Quick Overview
- 1#1: Waystar - Provides AI-driven revenue cycle management with advanced claims processing, scrubbing, and denial management for healthcare providers.
- 2#2: athenahealth - Offers integrated EHR and revenue cycle management with automated claims submission and payer reconciliation.
- 3#3: Kareo - Delivers cloud-based medical billing software for streamlined claims filing, tracking, and payment posting.
- 4#4: Availity - Serves as a leading healthcare clearinghouse for EDI claims submission, eligibility verification, and remittance advice.
- 5#5: AdvancedMD - Provides practice management and billing software with robust claims editing and electronic submission features.
- 6#6: Change Healthcare - Offers comprehensive claims processing, workflow automation, and payer connectivity solutions.
- 7#7: Office Ally - Provides a free online clearinghouse for submitting, tracking, and managing medical claims.
- 8#8: DrChrono - Features mobile EHR with integrated billing, claims scrubbing, and superbill generation.
- 9#9: NextGen Healthcare - Delivers practice management software with advanced claims management and revenue cycle tools.
- 10#10: eClinicalWorks - Offers EHR and practice management with claims processing, denial management, and reporting capabilities.
Tools were selected based on features like claims processing efficiency, integration capabilities, ease of use, and value, ensuring a comprehensive assessment that aligns with the diverse needs of healthcare practices
Comparison Table
This comparison table evaluates leading medical claims software tools, including Waystar, athenahealth, Kareo, Availity, AdvancedMD, and more, to help users identify solutions that align with their practice requirements. Readers will gain clarity on key features, usability, and functionality, enabling informed choices for efficient claim processing and operational effectiveness.
| # | Tool | Category | Overall | Features | Ease of Use | Value |
|---|---|---|---|---|---|---|
| 1 | Waystar Provides AI-driven revenue cycle management with advanced claims processing, scrubbing, and denial management for healthcare providers. | enterprise | 9.6/10 | 9.8/10 | 8.7/10 | 9.3/10 |
| 2 | athenahealth Offers integrated EHR and revenue cycle management with automated claims submission and payer reconciliation. | enterprise | 9.1/10 | 9.5/10 | 8.2/10 | 8.7/10 |
| 3 | Kareo Delivers cloud-based medical billing software for streamlined claims filing, tracking, and payment posting. | enterprise | 8.7/10 | 9.2/10 | 8.5/10 | 8.0/10 |
| 4 | Availity Serves as a leading healthcare clearinghouse for EDI claims submission, eligibility verification, and remittance advice. | specialized | 8.6/10 | 9.2/10 | 7.7/10 | 8.3/10 |
| 5 | AdvancedMD Provides practice management and billing software with robust claims editing and electronic submission features. | enterprise | 8.6/10 | 9.1/10 | 7.8/10 | 8.2/10 |
| 6 | Change Healthcare Offers comprehensive claims processing, workflow automation, and payer connectivity solutions. | enterprise | 8.2/10 | 8.8/10 | 7.4/10 | 7.9/10 |
| 7 | Office Ally Provides a free online clearinghouse for submitting, tracking, and managing medical claims. | specialized | 7.8/10 | 7.2/10 | 8.3/10 | 9.6/10 |
| 8 | DrChrono Features mobile EHR with integrated billing, claims scrubbing, and superbill generation. | enterprise | 8.2/10 | 8.5/10 | 8.7/10 | 7.9/10 |
| 9 | NextGen Healthcare Delivers practice management software with advanced claims management and revenue cycle tools. | enterprise | 8.1/10 | 8.7/10 | 7.4/10 | 7.8/10 |
| 10 | eClinicalWorks Offers EHR and practice management with claims processing, denial management, and reporting capabilities. | enterprise | 7.6/10 | 8.2/10 | 6.8/10 | 7.1/10 |
Provides AI-driven revenue cycle management with advanced claims processing, scrubbing, and denial management for healthcare providers.
Offers integrated EHR and revenue cycle management with automated claims submission and payer reconciliation.
Delivers cloud-based medical billing software for streamlined claims filing, tracking, and payment posting.
Serves as a leading healthcare clearinghouse for EDI claims submission, eligibility verification, and remittance advice.
