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Eligibility and Enrollment Services

Top 10 Eligibility and Enrollment Services Alternatives & Competitors

Uncompensated care continues to have an enormous impact on providers’ bottom lines, with $41.3B in charity care and bad debt recorded for 20182. As millions of consumers have recently lost their employer-based healthcare coverage due to unemployment, and millions of others struggle with high out-of-pocket deductibles, it falls to you to help alleviate patients’ financial stress and simultaneously support the bottom line. We can help via our proven strategy that drives patient satisfaction, loyalty, and revenue. Engage our Expertise: Helping patients to secure financial assistance requires a combination of innovative technology and expert staff: • Our Eligibility & Enrollment Services leverage AI and other innovative tools to improve process efficiency and screen all patients. Bedside tablets are part of our proprietary workflow and can be used to capture patient documentation and signatures in a timely, efficient manner. • Our staff has local, state, and federal-specific expertise and in-depth experience in sourcing potential coverage for each patient. We leave no stone unturned as we assess patients’ eligibility for Medicare/Medicaid, Disability/SSI, Third-party Liability, commercial insurance, state and county programs, social programs, and charity. We then help patients to enroll in the appropriate program(s) and process claims for payment. Customizable Services: Our team is tightly integrated to serve as an extension of your organization. We understand that patient experience is enhanced with our ability to express empathy and kindness as we assist patients in understanding their financial responsibility while helping them to find and enroll in programs. We offer onsite services where our team is embedded to deliver high-touch assistance early in the patient journey, driving faster enrollment to accelerate payment. We also offer remote services as needed.
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Top 10 Eligibility and Enrollment Services Alternatives & Competitors

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Overall Top 10 Eligibility and Enrollment Services Alternatives & Competitors

Browse options below. Based on data from AVIA reviews and gathered information about the vendor's clients, you can see how Eligibility and Enrollment Services stacks up to the competition. Check reviews from current & previous users at organizations like yours 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
High Performer
High Performer
5+ years in business
5+ years in business
Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
High Performer
High Performer
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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#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

We are not just RPA Developers! In other words, we do not just build your automations and drop them at your door. CampTek Software is a full life cycle Managed Service provider that offers an array of Services based on your current and future requirements and can tailor hybrid solutions that you can take advantage of.

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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
Rated In Top 10%
Rated In Top 10%
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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#4

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

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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#6

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Niche
Niche
5+ years in business
5+ years in business
Niche
Niche
5+ years in business
5+ years in business
Allscripts® Practice Financial Platform is a comprehensive portfolio of revenue cycle management solutions for physician practices. It boosts practices’ operational efficiency and productivity by helping manage scheduling, collections, claims and denials. The portfolio includes Allscripts® Practice Management, Payerpath, Opargo and Melissa Data.
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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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#7

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Versatile platform
Versatile platform
High Performer
High Performer
5+ years in business
5+ years in business
Versatile platform
Versatile platform
High Performer
High Performer
5+ years in business
5+ years in business
ArcoInvoice helps to automate the process of your (supplier) invoices. Whether you receive invoices via paper, e-mail or EDI, we extract the data into our platform and connect to your existing ecosystem such as your CRM, DMS and ERP software package. We use your internal business rules and customize your workflows (GL codes, cost centers, approval flows) to avoid manual errors, in a fully legally compliant and auditable way.
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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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#8

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Versatile platform
Versatile platform
Trailblazer
Trailblazer
Versatile platform
Versatile platform
Trailblazer
Trailblazer
efficientC is a comprehensive decision support and claims management technology platform. It combines powerful denial analytics, claim scrubber and clearinghouse technologies, to deliver the finest denial prevention tool on the market today. efficientC’s Insights, is a predictive analytics solution that leverages machine learning to provide actionable intelligence to help keep denials at bay. Built on the backbone of its proprietary and powerful claim scrubber and stellar support team, the efficientC platform delivers the best possible results to hospital revenue cycle teams.
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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

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High Performer
High Performer
5+ years in business
5+ years in business
High Performer
High Performer
5+ years in business
5+ years in business

Waystar’s Eligibility Verification solution automates much of the eligibility process so you can say goodbye to the days of searching and interpreting patient coverage and focus on what really matters: your patients. With our powerful technology, you can:

  • Prevent more rejections + denials
  • Strengthen front-end collections
  • Optimize staff productivity
  • Elevate the patient payment experience

What makes Waystar the industry’s most accurate eligibility verification tool?

Getting insurance verification right the first time is crucial. Incorrect or incomplete eligibility has a ripple effect across the revenue cycle, from missed authorizations to reworking denied claims.  

Powered by Waystar’s AI + RPA, our Eligibility Verification tool combs through payer data to curate the most accurate and comprehensive benefit information. With richer coverage detail, staff can easily identify eligibility issues. Plus, our eligibility engine seamlessly integrates with all major EHRs.

Features + benefits

  • Superior eligibility results with RPA + expansive payer connectivity
  • Plan code matching to mitigate registration errors
  • Normalization of payer data for more efficient workflows
  • Intelligent alerts with actionable guidance for staff

Enriched benefit data

  • Utilize RPA + EDI connections to surface complete response
  • Expansive payer connectivity for best data in the market
  • Enriched eligibility data when no EDI is available

Automated, intelligent workflow

  • Integrated workflow for seamless user experience
  • Intelligent warnings + Medicare Advantage plan alerts
  • Guided next best user actions

Unparalleled financial clearance operations

  • Auto-rechecks eligibility whenever account data is updated
  • Benefit information is normalized for ease of consumption
  • Self-pay validation for coverage verification

What our users have to say:

“ Before Waystar, we were going to a variety of carrier websites and spending a lot of time on the phone to check eligibility. It was labor intensive. Now we have all our carrier information in one location in our system. ”

- Manager of Revenue Cycle Billing & Coding

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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

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Versatile platform
Versatile platform
High Performer
High Performer
5+ years in business
5+ years in business
Versatile platform
Versatile platform
High Performer
High Performer
5+ years in business
5+ years in business
We simplify workflows with timely access via multiple digital front doors that work across the healthcare ecosystem.
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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