Quick Overview
- 1#1: Cotiviti - Delivers AI-powered medical bill review, claims auditing, and payment integrity solutions to detect overpayments and ensure compliance.
- 2#2: Optum - Provides comprehensive payment integrity and medical bill review tools with advanced editing rules and analytics for payers.
- 3#3: MultiPlan - Offers robust medical bill repricing, review, and negotiation software to optimize payments and reduce costs.
- 4#4: Verisk - Utilizes predictive analytics and AI for precise medical bill review, fraud detection, and utilization management.
- 5#5: Change Healthcare - Powers claims adjudication and medical bill review platforms with real-time editing and compliance checks.
- 6#6: TechRx - Specializes in automated medical bill review software for identifying billing errors and overcharges efficiently.
- 7#7: Plexus - Provides claims auditing and medical bill review software focused on accuracy and recovery for healthcare payers.
- 8#8: MedCombs - Offers web-based medical bill review and auditing tools for streamlined analysis and reporting.
- 9#9: ClaimDOC - Delivers independent medical bill review software with detailed audits and expert analysis capabilities.
- 10#10: MRIoNY - Focuses on Medicare Secondary Payer bill review software for compliance and cost recovery.
We prioritized tools based on advanced functionality—including AI and analytics—accuracy in detecting overpayments and errors, user experience, and overall value in driving compliance and financial performance.
Comparison Table
Explore a breakdown of leading medical bill review software, including Cotiviti, Optum, MultiPlan, Verisk, Change Healthcare and more, to identify the right fit for your needs. This comparison table highlights key features, performance metrics, and usability, helping readers assess compatibility with their practice or organization's requirements.
| # | Tool | Category | Overall | Features | Ease of Use | Value |
|---|---|---|---|---|---|---|
| 1 | Cotiviti Delivers AI-powered medical bill review, claims auditing, and payment integrity solutions to detect overpayments and ensure compliance. | enterprise | 9.5/10 | 9.8/10 | 8.2/10 | 9.3/10 |
| 2 | Optum Provides comprehensive payment integrity and medical bill review tools with advanced editing rules and analytics for payers. | enterprise | 8.9/10 | 9.4/10 | 8.2/10 | 8.6/10 |
| 3 | MultiPlan Offers robust medical bill repricing, review, and negotiation software to optimize payments and reduce costs. | enterprise | 8.7/10 | 9.2/10 | 7.9/10 | 8.5/10 |
| 4 | Verisk Utilizes predictive analytics and AI for precise medical bill review, fraud detection, and utilization management. | enterprise | 8.4/10 | 9.2/10 | 7.6/10 | 8.1/10 |
| 5 | Change Healthcare Powers claims adjudication and medical bill review platforms with real-time editing and compliance checks. | enterprise | 8.2/10 | 8.7/10 | 7.8/10 | 8.0/10 |
| 6 | TechRx Specializes in automated medical bill review software for identifying billing errors and overcharges efficiently. | specialized | 8.1/10 | 8.5/10 | 7.7/10 | 7.9/10 |
| 7 | Plexus Provides claims auditing and medical bill review software focused on accuracy and recovery for healthcare payers. | specialized | 6.2/10 | 5.8/10 | 7.1/10 | 5.9/10 |
| 8 | MedCombs Offers web-based medical bill review and auditing tools for streamlined analysis and reporting. | specialized | 7.6/10 | 8.1/10 | 7.4/10 | 7.0/10 |
| 9 | ClaimDOC Delivers independent medical bill review software with detailed audits and expert analysis capabilities. | specialized | 7.8/10 | 7.5/10 | 8.2/10 | 8.5/10 |
| 10 | MRIoNY Focuses on Medicare Secondary Payer bill review software for compliance and cost recovery. | specialized | 7.1/10 | 7.4/10 | 6.7/10 | 6.9/10 |
Delivers AI-powered medical bill review, claims auditing, and payment integrity solutions to detect overpayments and ensure compliance.
Provides comprehensive payment integrity and medical bill review tools with advanced editing rules and analytics for payers.
Offers robust medical bill repricing, review, and negotiation software to optimize payments and reduce costs.
Utilizes predictive analytics and AI for precise medical bill review, fraud detection, and utilization management.
Powers claims adjudication and medical bill review platforms with real-time editing and compliance checks.