Provides practice management and billing software with robust claims editing and electronic submission features.
Offers comprehensive claims processing, workflow automation, and payer connectivity solutions.
Provides a free online clearinghouse for submitting, tracking, and managing medical claims.
Features mobile EHR with integrated billing, claims scrubbing, and superbill generation.
Delivers practice management software with advanced claims management and revenue cycle tools.
Offers EHR and practice management with claims processing, denial management, and reporting capabilities.
Waystar
enterpriseProvides AI-driven revenue cycle management with advanced claims processing, scrubbing, and denial management for healthcare providers.
ClaimsIQ AI engine, which predicts and prevents denials before submission with machine learning trained on billions of claims
Waystar is a leading revenue cycle management platform focused on medical claims processing for healthcare providers. It automates claims submission, scrubbing, eligibility verification, and denial management to accelerate reimbursements and reduce errors. The platform integrates seamlessly with EHRs and payers, offering real-time analytics and AI-driven insights to optimize financial performance across hospitals and physician practices.
Pros
- Comprehensive automation for claims lifecycle, including scrubbing and multi-payer submission
- AI-powered denial prevention with high accuracy rates (up to 90% reduction in denials)
- Robust analytics dashboard for real-time visibility into revenue cycle metrics
Cons
- Enterprise pricing can be prohibitive for small practices
- Initial implementation and training require significant time and resources
- Customization may need professional services for complex workflows
Best For
Large hospitals, health systems, and high-volume physician groups seeking scalable, enterprise-grade claims management.
Pricing
Custom quote-based pricing, typically transaction-based (per claim or percentage of collections) starting at $50K+ annually for mid-sized clients.
athenahealth
enterpriseOffers integrated EHR and revenue cycle management with automated claims submission and payer reconciliation.
AI-powered claims intelligence that proactively predicts denials and optimizes submissions
athenahealth's athenaOne platform offers robust medical claims software through its integrated revenue cycle management tools, automating claims submission, scrubbing, and adjudication. It handles eligibility verification, denial management, payment posting, and AR follow-up with high accuracy via cloud-based processing. As part of a full EHR and practice management suite, it provides real-time analytics to optimize revenue cycles for healthcare providers.
Pros
- Advanced automation minimizes claim denials and accelerates reimbursements
- Seamless integration with EHR and practice management for end-to-end workflows
- Powerful analytics and reporting for revenue cycle insights
Cons
- High subscription costs can strain smaller practices
- Steep learning curve and complex interface for new users
- Limited flexibility for custom workflows
Best For
Mid-sized to large medical practices needing integrated EHR, billing, and claims management with strong automation.
Pricing
Subscription-based starting at ~$419 per provider/month, plus per-claim fees; scales with practice size and volume.
Kareo
enterpriseDelivers cloud-based medical billing software for streamlined claims filing, tracking, and payment posting.
AI-powered claims intelligence that proactively scrubs and optimizes claims to maximize clean claim rates and reimbursements
Kareo is a cloud-based medical billing and practice management software designed for independent healthcare practices, focusing on streamlining the revenue cycle from claims submission to payment collection. It offers automated claims scrubbing, electronic remittance advice (ERA) posting, denial management, and eligibility verification to minimize errors and accelerate reimbursements. Integrated with EHR functionality, Kareo helps practices manage claims efficiently while providing analytics for financial performance.
Pros
- Advanced claims scrubbing reduces denials by identifying errors before submission
- Automated ERA posting and reconciliation speeds up payment processing
- Real-time eligibility checks and patient payment portals improve cash flow
Cons
- Pricing can be steep for very small practices or solo providers
- Some users report a learning curve for advanced reporting and customization
- Customer support response times vary, with occasional delays
Best For
Small to mid-sized independent medical practices seeking an integrated claims and billing solution with strong automation.
Pricing
Starts at approximately $300 per provider per month for core billing features, with tiered plans and custom quotes based on practice size and modules.
Availity
specializedServes as a leading healthcare clearinghouse for EDI claims submission, eligibility verification, and remittance advice.
Largest U.S. health information network connecting over 3,400 payers and 2 million providers for unmatched claims interoperability.
