Top MD Clarity Alternatives

Insurance Discovery improves financial results by identifying previously overlooked billable coverage that healthcare providers might not know about, which reduces both underpayments and uncompensated care. Utilizing sophisticated search capabilities, this tool can uncover situations where patients have multiple active insurance payers, thereby enhancing the potential for better reimbursement. Moreover, it aids in avoiding reimbursement delays and speeds up revenue collection by ensuring that claims are accurately directed to the correct payers on the first submission, attributed to more precise coverage information. When combined with verified demographic data, Insurance Discovery offers dependable insights into coverage and eligibility. This innovative method replaces conventional manual insurance discovery processes with a rapid and exhaustive search that accesses numerous databases within seconds, providing comprehensive and precise coverage details. Additionally, it improves the overall experience for patients and residents by allowing for accurate assessments of out-of-pocket costs, leading to a more positive financial journey. By simplifying these procedures, healthcare providers can devote more attention to patient care rather than getting bogged down by administrative duties, ultimately enriching the quality of service delivered.

NextGen Healthcare stands out as a prominent provider of software and services that facilitate the evolution of outpatient health care. Their solutions, NextGen Office for smaller practices with 1 to 10 physicians and NextGen Enterprise for larger practices exceeding 10 doctors, offer advanced electronic health record systems designed to alleviate documentation challenges, enhance clinical results, integrate with other health networks, boost satisfaction for both providers and patients, optimize revenue processes, and promote healthier communities overall. By leveraging these innovative technologies, ambulatory practices can focus more on patient care and less on administrative burdens.

Denials of medical necessity pose a substantial financial strain on healthcare providers, leading to potential losses that can soar into the millions each year due to write-offs, coupled with the costly labor required to investigate and challenge these denials while also managing patient inquiries. On the other hand, payers encounter similar difficulties within the claims management framework, facing costs associated with unnecessary medical treatments and the resources allocated to address denial appeals, none of which enhance patient outcomes. Moreover, patients endure high copays and out-of-pocket costs, alongside a stressful healthcare journey filled with unjustified charges and services. In response to these challenges, the ABN Assistant™ from Vālenz® Assurance provides providers with vital tools for prior authorization that confirm medical necessity, create Medicare-compliant Advanced Beneficiary Notices (ABNs) with estimated costs, and effectively mitigate over 90 percent of medical necessity denials by validating necessity prior to patient care. By implementing this innovative system, healthcare providers not only bolster their financial stability but also elevate patient satisfaction and streamline the efficiency of care. Thus, the comprehensive approach offered by Vālenz® has the potential to reshape the landscape of healthcare delivery by minimizing unnecessary costs for all parties involved.

Zuub is an innovative platform that utilizes artificial intelligence to improve revenue cycle management in dental practices, making vital administrative tasks more efficient. It offers an array of features such as instant verification of insurance, digital treatment proposals, online payment capabilities, oversight of accounts receivable, and electronic consent forms. By seamlessly integrating with current practice management systems, Zuub reduces manual workload, enhances overall efficiency, and provides patients with clearer insights into the costs and insurance coverage related to their treatments. With the ability to handle insurance verifications for over 350 payers in less than five seconds, the platform significantly speeds up processes. In addition, Zuub's digital treatment plans are designed to enhance patient understanding and increase acceptance rates for recommended services, while its partnership with Sunbit provides patients with accessible financing options. This forward-thinking strategy not only boosts the financial performance of dental practices but also greatly enriches the patient experience, making Zuub a crucial tool for modern dental care providers. As the dental industry continues to evolve, Zuub's capabilities will likely play an essential role in shaping the future of practice management.

The RCM Cloud® utilizes a "software as a service" (SaaS) model aimed at transforming the intricate landscape of medical billing through digital innovations that reduce the need for manual efforts and improve operational workflows with automation. This pioneering system enhances efficiency in operations while allowing organizations to broaden their service delivery capabilities with only modest increases in administrative staff. By adopting this advanced technology, companies can grow and prosper without the necessity of substantially augmenting their workforce. On the administrative side, RCM Cloud® and its associated services function on the dependable, secure medsphere cloud services platform, ensuring reliability. The RCM Cloud® suite includes a variety of modules, such as patient and resource scheduling, enterprise registration, real-time verification of payer eligibility, contract management, medical records processing, billing operations, claims handling, collections for both payer and self-pay, point-of-sale payment processing, and management of bad debts, thus enabling healthcare organizations to effectively transform their revenue cycles. This holistic strategy not only optimizes operations but also equips healthcare providers for enduring success in a competitive environment. Ultimately, by leveraging such comprehensive solutions, healthcare entities are better positioned to adapt to evolving industry demands.

