Insurance claims can be the most stressful and confusing aspect of running a medical practice. With the medical insurance landscape constantly in flux, it can be too much to stay on top of everything with a manual system. More physicians and practices are opting for medical billing software that incorporates patients’ electronic health records, patient portals, revenue cycles and clinical cycles to streamline the medical experience.
That’s where medical claims processing software comes in. The best medical claims management software should have great claims management functionality as a priority — but not all of it does. That’s why we made a list of the best medical claims processing systems on the market to help you make informed, empowered decisions for your business.
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CureMD aims to eliminate revenue leakages by streamlining your entire workflow from eligibility to check in to copay collection to solution. Their goals for your practice include: five to ten percent increase in collections in the first few months, 96 percent of claims getting paid on first submission, a significant reduction in A/R days and denials and timely patient statement dispatch. CureMD Billing Service supports a comprehensive range of features including payer management, electronic claims tracking and submission, electronic remittances, automatic charge capture, clean claim checks, and electronic payment posting.
By segregating claims under complete and incomplete charge entries, this solution supports claims reconciliation and enables users to process claims falling under the complete category. The solution’s inbuilt ERA tab allows users to view ERA/EOB information filtered by primary, secondary or tertiary-level insurance providers.
Additionally, CureMD’s med claims software provides a complete log of claims processed and rejected. Users can navigate through the claim history menu with the option to search for specific data such as the total number of claims submitted, pending claims, waiting to be billed, etc. CureMD provides pre-formatted reports to measure your practice performance and highlight areas for improvement. Users can access customized reports to gain insight into your business’ unique pain points and performance initiatives.
CureMD is also super secure: it is certified for Meaningful Use and CCHIT certified as a comprehensive EMR. CureMD is also Surescripts Gold Certified for electronic prescribing, ISO 9001:2000 certified for quality operations and ISO 270001:2005 certified for information security.
One reason Epic Systems is a technology leader in healthcare is that it has built an integrated platform for almost all areas of care. When Epic sees the need to advance technology in a new specialty, it takes the time to develop modules built on the same platform and data structure as all of their other products.
The EMR is one of these modules, and offers a combination of documentation, chart review and order management options to ease workflows. This EMR platform integrates clinical and revenue cycle management systems to track bills, invoices and payments. It scores high for mobility and is accessible from multiple devices at once, making it ideal for larger organizations. Instead of starting from scratch, Epic customers build on existing content from successful customers — including decision support, order sets, reports and documentation tools.
Organizations that use Epic for both professional and hospital billing can take advantage of an integrated Single Billing Office. It features a single bill and payment plan, a single account that simplifies back office staffing and a single point of customer service to make it convenient for both administrators and patients.
Epic Billing provides strong medical claims scrubbing functionality built on an ANSI ASC X12N interface. This EHR solution supports claim status tracking, error reporting and claim reconciliation. Users can scrub all claims using the code editor to correct claim codes before processing. Additionally, it enables users to send electronic claims to primary and secondary payers from the centralized pool of insurance providers.
AdvancedBilling provides a centralized, cloud-based billing solution. It offers features to calculate patient copays and automatically post payments to patient accounts, streamlining customers’ financial workflows.
Users can automatically verify patient insurance coverage prior to appointments, process statements, send soft collection letters in an electronic format and write off specific accounts to a collection agency file from one screen.
This dynamic medical claim software integrates with AdvancedMD’s scheduling, front office and clearinghouse solutions for automated payments management. AdvancedBilling provides an inbuilt list of insurance payers, processes claims and displays status updates in real time. The Claim Inspector scrubs each claim, resulting in an average 95 percent first-pass acceptance rate. Users can review claims and edit them in the same screen, then approve them in batches for timely processing and reimbursement.
AdvancedBilling provides EMR/EHR integration which automatically transfers claims data and copay charges into an electronic health record, preventing manual processing and double data entry. It also enables users to post ERA information and track remittances. If a claim needs to be flagged for future review or edits, AdvancedBilling automatically adds it to an actionable worklist.
The drchrono EHR is a patient care platform that offers customization both at the point of care and on the go. In addition to EHR, drchrono includes scheduling, billing and patient reminder capabilities. The drchronoEHR & Billing solution also offers comprehensive claims management functionality. This platform automates patient check-ins, patient scheduling, triaging, clinical documentation, ePrescribing, lab orders, doctor referrals, billing and more.
