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Authorization Management Services

Top 10 Authorization Management Services Alternatives & Competitors

Obtaining pre-authorizations without delay is essential to both preventing unnecessary delays in care and ensuring accurate reimbursement for services provided. But there are multiple challenges to administering an efficient, effective pre-authorization program, including: • Recruiting and retaining staff who have both clinical and revenue cycle expertise • Dedicating resources to stay up to date on complex, evolving guidelines and payer-specific requirements, and to manage payer responses • Lack of a consistent, technology-enabled workflow An Efficient Solution: Our Authorization Management Services staff manages pre-certification and authorization needs for inpatient and outpatient diagnostic and therapeutic services. We also provide comprehensive concurrent or retrospective inpatient authorizations after admission. Our solution includes: • Authorization Experience and Expertise – Our services are provided by clinicians (nurses or allied health depending on client need) who have specialized education in authorization requirements and commercial screening tools. Our team members average more than five years of clinical and authorization experience, stay up to date with training and compliance, and are dedicated to helping ensure that no part of your authorization request slips through the cracks. • A Centralized and Streamlined Technology Process – Our team leverages a centralized system to accelerate payer response, with processes that are efficient and repeatable. We incorporate robotic-process automation to assist with account statuses and system updates. • Thorough Authorization Clinical Review – Our team reviews each medical record, focusing on payer-specific requirements and obtaining authorization for services scheduled or rendered. We stay abreast of changes to Medicare, Medicaid, and commercial payer guidelines. • A Focus on Reducing Authorization-Related Denials – We take a holistic approach to authorization, which includes working auth-related denials. We review denied admissions, days, and services, and complete all necessary steps for reconsideration and appeal requests. Our denial workflow is customized so that we can pair expertise to the type of denial; for example, leveraging technical versus clinical staff depending on the reason for denial. • Detailed Performance Reporting – We provide detailed performance reporting that includes a month-over-month view of account activity including: √ current status √ completion percentages √ approval percentages
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Authorization Management Services
Top 10 Authorization Management Services Alternatives & Competitors

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Overall Top 10 Authorization Management Services Alternatives & Competitors for Small Health Systems

Browse options below. Based on data from AVIA reviews and gathered information about the vendor's clients, you can see how Authorization Management Services stacks up to the competition. Check reviews from current & previous users at other small hospitals and health systems to find the best product for your you organization.

#1

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Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
svg iconGreat fit for AMC
svg iconGreat fit for AMC
5+ years in business
5+ years in business
Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
svg iconGreat fit for AMC
svg iconGreat fit for AMC
5+ years in business
5+ years in business
There’s a wealth of powerful data within your EHR—you just need real-time insights and seamless integration to make it actionable. Our Prior Authorization solution, powered by Waystar’s Hubble: - Automatically verifies, initiates, statuses and retrieves comprehensive authorization details - Enables efficient, intelligent automation by initiating authorizations at twice the speed of manual processes - Integrates directly with all major HIS and PM systems - Provides end-to-end authorization platform, including authorizations submissions for unscheduled admissions, as well as auto-generating ABNs or Notice of Non-coverage forms for Medical Necessity - Adapts to constantly shifting payer rules and requirements - Was built and is maintained by our in-house team of experts
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key clients
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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#2

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Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
5+ years in business
5+ years in business
Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
5+ years in business
5+ years in business

XpertCoding is an AI enabled autonomous medical coding platform that automates over 90% of medical coding with 99% accuracy within 24 hours. XpertCoding also includes a Business Intelligence suite with a Clinical Documentation Improvement (CDI) Dashboard and a Comprehensive Data Analytics Dashboard, providing essential insights for healthcare leaders and teams to optimize operations.