Collecting payments and providing cost estimates upfront for patients is crucial. With automatic checks for eligibility and benefits, you can quickly determine what patients are responsible for, ensuring you have access to hyper-accurate estimates derived from your practice data. This accuracy not only enhances patient care but also contributes to a more robust financial health for your practice. Estimates can be conveniently sent through email or text while adhering to HIPAA regulations. Embracing modern payment solutions in 2020 means your practice can maximize collections like never before. By minimizing account receivables and eliminating write-offs, you set your practice up for sustained success. Additionally, streamlined patient payment processes can foster greater trust and satisfaction among patients.

Adonis is a cutting-edge platform that leverages artificial intelligence to revolutionize revenue cycle management by providing features for monitoring, alert notifications, and proactive resolution of issues. It enhances task prioritization for entities involved in revenue cycle management by delivering insights into trends concerning denials, underpayments, and key performance indicators. Through AI-driven analytics, Adonis aims to boost first-pass acceptance rates while minimizing human errors, going beyond just simple automation. The platform adopts a proactive stance towards denial prevention by automating routine tasks, allowing teams to focus more on patient care and improving the overall experience. Seamlessly integrating with existing electronic health records, practice management systems, billing solutions, and patient portals in real time, Adonis effectively eliminates data silos and encourages a cohesive workflow. Its solutions are tailored to accommodate a diverse array of healthcare organizations, such as hospitals, physician group practices, healthcare systems, digital health providers, and practice management services, ensuring each entity reaps the benefits of its customized offerings. This all-encompassing strategy not only optimizes operations but also cultivates a more effective and efficient healthcare environment, ultimately enhancing patient outcomes and satisfaction levels.

Our secure payment vault, which meets PCI compliance standards, safely houses your patient's payment details. With the patient's approval, you can streamline the process by automating and collecting payments for a predetermined amount once the claim has been adjudicated. Healthcare practices can also gather copays from patients prior to care, using estimates to enhance financial management and facilitate plan activation, or they can process pre-authorized payments after care has been delivered. Additionally, a fully customizable online portal enables patients to make payments or establish payment plans while ensuring their payment information remains secure. To foster a more transparent financial experience, accurately estimating out-of-pocket expenses allows for early discussions on payment plans, ultimately leading to higher treatment acceptance rates. This approach not only benefits the practice but also enhances patient satisfaction and trust.

Streamlining workflow processes through real-time transactions that are integrated with modern technology platforms significantly enhances efficiency. This innovative method allows both providers and payers to reduce the time and effort associated with benefits and utilization management by up to 90%. By removing the confusion inherent in the current benefits and utilization management system, clarity is greatly improved for patients, providers, and payers. With the implementation of self-learning automation and a reduction in the number of clicks needed, healthcare professionals can allocate more time to patient care, thereby focusing on their primary responsibilities. Myndshft simplifies the intricacies of utilizing multiple point solutions by providing a comprehensive, end-to-end platform that fosters immediate communication among payers, providers, and patients. In addition, the platform continuously enhances its automated workflows and rules engines through real-time feedback from interactions between providers and payers. It also intelligently adjusts to the specific regulations employed by different payers. As the platform is utilized more frequently, its intelligence grows, utilizing an extensive repository of thousands of up-to-date rules specifically designed for national, state, and regional payers, which leads to greater efficiency and effectiveness in the healthcare sector. Ultimately, with the ongoing evolution of such technology, an optimized care delivery environment is created, yielding benefits for all parties involved, including improved patient outcomes and streamlined administrative processes.