This EHR offers great solutions for helping the medical insurance claims process along. Preset billing profiles, electronic health processing to insurance companies and single data entry for billing make your payment processing quick and simple. There are auto-generated forms available as well to make it as easy as possible for your billing team.
This EHR solution allows users to file electronic claims with the insurance payers listed in the solution directory. All patient information only needs to be entered once and data will automatically sync to clinical charts, eRx, lab orders, billing and other EMR information.
With drchronoEHR, users can work to improve clean claim rate and prevent human error occurrences in multiple data entry and reporting errors. This medical claims management solution provides live feeds of submitted claims that help users sort and filter claim records by various categories such as appointment profiles, billing status, claims rejected or electronic remittance advice (ERA) denied, etc.
DrchronoEHR & Billing users can track claim history and ensures accurate claim submission by identifying and correcting claim errors before they are processed. The solution also notifies users in case of claim rejections if they occur.
Navicure’s revenue cycle management (RCM) software is a comprehensive system for managing all elements of the revenue cycle. Changes in payer policies, annual coding changes, staff turnover and other volatile factors mean that there are always challenges to overcome when maintaining a consistent and predictable cash flow.
Navicure lets you stay on top of the ever-changing landscape of your revenue cycle by providing ongoing actionable data that is updated nightly (rather than monthly as with many other solutions) and points your staff to the specific issues impeding reimbursement. This lets you focus on which claims and payers need attention to make immediate improvements and to prevent the same problems from resurfacing in the future.
Navicure Total RCM provides an intuitive claim management solution that enables easy tracking and monitoring of every claim through its lifecycle and measures progress on the dashboard. The solution includes 3-Ring Client Service that ensures all claim-related calls are addressed within 3 rings, thereby optimizing customer satisfaction. It also lets users print e-claims and paper claims, increase clean-claim rate with the medical necessity and CCI edits, receive ERA from insurance payers and automatically post them into the system.
Navicure’s cloud-based application was built using premier hardware and software components, including well known technology names like Oracle and Cisco. By leveraging a powerful relational database in a transaction-intensive environment, the Navicure platform facilitates highly efficient claim data routing. This is in accordance with the privacy and security requirement stipulated under the HIPAA statute.
Kareo Billing provides excellent medical claims billing software functionality. This billing solution can submit both primary and secondary claims to payers directly. Users can track claims through various stages of claim processing, and get complete visibility on where the claims are and what’s being done to get users paid.
The ability of Kareo to connect with insurance companies in real time allows medical professionals to quickly ascertain the eligibility of patients. It also provides a “Proof of Timely Filing” option to track clearinghouse claim history. Kareo Billing offers a thorough code scrubber that ensures claims are clean and free from errors before submission. Users can can send electronic claims to more than 2,500 government and commercial insurers, print paper claims when necessary and receive claim processing reports with frequent status updates.
Users can receive electronic remittance advice (ERA) reports, including details on electronic funds transfer (EFT), and automate the payment posting process. Kareo even lets users send collection alert messages to patients, enabling faster collections. This medical claim processing software allows users to enter charges, check coding, send insurance claims and patient statements, process credit cards, automatically post payments, print reports, manage denials and collections, load fees and contracts, scan documents, and more.
The athenaCollector solution helps users view scheduling and patient billing information in real time. This streamlines workflows by minimizing administrative and other billing work. The claims tool features a Billing Rules Engine which automatically updates payer rules and alerts users in the event of any issues before submission.
AthenaCollector integrates practice management, an extensive rules database and back-office services into a single, unified platform. This module is specifically developed to help practices process their claims. With athenaCollector, medical practitioners don’t have to spend their precious time sending and processing claims. The software does all the hard work, including claim tracking, denial management and checking patient eligibility.
With athenaCollector, users can scrub claims as they are entered, enhancing workflow and minimizing errors. The solution provides denial management functionality and helps filing error-free claims. You can integrate athenaCollector with Trizetto revenue management solutions to post ERA from the system to Trizetto on a daily basis.
All of athenaHealth’s clients use this rules engine, so it remembers problems in other clients’ claims to prevent the same problems from happening in future claims from any client.
Choosing the right medical claims management system can be daunting, but there are plenty of great options out there. These solutions are all part of larger EHR software systems, so finding the right match for you may take more than this single article. Luckily, we have a comprehensive comparison report to provide you with side-by-side comparisons of what you should expect from these and other software.
What do you use for your medical claims software? What do you love about it? What do you hate about it? Let us know in the comments!