Availity is a comprehensive cloud-based platform designed for healthcare revenue cycle management, specializing in medical claims submission, tracking, eligibility verification, and electronic remittance advice (ERA). It connects providers with over 3,400 payers through the largest health information network in the U.S., enabling efficient claims processing and faster reimbursements. The platform also offers denial management, analytics, and patient payment solutions to streamline administrative workflows for healthcare organizations.
Pros
- Extensive payer network for high claims acceptance rates
- Advanced analytics and denial management tools
- Seamless integrations with major EHR systems like Epic and Cerner
Cons
- Steep learning curve for new users
- Custom pricing can be opaque and costly for small practices
- Occasional performance lags during peak usage
Best For
Mid-to-large healthcare providers and billing companies handling high-volume claims that need robust payer connectivity and revenue cycle automation.
Pricing
Custom enterprise pricing, typically subscription-based starting at $500/month with per-transaction or per-claim fees; often bundled with payer contracts.
AdvancedMD
enterpriseProvides practice management and billing software with robust claims editing and electronic submission features.
Revenue Cycle Intelligence with AI-driven denial prediction and automated workflows
AdvancedMD is a comprehensive cloud-based platform offering integrated electronic health records (EHR), practice management, and medical billing solutions tailored for healthcare providers. Its medical claims software excels in automating claims submission, scrubbing for errors, and managing denials to optimize revenue cycle management. The system supports real-time eligibility verification, multi-payer compatibility, and detailed reporting to streamline reimbursements and reduce administrative burdens.
Pros
- Robust claims scrubbing and auto-submission reduce errors and denials
- Integrated RCM tools with real-time analytics for better cash flow
- Strong payer connectivity and eligibility verification
Cons
- Steep learning curve for new users due to extensive features
- Pricing can be high for small practices
- Customization requires additional support
Best For
Mid-sized to large medical practices seeking an all-in-one platform for efficient claims processing and revenue management.
Pricing
Subscription-based starting at around $729 per provider per month, plus per-user fees and add-ons for advanced modules.
Change Healthcare
enterpriseOffers comprehensive claims processing, workflow automation, and payer connectivity solutions.
AI-powered Intelligent Claims Scrubber that achieves 95%+ first-pass acceptance rates
Change Healthcare offers a robust suite of medical claims software solutions designed to automate and optimize the revenue cycle management process for healthcare providers. Key functionalities include electronic claims submission to over 5,000 payers, real-time eligibility verification, automated denial management, and advanced analytics for payment optimization. The platform integrates seamlessly with major EHR systems and leverages AI for claims scrubbing to achieve high first-pass acceptance rates, reducing administrative burdens.
Pros
- Extensive connectivity to thousands of payers for reliable claims submission
- AI-driven claims editing and denial prevention for high efficiency
- Scalable analytics and reporting for enterprise-level revenue insights
Cons
- Complex interface with a steep learning curve for smaller teams
- Custom pricing can be expensive for low-volume practices
- Past cybersecurity incidents have raised reliability concerns
Best For
Large hospitals, health systems, and billing companies managing high-volume medical claims.
Pricing
Enterprise custom pricing, typically subscription-based starting at $5,000+/month depending on claim volume and features.
Office Ally
specializedProvides a free online clearinghouse for submitting, tracking, and managing medical claims.
Completely free electronic claims submission to over 4,000 insurance payers with no transaction fees for core services
Office Ally is a web-based clearinghouse platform specializing in medical claims processing, offering free electronic submission of CMS-1500 and UB-04 forms to over 4,000 payers. It includes tools for real-time eligibility verification, claim status tracking, electronic remittance advice (ERA) posting, and patient statement generation. Designed for small practices, it streamlines billing workflows without requiring software installation.
Pros
- Free core claims submission and eligibility checks for thousands of payers
- No software installation required; fully web-based
- Reliable claim scrubbing and status tracking
Cons
- Limited advanced practice management or EHR integrations
- Dated user interface compared to modern competitors
- Customer support mainly ticket-based with slower response times
Best For
Small medical practices or solo providers seeking a cost-free, straightforward claims clearinghouse solution.