Focusing on the front end is vital for improving the patient financial journey and streamlining revenue cycle results. By adopting unified front-end strategies, healthcare organizations can tackle delivery challenges, which in turn decreases the number of returned mail and outstanding invoices. It's important to limit input mistakes by thoroughly verifying patient identities and demographic information. In addition, checking insurance eligibility at the service point is crucial for maximizing revenue while adhering to legal requirements. Streamlining processes through the automation of prior authorization from beginning to end within seconds can enhance overall efficiency. Moreover, automating notifications ensures that payers receive prompt updates about inpatient hospital admissions. Providing clear communication regarding patients' out-of-pocket costs further enhances financial transparency. By evaluating patients' willingness to pay and their eligibility for financial assistance, hospitals can significantly improve their collection rates. Once considered a secondary priority, patient access has now emerged as a key factor in healthcare settings. Our flexible platform leverages integrated data from multiple verification sources, accompanied by smart guidance, to develop a holistic solution. This integration not only enhances patient access but also propels the overall effectiveness of the organization, ultimately leading to better financial outcomes and patient satisfaction.

Successful teamwork in patient care relies heavily on ongoing connectivity and access to current information. It is becoming ever more important to facilitate the flow of this information with insurance companies. Availity streamlines the collaboration with payers, assisting providers from the initial step of confirming a patient's eligibility all the way to resolving reimbursements. Healthcare professionals seek quick and easy access to details regarding health plans. With Availity Essentials, a free service supported by health plans, providers can take advantage of real-time data exchanges with many of the payers they regularly interact with. Moreover, Availity offers a premium service called Availity Essentials Pro that is designed to enhance revenue cycle performance, reduce claim denials, and secure patient payments more efficiently. By utilizing Availity as your reliable source for payer information, you can concentrate your efforts on providing high-quality patient care. Their electronic data interchange (EDI) clearinghouse and API solutions allow providers to seamlessly incorporate HIPAA transactions and other vital functions into their practice management systems, leading to improved operational efficiency. This holistic method not only supports healthcare providers in their operational tasks but also reinforces their ultimate goal of prioritizing patient well-being and satisfaction.

HexIQ software provides users with rapid and easy access to negotiated rate data, allowing them to search, download, and analyze complex healthcare reimbursement rates linked to specific codes, payers, providers (NPI), or tax identification numbers (TIN), thus promoting transparency in coverage criteria for improved business decisions and negotiation strategies. Each month, the software processes a vast array of machine-readable files (MRFs) from different payers, thoroughly cleaning and enhancing the data by adding relevant provider names, addresses, and network affiliations, and continuously updating it to enable users to compare their negotiated rates with those of peers in the same specialty and geographical location without relying on cumbersome Excel spreadsheets. With advanced search functionalities, users can filter results based on various criteria such as code, specialty, state, place of service, payer, NPI, or TIN, while also having the ability to export their findings in CSV format for more detailed analysis. Additionally, integrated analytics and visualization tools offer insights into rate distributions, average and mode rates, and contracted provider networks, enabling users to better comprehend market trends. This all-encompassing method not only simplifies the data retrieval process but also equips healthcare professionals with the information they need to make well-informed strategic choices based on trustworthy data. By harnessing the power of HexIQ, stakeholders can navigate the complexities of healthcare reimbursement with greater confidence and clarity.

Veradigm Payerpath provides an extensive range of revenue cycle management tools aimed at improving the financial health of healthcare institutions by fostering better communication with both payers and patients, which in turn boosts profitability for practices of all sizes and specialties. The platform effectively tackles challenges such as incomplete data, erroneous coding, and input mistakes, ensuring that claims are lodged accurately and without issues. It further confirms that submissions are free of errors and missing information, optimizing the claims process. Moreover, through sophisticated analytical reporting, healthcare practices can compare their performance against local, national, and specialty benchmarks, helping them enhance their productivity and financial results. Additionally, Veradigm Payerpath assists in reminding patients about upcoming appointments while verifying their insurance benefits and coverage, simplifying the overall process. The system also automates the collection of patient responsibilities, making financial management more straightforward for practices. Importantly, the integrated solutions of Veradigm Payerpath are compatible with all major practice management systems, enhancing its adaptability across diverse healthcare environments. This compatibility not only increases its utility but also allows healthcare providers to devote more attention to patient care while effectively handling their financial processes. As a result, Veradigm Payerpath emerges as a crucial asset for healthcare organizations striving for operational efficiency and improved financial health.