What organizations can expect from XpertDox:

Unmatched Automation and Accuracy

  • Fully Automated Medical Coding: Automates 94% of claims without human review, ensuring speed, accuracy, and efficiency with minimal supervision.
  • Performance-Based Coding: Tracks quality and performance metrics effectively with support for Category II CPT codes.
  • Reduces Coding Errors to Less Than 1%: Ensures compliance and minimizes claim denials, delivering precise and consistent coding outcomes with >99% coding accuracy
  • Faster Claim Processing in less than 24 Hours: Accelerates claim submission timelines, ensuring faster reimbursements and reduced backlogs.
  • Smart Claim Scrubber: Customizable to align with payor-specific rules, reducing denials and rejections for smoother claim submissions.
  • EMR or EHR-Agnostic Solution: Enables easy data extraction and Fully Automated Claim Submission, ensuring uninterrupted workflows with any EMR or EHR system.
  • Modifies and Improves 80% of Claims: Streamlines workflows, eliminating bottlenecks and enhancing operational efficiency.

Enhanced Financial Outcomes for Clients

  • Flexible Pricing Model: Offers transparent, per-claim pricing for scalable and cost-effective solutions tailored to your needs.
  • Delivers a 15% Increase in Charge Capture: Optimizes revenue generation and ensures accurate billing practices.
  • Reduces Claim Denials by 22%: Strengthens the revenue cycle and minimizes payment delays.
  • Drives 23% Growth in PMPM Payments: Boosts practice revenue by up to 19%, significantly enhancing financial performance.

Revenue Cycle Optimization and Advanced Insights

  • Revenue Cycle Dashboard: Provides real-time visibility into key performance metrics and financial health, empowering data-driven decisions.
  • Clinical Documentation Improvement (CDI): Optimizes compliance and documentation accuracy for improved financial outcomes and streamlined workflows.
  • Advanced Analytics Suite: Benchmarks provider and clinic performance with actionable insights, helping healthcare teams make informed, strategic decisions.
  • Proactively Recovers Missed Charges: Identifies and retrieves overlooked charges from previously submitted claims, enhancing revenue integrity.

Secure and Risk-Free Implementation

  • HIPAA-Compliant Infrastructure: Ensures secure data privacy and full regulatory compliance, offering peace of mind for healthcare organizations.
  • Risk-Free Implementation: Includes zero upfront fees and a complimentary first month, allowing you to experience the benefits without risk.
  • ISO 27001, ISO 22301, SOC2 Type II compliant

Proven Results

  • Reduces charge entry lag by 40%, ensuring timely claim submissions. Achieves less than 1% coding errors, significantly improving compliance and reducing denials.
  • Enhances efficiency and accuracy, enabling healthcare teams to focus more on delivering high-quality patient care.

XpertCoding by XpertDox

XpertCoding is XpertDox's premier autonomous medical coding platform, designed to accelerate the revenue cycle with unmatched accuracy and efficiency. With risk-free implementation, zero upfront fees, and a complimentary first month, healthcare organizations can experience the transformative benefits of XpertCoding firsthand.

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product capabilities
Intelligent Automation
Advanced Analytics and Reporting
Compliance and Security
Continuous Performance Improvement
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key clients
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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#3

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Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
svg iconGreat fit for AMC
svg iconGreat fit for AMC
Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
svg iconGreat fit for AMC
svg iconGreat fit for AMC

There is a different way to work. If you were to reimagine the way you run your business, what would you do differently? What if you could save up to 80% of your operational costs by reimagining the way business outcomes are delivered?

Through the power of automation emerging technologies, we challenge you to think differently about how you work and how you use your people to full effective.

We can help you across the automation journey from thinking through your strategy to implementing and executing robotic process automation, machine learning and other emerging technologies across the enterprise.  

Revenue Cycle Management:

Prior Authorization ​

Insurance Claims - Posting

Patient Payment - Posting

Coordination of Benefits: Primary, Secondary, & Tertiary

Revenue Integrity - Payment Audits (Under & Over)

Provider: Insurance Enrollment

Revenue Integrity - Charge Description Master (CDM) Management

Revenue Integrity - IME or IMR Audits (CMS & Medicare Advantage)

Insurance Claims - Denied & Rejected Follow-Up

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key clients
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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#4

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Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
5+ years in business
5+ years in business
Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
5+ years in business
5+ years in business

Valer’s technology speeds and simplifies prior authorization and referral management by automating submissions, status checking, verification, reporting, and EHR synchronization across all mid-to-large sized healthcare settings, specialties, and payers from one platform and portal.