Specializes in automated medical bill review software for identifying billing errors and overcharges efficiently.
Provides claims auditing and medical bill review software focused on accuracy and recovery for healthcare payers.
Offers web-based medical bill review and auditing tools for streamlined analysis and reporting.
Delivers independent medical bill review software with detailed audits and expert analysis capabilities.
Focuses on Medicare Secondary Payer bill review software for compliance and cost recovery.
Cotiviti
enterpriseDelivers AI-powered medical bill review, claims auditing, and payment integrity solutions to detect overpayments and ensure compliance.
Exemplar Clinical Analytics platform with AI-driven, real-time bill review achieving up to 95% accuracy in overpayment detection
Cotiviti is a comprehensive payment integrity platform designed for healthcare payers, specializing in medical bill review through advanced AI, machine learning, and analytics to identify overpayments, fraud, and coding errors. It automates prospective and retrospective reviews, ensuring accurate reimbursements while integrating seamlessly with existing claims systems. The solution processes millions of claims annually, delivering measurable savings and compliance support for insurers and self-funded employers.
Pros
- Industry-leading AI and ML for precise bill auditing and fraud detection
- Scalable processing for high-volume claims with proven ROI through savings
- Robust integration with payer systems and regulatory compliance tools
Cons
- Enterprise-level pricing may be prohibitive for smaller organizations
- Steep implementation and customization process
- Interface can feel complex for non-technical users
Best For
Large health insurance payers, TPAs, and self-insured employers needing enterprise-grade medical bill review at scale.
Pricing
Custom enterprise pricing, typically subscription-based or per-claim/review volume, starting in the high six figures annually for mid-sized payers.
Optum
enterpriseProvides comprehensive payment integrity and medical bill review tools with advanced editing rules and analytics for payers.
Proprietary Clinician Reviewer network combining AI with expert physician reviews for unmatched accuracy in complex claims
Optum's medical bill review software, part of its comprehensive revenue cycle management suite, uses AI-driven analytics and a vast proprietary database to audit claims, identify overcharges, coding errors, and compliance issues. It supports payers and providers in reducing denials, accelerating reimbursements, and recovering lost revenue through automated reviews and detailed reporting. The platform integrates with EHRs, claims systems, and offers tools for DRG validation and utilization review.
Pros
- Advanced AI and machine learning for precise bill auditing and fraud detection
- Extensive compliance database with real-time coding updates
- Seamless integration with major EHR and billing systems
Cons
- Enterprise-focused pricing can be prohibitive for small practices
- Steep learning curve for non-technical users
- Customization requires significant implementation time
Best For
Large healthcare payers, hospitals, and insurers needing scalable, data-intensive bill review capabilities.
Pricing
Custom enterprise pricing starting at $50,000+ annually, based on volume and modules; subscription model with implementation fees.
MultiPlan
enterpriseOffers robust medical bill repricing, review, and negotiation software to optimize payments and reduce costs.
Data iSight analytics engine leveraging billions of historical claims for precise fair pricing recommendations
MultiPlan is a leading healthcare cost management platform specializing in medical bill review, offering tools for payers to audit claims, detect overbilling, and negotiate payments using a vast proprietary database and provider network. The software includes advanced analytics via Data iSight for identifying payment integrity issues and optimizing reimbursements. It supports health plans, TPAs, and self-insured employers in reducing out-of-network costs through repricing and clinical reviews.
Pros
- Extensive database of over 4 billion claims for accurate benchmarking and fraud detection
- Proven 40-60% average savings on out-of-network bills through negotiation tools
- Integrated analytics dashboard for real-time insights and reporting
Cons
- Enterprise-focused with a steep learning curve for smaller organizations
- Custom pricing lacks transparency and can be costly for low-volume users
- Limited customization options for non-standard workflows
Best For
Large health plans, third-party administrators, and self-insured employers needing scalable bill review for high-volume claims.
Pricing
Custom enterprise pricing based on claims volume; typically per-claim fees or annual subscriptions starting at $100K+ for mid-sized plans.
Verisk
enterpriseUtilizes predictive analytics and AI for precise medical bill review, fraud detection, and utilization management.