Sift simplifies the intricate landscape of healthcare payment systems by integrating actionable insights within revenue cycle management, thereby allowing healthcare entities to improve payment outcomes and reduce collection expenses. It equips providers with essential information regarding denial management, helping to protect their receivables while accelerating cash flow. By assembling insurance claims and patient financial data into a secure, HIPAA-compliant cloud solution, Sift ensures a trustworthy information source about healthcare payments. Additionally, it bridges the gaps between electronic health records, clearinghouses, workflow management systems, and patient engagement tools, creating a robust and proprietary dataset that grants a holistic view of payment processes. Through the application of diverse data science techniques, Sift offers detailed and integrated recommendations for denial management, payer assessment, patient collection optimization, and patient acquisition strategies, ultimately contributing to superior financial outcomes for healthcare professionals. This forward-thinking approach not only enhances operational efficiency but also cultivates a more effective healthcare payment framework, paving the way for sustained improvements in financial health. By prioritizing seamless data integration, Sift helps providers focus on patient care while ensuring their financial stability.

By concentrating on a select number of premium prices and implementing more competitive pricing strategies, we enhance our capacity to generate additional net revenues. This is accomplished by reducing or removing the gaps between charges and negotiated rates for contracts that include "lesser of" clauses. In addition, we increase net revenues through the detection and recovery of underpayments. Our customized models serve each client effectively, as we refrain from confining their data to a generic software solution. These tailored models achieve high accuracy because we carefully analyze every contract, model all pertinent terms, confirm the alignment between plan codes and insurance products, and perform thorough testing on our models. We consider every reimbursement impacted by price changes, which results in the most accurate predictions available in the industry. Moreover, our pricing methodology is not only defensible but also straightforward and comprehensible for patients, ensuring our pricing structures are logical and appropriately tiered. Ultimately, this comprehensive approach significantly boosts revenue generation while upholding transparency and fairness in our pricing practices, fostering trust between us and our clients.

Leverage cutting-edge automation and sophisticated intelligence to address issues concerning patient access and the revenue cycle, all while improving the reimbursements for the services rendered. Despite the progress made with AI and automation in optimizing patient access and revenue cycle functions, there is still a significant need for professionals who possess expertise in revenue cycle management, clinical practices, and compliance to guarantee that patients are appropriately screened for financial matters and that all services provided are accurately billed and compensated. Our clients benefit from a robust blend of technological solutions and expert team support, underpinned by a deep understanding of the complex reimbursement environment. With insights derived from processing billions of transactions for leading healthcare providers and over 1,400 payers across the nation, our technology and dedicated team are exceptionally positioned to achieve outstanding outcomes. Our patient access platform facilitates quicker financial clearance for patients before they receive treatment, offering a comprehensive approach to eligibility checks, benefit verifications, estimates of patient payments, and prior authorization approvals, all seamlessly integrated into one system. By refining these procedures, we strive to improve both the effectiveness of healthcare service delivery and the efficiency of financial operations, ultimately benefiting both patients and providers alike.

Thrizer is a groundbreaking payment solution designed to simplify the billing procedures for out-of-network therapy services, benefiting both therapists and clients alike. For therapists, it functions similarly to popular payment platforms like Stripe or Square, enabling them to charge clients while seamlessly managing out-of-network claims submissions, which greatly reduces administrative burdens and eliminates the need for superbills. Clients are only responsible for their co-insurance after their deductibles are met, as Thrizer handles the remaining fees upfront and oversees the insurance reimbursement process, resulting in reduced initial costs and quicker access to therapy services. Additionally, Thrizer boasts a free real-time benefits calculator that enhances transparency by offering insights into out-of-network benefits and expected out-of-pocket costs before therapy appointments. It also includes a superbill upload feature for clients whose therapists choose not to utilize the platform, allowing for more efficient claims navigation. This all-encompassing approach not only streamlines the billing experience but also creates a more accessible route to mental health care for everyone involved. By addressing both administrative challenges and financial barriers, Thrizer ultimately empowers users to prioritize their mental well-being without unnecessary complications.