All built just for you.

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product capabilities
Requirements Identification
Form Completion
Forms Library
Documentation Collection
Request Submission
Status Monitoring
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key clients
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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#5

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Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
5+ years in business
5+ years in business
Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
5+ years in business
5+ years in business

Cedar Pay makes it simpler for patients to navigate the post-service financial journey and take control of their medical bills. We deliver enterprise-grade patient billing and payment solutions that leverage Cedar's cutting-edge consumer engagement technology, unique payer integrations and aligned incentives to help provider organizations increase collections, boost efficiency and deliver an exceptional patient experience. More than 55 of the nation's leading health systems and physician groups turn to Cedar to transform the patient financial experience. On average, Cedar Pay lifts patient collection rates by 30%, with 88% of patients reporting a positive experience.

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product capabilities
Self-service out-of-pocket estimator
Digital statementing
Statement consolidation
EOB reconciliation
Post-service patient payment
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key clients
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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#6

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Versatile platform
Versatile platform
Versatile platform
Versatile platform

HealthNautica’s eORders™, software is a comprehensive, easy-to-use, cloud solution for managing the entire perioperative process and surgical scheduling without changing your scheduling system. It begins with the physician’s office filling out an online surgery scheduling or procedure request.

Gone are the days of illegible, incomplete, inaccurate faxes sent back and forth between the physician’s office and the facility’s scheduling department. The cumbersome and error prone faxing process is replaced by an electronic form that is configured to each facility’s exact specifications and reacts to the user’s input thereby assisting the physician’s office in getting it right the first time.

All orders are legible, complete, screened for CMS Medical Necessity, incorporate SCIP, VTE, SSI and ACS NSQIP measures, verified for insurance eligibility, pre-certified and satisfy edits by CMS, commercial payers and the facility. Our solution ensures efficient surgery center scheduling and block time management while streamlining processes such as prior authorization.

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key clients
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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Visit Website

#7

Product Logo
Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
5+ years in business
5+ years in business
Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
5+ years in business
5+ years in business

This solution automates the process of checking requests under review as well as continued status changes and updates. It supports many portals such as Evicore, Magellan, UHC and others. The solution includes business rules, exception handling and daily reporting functionality with customizable dashboard views. AI is also used to do analysis and supply predictive capabilities. The solution can also be hosted and supported by CampTek as an ongoing managed service.

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key clients
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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Visit Website

#8

Product Logo
Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
5+ years in business
5+ years in business
Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
5+ years in business
5+ years in business
Make your operations more efficient: With Passport Authorizations, inquiries take place without user intervention, as does status monitoring. Submissions guide staff through the workflow, auto-filling all information Experian Health has received and prompting users only if their involvement is required. Access the industry’s most complete payer database: Experian Health's pre-authorization knowledge base stores and dynamically updates payer prior authorization requirements. Your staff can check whether prior authorization is required for a particular procedure or service, and the knowledge base automatically responds to queries with information needed.
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key clients
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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#9

Product Logo
Versatile platform
Versatile platform
5+ years in business
5+ years in business
Versatile platform
Versatile platform
5+ years in business
5+ years in business
R1 offers an end-to-end, technology-driven RCM platform that integrates with existing infrastructure to help solve your toughest financial challenges. With proven and scalable operating models, R1 seamlessly complements a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flow, reducing operating costs and enhancing the patient experience. Our size and scope, extensive client base and proven results mean that you can trust your financial performance to R1.
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key clients
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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#10

  • Cohere Unify™ Intake: Digitizing and improving intake across fax, EMR, and portal
  • Cohere Unify™ Decisioning: Prior authorization check, completeness scan, automated clinical review, and pended review pre-processing
  • Cohere Unify™ Review: Queue management, AI-assisted manual review, and letter generation

View full profile
key clients
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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