Pricing
Free for basic claims submission, eligibility, and ERA; optional paid upgrades for advanced features starting at $0.09 per claim or subscription plans from $19/month.
DrChrono
enterpriseFeatures mobile EHR with integrated billing, claims scrubbing, and superbill generation.
Real-time eligibility verification and claims tracking via native iOS apps, enabling bedside or remote billing without desktop dependency
DrChrono is a cloud-based EHR and practice management platform with integrated medical claims processing capabilities, enabling electronic submission to major payers, eligibility verification, and denial management. It supports advanced coding (ICD-10, CPT, HCPCS), claims scrubbing, and ERA auto-posting to streamline revenue cycles for medical practices. The software emphasizes mobility, allowing claims tasks via iOS apps, and integrates with clearinghouses like Office Ally for efficient reimbursements.
Pros
- Intuitive mobile-first interface for on-the-go claims submission and eligibility checks
- Robust denial management and claims scrubbing to reduce errors and speed reimbursements
- Seamless integrations with EHR, scheduling, and major clearinghouses
Cons
- Pricing can escalate for multi-provider practices with add-ons
- Limited advanced customization for complex enterprise billing workflows
- Occasional reports of slower support response times during peak issues
Best For
Small to mid-sized ambulatory practices seeking an all-in-one EHR with strong, user-friendly medical claims handling.
Pricing
Starts at $199/provider/month (billed annually), plus one-time implementation fees and per-claim costs; custom quotes for larger practices.
NextGen Healthcare
enterpriseDelivers practice management software with advanced claims management and revenue cycle tools.
AI-powered predictive analytics for claims denial prevention and revenue optimization
NextGen Healthcare offers a comprehensive EHR and practice management platform with robust medical claims software capabilities, automating claims submission, eligibility verification, and payment posting. It integrates seamlessly with clinical workflows to streamline revenue cycle management for healthcare providers. The solution supports multiple payers and includes tools for denial management and analytics to optimize reimbursements.
Pros
- Deep integration with EHR for end-to-end revenue cycle management
- Advanced denial management and analytics tools
- Strong compliance with HIPAA and payer requirements
Cons
- Steep learning curve for new users
- High implementation and customization costs
- Customer support can be inconsistent for smaller practices
Best For
Mid-sized to large medical practices or specialties seeking integrated EHR and claims processing with enterprise-level scalability.
Pricing
Custom enterprise pricing, typically $300-$600 per provider/month plus implementation fees; volume discounts available.
eClinicalWorks
enterpriseOffers EHR and practice management with claims processing, denial management, and reporting capabilities.
Prism analytics for predictive denial prevention and revenue forecasting
eClinicalWorks is a comprehensive EHR and practice management platform with integrated medical claims software that automates claims creation, submission, and tracking to major payers. It features eligibility verification, claims scrubbing to reduce errors, and robust denial management tools to accelerate reimbursements. The system also provides revenue cycle analytics and MIPS reporting to optimize financial performance for healthcare providers.
Pros
- Seamless EHR integration for accurate claims data
- Automated scrubbing and electronic submission to reduce denials
- Advanced analytics for revenue cycle optimization
Cons
- Steep learning curve and outdated interface
- Reported customer support delays
- High implementation and ongoing costs
Best For
Medium to large medical practices needing an all-in-one EHR with strong claims management.
Pricing
Custom pricing starting at around $449 per provider/month, plus one-time implementation fees and add-ons for RCM services.
Conclusion
The landscape of medical claims software offers standout solutions, with Waystar emerging as the top choice for its AI-driven revenue cycle management, excelling in claims processing, scrubbing, and denial management. athenahealth and Kareo follow closely—athenahealth with integrated EHR and automated submission, and Kareo with cloud-based billing efficiency—each providing unique strengths for different practice needs. Whether prioritizing advanced technology, integration, or simplicity, the reviewed tools demonstrate the industry’s commitment to streamlining revenue cycles.
Explore Waystar today to unlock its AI-powered capabilities and elevate your claims management, ensuring smoother operations and faster payment cycles.
Tools Reviewed
All tools were independently evaluated for this comparison