Transform your revenue cycle management with Oracle Health RevElate Patient Accounting, a versatile solution independent of any particular EHR, designed to improve financial performance via integrated, cloud-based billing systems that emphasize automation and flexibility. By utilizing RevElate Patient Accounting, you can: Reduce workflow redundancy through the use of interconnected processes and analytics that boost efficiency. Shift your focus towards recovering outstanding accounts receivable by employing built-in business rules that efficiently assign and prioritize tasks. Establish a flexible framework that accommodates workflows across Oracle Health solutions, third-party applications, and large enterprises. Improve compliance and enhance reimbursement efforts by integrating payer regulations seamlessly. RevElate Patient Accounting offers a holistic view of both clinical and financial data, granting you deeper insights into patient interactions and their related accounts, which ultimately enhances operational effectiveness. This solution not only equips healthcare organizations to reach their financial objectives but also ensures the maintenance of exceptional patient care standards, further solidifying its importance in the industry landscape. The comprehensive capabilities of RevElate empower healthcare providers to navigate complex revenue challenges with greater confidence.

We support the shift towards value-based healthcare by assessing a range of treatments, medications, processes, and costs, which assists hospitals, life sciences companies, and insurance providers in identifying treatment approaches that result in the best patient outcomes. Our CRCA™ P&T platform empowers P&T committees to make data-informed improvements in quality measures, including average length of stay (ALOS) and 30-day readmission rates. Moreover, our cutting-edge POP-BUILDER Rx™ solution presents comparative insights between selected groups and CRCA's vast database of real-world data, which includes over 140 million longitudinal patient records. In addition, our drug remittance dashboard thoroughly examines and reports on drug remittance details across various payer categories, with a focus on high-cost medications down to the National Drug Code (NDC) level. We also enable hospital finance teams to effectively monitor and improve service line costs, profitability, productivity, and revenue cycle performance through our detailed analytics and reporting, along with the support of our Agilum Healthcare Intelligence team. This ensures healthcare providers can make well-informed decisions that enhance their operations and patient care. By integrating these diverse resources, we create a comprehensive understanding of the complex financial and clinical environment in which healthcare providers function, ultimately aiming to improve overall healthcare delivery.

Elevate consumer expectations in healthcare by driving significant growth and loyalty. Press Ganey's innovative Consumer Experience technology is poised to revolutionize how healthcare organizations approach patient acquisition, retention, and reputation management. The recent integration of SPH Analytics (SPH), a leader in enhancing member experiences within the health insurance industry, represents a transformative step for Press Ganey. By merging its top-tier patient experience data with SPH's extensive member insights, Press Ganey is dedicated to fostering a comprehensive understanding of the interactions between providers and payers, ultimately enhancing healthcare results. You will have the unwavering support of your dedicated Press Ganey success team throughout every step of this journey. Our steadfast commitment to investing in cutting-edge technology and exceptional talent guarantees that our clients will continue to excel in the healthcare sector, ready to tackle upcoming challenges with confidence. As we collaborate, we can create a more cohesive and responsive healthcare landscape that benefits everyone involved. Together, we will shape the future of healthcare for the better.

Rhyme creates an intelligent integration between payers and providers in the prior authorization workflow, effectively recovering precious time that would otherwise be squandered on repetitive communications, allowing it to be redirected towards patient care. While our primary focus lies in automating routine tasks, this is merely the beginning of what we offer. When complex clinical decisions require collaboration between payers and providers, Rhyme guarantees that your processes stay streamlined, adaptable, and efficient. We have established the largest network for integrated prior authorizations, moving past a disjointed system to promote smart collaboration. Our platform features strong connections with EHRs, payers, and benefits managers, all of which are integrated seamlessly. This eliminates the need for frantic searches, tedious screen-scraping, and dependency on indirect data sources. We work directly with providers and payers within their existing systems and workflows, making connections simple so that we can adapt to your requirements rather than imposing changes on you. Prior authorizations are not merely an additional component of our platform; they are central to our mission, enabling us to excel in this crucial area and provide outstanding service. By emphasizing these key aspects, we strive to revolutionize the management of prior authorizations and elevate the experience for everyone involved, ultimately leading to better health outcomes for patients.

