1. ClaimScrubber by Waystar:
ClaimScrubber is a powerful denial management tool that helps healthcare organizations prevent denials before they happen. It checks claims for coding and billing errors prior to submission, allowing practices to correct issues in real-time. Its customizable rule sets and payer-specific logic increase the first-pass claim acceptance rate.
2. eSolutions Denial Management:
eSolutions offers a comprehensive denial management suite that analyzes the root causes of denials, tracks trends, and automates appeals. Its dashboard provides real-time insights into denial rates and success of resubmissions, empowering billing teams to act quickly and effectively.
3. Availity Essentials Pro:
Availity’s platform integrates denial tracking, clearinghouse services, and payer communications. It simplifies workflows by flagging denied claims with detailed reasons, helping staff prioritize high-impact resubmissions. Availity also facilitates appeal submissions directly through its interface, reducing administrative workload.
4. Change Healthcare Revenue Performance Advisor:
This solution focuses on preventing denials through predictive analytics, real-time eligibility verification, and claim status tracking. The software highlights problematic areas and payer trends, giving medical billing teams actionable data to improve reimbursement rates and reduce the number of future denials.
5. Kareo Billing:
Kareo offers an easy-to-use billing platform with built-in tools to manage and reduce claim denials. It provides visibility into rejected claims, reasons for denials, and step-by-step guidance on how to correct and resubmit them. It also helps smaller practices track performance metrics and streamline denial workflows.
6. Experian Health ClaimSource:
ClaimSource uses automation to monitor claim status, alert teams about denials, and provide instant access to denial reasons. It integrates with other revenue cycle systems, enabling a seamless approach to correction and resubmission. The platform also assists in evaluating payer-specific denial patterns.
7. R1 RCM Denial Management Suite:
R1 RCM focuses on end-to-end denial management by offering tools for proactive prevention and reactive resolution. Its robust reporting features help healthcare providers understand denial categories, track appeal timelines, and improve overall cash flow. It also supports complex payer negotiations and regulatory compliance.