Access to Verisk's massive claims database covering billions of transactions for unparalleled benchmarking accuracy
Verisk's Medical Bill Review software is an enterprise-grade platform designed for payers in insurance, workers' compensation, and healthcare, utilizing AI-driven analytics to audit medical bills for overcharges, compliance issues, and fraud. It benchmarks bills against vast proprietary datasets of historical claims and fee schedules to recommend fair reimbursements and identify savings opportunities. The solution integrates seamlessly with claims management systems, automating reviews to accelerate processing and reduce manual intervention.
Pros
- Extensive proprietary database for accurate benchmarking and savings identification
- Advanced AI and machine learning for fraud detection and clinical editing
- Robust integrations with major claims platforms like Guidewire and Duck Creek
Cons
- High cost suitable mainly for large enterprises
- Steep learning curve for non-technical users
- Limited customization options for smaller-scale deployments
Best For
Large insurers, TPAs, and self-insured employers managing high-volume medical claims who need data-driven auditing at scale.
Pricing
Enterprise pricing via custom quote; typically subscription-based with per-bill review fees starting at $5-15 per bill, plus setup costs.
Change Healthcare
enterprisePowers claims adjudication and medical bill review platforms with real-time editing and compliance checks.
ClaimsXten™ real-time clinical editing engine for automated, rules-based bill review and compliance validation
Change Healthcare provides a comprehensive medical bill review platform as part of its revenue cycle management solutions, utilizing AI-driven analytics, claims editing, and fraud detection to audit bills for accuracy, compliance, and cost savings. The software, including tools like ClaimsXten, automates clinical rule application, identifies overbilling, and supports high-volume claims processing for payers and providers. It integrates seamlessly with EHRs, payer systems, and clearinghouses to streamline workflows and reduce denials.
Pros
- Powerful AI and rules-based editing for precise bill auditing and fraud detection
- Scalable for enterprise-level high-volume claims processing
- Strong integrations with major healthcare systems and EHRs
Cons
- Steep learning curve and complex interface requiring extensive training
- High enterprise pricing not suitable for small practices
- Customer support can be slow during peak issue periods
Best For
Large healthcare payers, providers, and self-insured employers managing millions of claims annually.
Pricing
Custom enterprise pricing upon request; typically subscription-based with per-claim or volume-tiered fees starting in the mid-five figures annually.
TechRx
specializedSpecializes in automated medical bill review software for identifying billing errors and overcharges efficiently.
Proprietary clinical intelligence engine combining AI with nurse auditor oversight for precise, defensible bill adjustments
TechRx by The Basis Group is a specialized medical bill review software platform designed for insurers, third-party administrators (TPAs), and self-insured employers to audit and analyze healthcare bills efficiently. It employs AI-driven automation, clinical expertise, and proprietary algorithms to detect overbilling, duplicates, and non-compliant charges across workers' compensation, auto, and liability claims. The solution provides actionable insights, payment recommendations, and detailed reporting to reduce costs and accelerate claims processing.
Pros
- Advanced AI and clinical rules for accurate overcharge detection
- Fast turnaround times with automated processing
- Comprehensive analytics and customizable reporting
Cons
- Steep learning curve for advanced features
- Pricing can be high for low-volume users
- Limited native integrations with some legacy claims systems
Best For
Mid-sized insurers and TPAs managing high-volume medical claims who need reliable automation and expert review.
Pricing
Custom quotes based on bill volume; typically $5-15 per bill reviewed or subscription tiers starting at $2,000/month.
Plexus
specializedProvides claims auditing and medical bill review software focused on accuracy and recovery for healthcare payers.
Integrated anesthesia documentation that automatically populates billing data to minimize errors upstream
Plexus from Plexus Technology Group (plexustg.com) is primarily a perioperative software suite, including the ProVision Anesthesia Information Management System (AIMS), designed to streamline anesthesia documentation, workflows, and financial processes for healthcare providers. While it supports charge capture and billing integration to improve accuracy in perioperative billing, it lacks dedicated tools for third-party medical bill auditing, overcharge detection, or payer-side review common in specialized Medical Bill Review Software. Its analytics and reporting can provide some insights into costs and utilization, but it is not optimized for comprehensive bill review workflows.
Pros
- Strong integration with EHR systems for accurate charge capture
- Perioperative-specific analytics for cost analysis
- User-friendly interface for clinical documentation
Cons
- Not designed for third-party bill auditing or review
- Limited scope to anesthesia and surgical bills only
- Enterprise pricing lacks transparency and affordability for smaller users
Best For
Healthcare providers and anesthesia departments seeking to enhance internal billing accuracy rather than external bill reviewers.