Enhance your practice's capabilities by adopting CareCloud, the leading cloud-based EHR and practice management software available today. CareCloud delivers a comprehensive suite of resources tailored for healthcare professionals and organizations of all sizes, ensuring that every need is met efficiently. Key offerings include Concierge, which serves as a robust revenue cycle management system; Central, an easy-to-use practice management application; Charts, a user-friendly electronic health records system; Community, which provides tools for fostering patient engagement and social connectivity; and Companion, a mobile app designed to assist with both clinical and administrative responsibilities. By leveraging these innovative tools, practices can not only streamline their operations but also significantly improve the quality of care provided to patients. Ultimately, integrating CareCloud into your operations can lead to enhanced efficiency and better health outcomes for those you serve.

This solution, built on FHIR v4, leverages native FHIR data models and a RESTful API to guarantee adherence to USCDI v1, thereby enabling the complete storage and provision of USCDI v1 data for both patients and partners. It facilitates the secure export of electronic health information, ensuring safe access for patients. By connecting your EHR, payer systems, or any health technology to fhirstation, you can swiftly meet the compliance requirements of the Final Rule. Fhirstation functions as a robust, scalable, and secure multi-tenant Software as a Service (SaaS) platform specifically designed for EHR vendors, health plans, hospitals, providers, and other entities obliged to furnish patient data per the USCDI v1 FHIR v4 API and the electronic health information export directives outlined in the HHS final rule and CMS interoperability standards. This platform effectively removes obstacles to information sharing by promoting data exchange across patients, health IT developers, health systems, EHR vendors, and payers. Furthermore, fhirstation is strategically designed to be SMART on FHIR ready, setting the stage for next-generation patient access applications while nurturing a collaborative healthcare environment. Such innovations are essential for enhancing patient engagement and improving overall healthcare outcomes.

By performing thorough evaluations of patients' financial eligibility, reviewing their insurance plans, and detecting any discrepancies, the eligibility checker guarantees a meticulous assessment process. In the event of inaccuracies in the data provided, our sophisticated scrubber employs cutting-edge AI and machine learning technologies to fix problems, such as coding errors and incomplete or erroneous financial information. At present, the software contains an impressive collection of 3.5 million pre-loaded edits to improve its performance. To streamline operations, automatic updates from the clearing house offer real-time insights into the status of outstanding claims. This comprehensive system manages the entire billing cycle, from confirming patient financial information to resolving denied or misplaced claims, and features a strong follow-up system for appeals. Additionally, our intuitive platform proactively notifies users of potential claim denials, allowing for prompt corrective actions, while also efficiently tracking and managing appeals related to any claims that have been lost or rejected. The seamless integration of these capabilities enhances the system's overall efficiency in navigating the complexities of medical billing, leading to improved revenue cycles for healthcare providers. This holistic approach not only maximizes operational effectiveness but also ensures that patients receive timely and accurate billing information.

LexisNexis® MarketView™ delivers medical claims-based insights specifically tailored for healthcare payers, providers, life sciences companies, and health IT organizations across the United States. This innovative platform equips users with actionable intelligence aimed at improving their competitive edge, allowing businesses to discover valuable insights and visualize groundbreaking strategies. Whether you are part of a life sciences organization, a health insurance provider, a healthcare system, or a health IT company, MarketView can significantly refine essential business functions like marketing, sales, strategic planning, physician engagement, outreach, market research, network optimization, talent acquisition, pricing strategies, contracting, and clinical management, among others. To maintain an advantage in the fast-paced market, it is crucial for your organization to access the most pertinent insights possible. However, identifying which areas to prioritize can often be difficult without a clear overall perspective. MarketView effectively tackles this challenge by delivering insights into diverse elements such as referral patterns, strategies for aligning with physicians, the performance of clinically integrated networks, and metrics regarding patient volume, all of which empower organizations to make well-informed decisions. Furthermore, by utilizing these insights, businesses can not only spark innovation but also enhance their operational efficiency significantly, ultimately leading to better patient outcomes and streamlined processes.

