprehensive analytics and reporting for revenue cycle optimization
Cons
- Steep learning curve and complex implementation for smaller practices
- Pricing is custom and opaque, often geared toward larger enterprises
- Limited customization options for unique payer requirements without additional support
Best For
Mid-sized to large healthcare organizations such as hospitals and labs seeking an end-to-end claims management solution with strong denial prevention.
Pricing
Custom quote-based pricing, typically subscription model based on claims volume or revenue percentage; contact for demo.
Kareo
specializedStreamlines medical billing and claims management for independent practices with intelligent scrubbing and one-click submission features.
Intelligent Claims Scrubber that achieves industry-leading clean claim rates and proactive denial prevention
Kareo is a cloud-based healthcare platform specializing in revenue cycle management, with robust tools for claims submission, scrubbing, tracking, and denial resolution. It integrates seamlessly with EHR and practice management systems to automate workflows and improve cash flow for medical practices. Designed primarily for independent providers, it offers real-time eligibility verification and ERA auto-posting to minimize errors and accelerate reimbursements.
Pros
- High clean claims rate (up to 99%) reducing denials
- Automated denial management and appeals workflow
- Real-time eligibility checks and patient payment estimates
Cons
- Pricing can be steep for very small practices
- Some users report a learning curve for advanced reporting
- Limited customization options compared to enterprise solutions
Best For
Independent medical practices and small to mid-sized groups seeking integrated claims management with strong automation.
Pricing
Subscription-based starting at $155/provider/month, with revenue cycle management options on a percentage-of-collections basis (typically 4-7%).
AdvancedMD
enterpriseOffers practice management software with integrated claims clearinghouse services for error-free submissions and faster payments.
Intelligent claims scrubbing engine that automatically detects and corrects errors pre-submission for high first-pass acceptance rates.
AdvancedMD is a comprehensive cloud-based practice management and EHR platform with robust healthcare claims management tools designed for medical practices. It streamlines electronic claims submission, scrubbing, eligibility verification, and denial management to accelerate reimbursements and reduce errors. The software integrates claims processing with patient billing, scheduling, and reporting for efficient revenue cycle management.
Pros
- Advanced claims scrubbing reduces rejections significantly
- Seamless integration with major clearinghouses and EHR
- Comprehensive denial management and analytics tools
Cons
- Steep learning curve for full utilization
- Pricing can be high for smaller practices
- Occasional customer support delays
Best For
Mid-sized to large medical practices seeking an integrated claims management solution within a full practice management suite.
Pricing
Custom pricing starting at around $400-$600 per provider per month, plus setup fees and add-ons for advanced features.
OfficeAlly
specializedProvides a cost-effective web-based clearinghouse for electronic claims filing, tracking, and ERA posting without monthly fees.
Pay-per-claim model with no monthly fees or minimums, making it ideal for low-volume practices
OfficeAlly is a web-based healthcare claims clearinghouse designed for medical practices to submit electronic claims (837), perform real-time eligibility verification, and manage remittances (835/ERA). It offers claims scrubbing to minimize denials, patient payment portals, and integration with various practice management systems. The platform emphasizes cost-efficiency with no upfront fees and supports thousands of payers nationwide.
Pros
- Extremely cost-effective with per-claim pricing and no monthly minimums
- Reliable claims transmission to over 4,000 payers with scrubbing
- Free real-time eligibility checks and patient payment tools
Cons
- Dated user interface that feels clunky for some users
- Limited advanced reporting and analytics compared to enterprise solutions
- Customer support can be slow during peak times
Best For
Small to mid-sized independent medical practices seeking affordable, no-frills claims processing without long-term contracts.
Pricing
Free signup; $0.19-$0.25 per submitted claim, with optional subscriptions from $39/month for higher volume or advanced features.
PracticeSuite
specializedDelivers cloud-based RCM software focused on claims processing, denial management, and analytics for specialty practices.
Rules-based claims scrubbing that identifies and corrects errors before submission for up to 99% clean claims
PracticeSuite is a cloud-based healthcare software platform specializing in revenue cycle management (RCM) with robust claims management capabilities for medical practices. It automates electronic claims submission, scrubbing, eligibility verification, and denial management to minimize errors and speed up reimbursements. The solution integrates practice management, EHR, scheduling, and patient billing into a unified system, supporting various specialties.
Pros
- Powerful claims scrubbing engine with high first-pass acceptance rates
- Integrated denial management and AR recovery tools
- Seamless connectivity with major payers and clearinghouses
Cons
- Dated user interface requiring some training
- Customer support can be inconsistent
- Pricing lacks transparency without a demo
Best For
Mid-sized medical practices needing an all-in-one RCM solution for efficient claims processing and billing.
Pricing
Custom quote-based pricing, typically $250-$500 per provider/month depending on practice size and modules.
Conclusion
The reviewed healthcare claims management software tools span diverse needs, from AI-powered end-to-end automation to cost-effective specialty support, highlighting a robust landscape. Waystar leads as the top choice, with its comprehensive AI-driven revenue cycle management streamlining processing, scrubbing, and denial management to maximize reimbursements. Availity and Change Healthcare stand out as strong alternatives: Availity for secure real-time payer connectivity, and Change Healthcare for advanced analytics and adjudication acceleration, each suited to distinct operational priorities. For providers seeking a high-performing, holistic solution, Waystar is the clear leader, though all three deliver significant value.
Begin optimizing your claims management today—explore Waystar to unlock automated, efficient processes and boost your practice’s reimbursements.
Tools Reviewed
All tools were independently evaluated for this comparison