Pricing
Custom enterprise licensing; typically high-cost subscriptions starting at $50,000+ annually depending on facility size, with no public tiered plans.
MedCombs
specializedOffers web-based medical bill review and auditing tools for streamlined analysis and reporting.
AI-driven predictive analytics that forecasts potential overcharges before final billing
MedCombs is an AI-powered medical bill review software that automates the auditing of healthcare bills to detect overcharges, coding errors, and compliance issues. It processes bills from various formats, compares them against industry benchmarks like Medicare rates and UCR data, and generates detailed reports for negotiations or appeals. The platform is designed for healthcare providers, insurers, and third-party administrators seeking to reduce costs and improve reimbursement rates. While effective for routine reviews, it excels in high-volume environments with its scalable cloud-based architecture.
Pros
- Advanced AI algorithms for accurate overcharge detection
- Supports multiple bill formats including PDFs and EDI
- Comprehensive reporting with savings projections
Cons
- Pricing can be steep for low-volume users
- Limited integrations with major EHR systems
- Occasional false positives requiring manual review
Best For
Mid-sized healthcare providers and bill review firms managing moderate to high claim volumes.
Pricing
Subscription tiers start at $199/month for basic access; volume-based enterprise plans custom quoted.
ClaimDOC
specializedDelivers independent medical bill review software with detailed audits and expert analysis capabilities.
Direct provider negotiation by licensed medical experts, often securing reductions unattainable through software alone
ClaimDOC is a medical bill review platform that enables users to upload bills for expert analysis by licensed clinicians and specialists, identifying overcharges, coding errors, and negotiation opportunities. It primarily serves attorneys, self-insured employers, and individuals dealing with personal injury or workers' compensation claims by providing detailed audit reports and handling direct negotiations with providers. The service focuses on reducing bill amounts by 40-60% on average through a combination of human expertise and a user-friendly online portal for case management.
Pros
- Expert clinician reviews ensure accurate identification of billing errors
- Contingency pricing means no upfront costs and payment only on savings
- Streamlined online portal for easy bill uploads and real-time case tracking
Cons
- Relies heavily on manual expert review, leading to potential delays (3-10 days turnaround)
- Limited advanced AI automation compared to newer competitors
- Savings-based fees (25-35%) can reduce net benefits on smaller bills
Best For
Personal injury attorneys and self-insured entities needing reliable expert negotiation without software development overhead.
Pricing
Contingency model: 25-35% of verified savings; no fees if no reduction achieved.
MRIoNY
specializedFocuses on Medicare Secondary Payer bill review software for compliance and cost recovery.
Physician-led clinical audits that combine AI flagging with human expert validation for superior accuracy
MRIoNY (Medical Review Institute of New York) is a specialized medical bill review software platform designed for auditing and analyzing healthcare bills, primarily for workers' compensation, liability, and no-fault claims. It leverages proprietary algorithms, clinical expertise from licensed physicians, and compliance tools to detect overbilling, validate DRG codes, and recommend fair reimbursements. The software supports high-volume processing with detailed reporting for insurers, TPAs, and self-insured employers.
Pros
- Strong clinical review backed by board-certified MDs
- Robust compliance with state-specific fee schedules
- Efficient handling of complex workers' comp bills
Cons
- Limited third-party integrations compared to leaders
- Interface feels dated and requires training
- Pricing lacks transparency for smaller users
Best For
Mid-sized insurers and TPAs focused on workers' compensation claims in high-regulation states like New York.
Pricing
Custom enterprise pricing based on bill volume; typically $5-15 per bill reviewed or subscription tiers starting at $10,000/month.
Conclusion
In the realm of medical bill review software, Cotiviti claims the top spot, distinguished by its AI-powered solutions that excel at detecting overpayments and ensuring compliance. Optum and MultiPlan follow as strong alternatives, with Optum offering comprehensive payment integrity tools and MultiPlan focusing on optimized payments through repricing. Together, these three stand out as leaders, each addressing unique needs in healthcare billing management.
Take the next step in efficient billing—explore Cotiviti today to leverage its cutting-edge capabilities for improved accuracy and cost savings.
Tools Reviewed
All tools were independently evaluated for this comparison