Zentist is a cutting-edge technology platform designed to streamline insurance revenue cycle management (RCM) for dental practices. By leveraging machine learning and robotic process automation (RPA), Zentist effectively automates monotonous billing procedures, addressing the significant financial losses—estimated at $2.1 million—incurred by dental practices due to outdated billing systems. The platform is highly adaptable, catering to the growing complexity of billing processes in modern dentistry, which is currently facing substantial consolidation and increasing demands to enhance RCM efficiency. This innovative solution reduces the likelihood of human error, optimizes insurance reimbursements, offers in-depth analytics on revenue streams, and fosters stronger relationships between patients and providers. Ultimately, Zentist empowers dental practices to thrive in a competitive landscape while ensuring they receive the financial support they deserve.

Droidal is redefining revenue cycle management for healthcare through the power of Generative AI and agentic automation. Its AI agents handle high-volume billing, claims, and prior authorization workflows that traditionally consume thousands of staff hours. Designed to mimic human behavior with superior accuracy, Droidal processes over 2.5 million AI-driven transactions monthly while maintaining top-tier compliance. Hospitals, physician networks, hospices, dental organizations, and surgical centers all benefit from accelerated reimbursements, reduced denials, and greater financial visibility. The platform integrates directly with existing healthcare systems, ensuring smooth adoption without disrupting operations. Its subscription-based model delivers predictable costs and faster ROI, cutting operational expenses by up to 50% and improving net patient revenue by 25% or more. Built with enterprise-grade security, Droidal adheres to stringent compliance frameworks and offers full transparency in certifications and documentation. The platform’s human-in-the-loop approach combines automation with oversight for maximum reliability. By turning administrative processes into intelligent, self-optimizing workflows, Droidal helps healthcare providers reclaim time, improve cash flow, and enhance patient satisfaction. For modern healthcare enterprises aiming to balance efficiency with empathy, Droidal delivers a transformative edge.

Certive’s Revenue Integrity Analytics platform stands out by integrating data science, clinical knowledge, and administrative expertise. With rich experience in the healthcare sector, Certive Health plays a crucial role in ensuring that hospitals maintain their revenue integrity and adhere to process compliance. At the heart of Certive Health's services lies the Revenue Integrity Analytics™ platform, which underpins their suite of Revenue Solutions. Additionally, the platform's sophisticated analytics capabilities, along with enhancements in workflow and marketing automation, leverage insights from clinical and payer domains, enabling clients to reduce expenses, improve healthcare outcomes, and significantly increase patient satisfaction. This holistic strategy not only optimizes operational workflows but also contributes to creating a more effective and sustainable healthcare landscape. Ultimately, Certive’s innovative solutions are designed to address the evolving challenges faced by healthcare organizations today.

The patient access process is crucial for establishing the entire revenue cycle management within the healthcare sector. By ensuring the accuracy of patient information from the beginning, healthcare providers can significantly reduce errors that frequently result in increased workload for administrative teams. Notably, a substantial 10 to 20 percent of a healthcare system's income is allocated to resolving denied claims, with an alarming 30 to 50 percent of these denials arising from the initial patient access stage. Shifting towards an automated, data-driven workflow not only reduces the likelihood of claim denials but also improves access to patient care, facilitated by capabilities like 24/7 online scheduling. Additionally, refining patient access can be achieved by optimizing billing procedures through real-time eligibility verification, which equips patients with accurate cost estimates during the registration process. Moreover, enhancing the precision of registration not only boosts staff productivity but also allows for the quick correction of discrepancies, thus averting costly claim denials and the necessity for further administrative adjustments. In the end, concentrating on these aspects not only protects revenue but also significantly enriches the overall experience for patients, making healthcare more effective and accessible for everyone involved.

Approved Admissions is a robust platform designed to streamline the monitoring of changes in coverage for Medicare, Medicaid, and commercial payers, while also providing real-time eligibility verification and coverage discovery. Its main objective is to assist healthcare providers in reducing the frequency of claim denials that occur due to overlooked insurance changes, thereby expediting the billing process. Features of Approved Admissions include: - Automated eligibility verification and re-verification processes - Notifications via email or API whenever any coverage changes are identified - Real-time verification capabilities - Batch processing for eligibility verification - Smooth integration with various Revenue Cycle Management (RCM) and Electronic Health Record (EHR) systems like PointClickCare, MatrixCare, SigmaCare, DKS/Census, FacilitEase, among others - RPA-enabled synchronization across different platforms to enhance efficiency. This comprehensive approach not only ensures accuracy in coverage tracking but also optimizes workflow for healthcare providers.