Healthcare / Healthcare Providers

Claims Optimization Platforms

EXECUTION STRENGTHMARKET STRENGTHLEADERHIGHFLIEROUTPERFORMERCHALLENGER

What is Claims Optimization Platforms?

These companies develop platforms that automate claim submissions and optimize them for higher probability of avoiding denials or underpayments from health plans. Performance analytics are captured over time to identify claim patterns and avoid future denials. Companies in this market also identify and prioritize claim denials by the likelihood of being paid. Some offer expedited reimbursement payments to providers in advance, allowing providers to bypass the typically monthslong procedure to process claims and collect payment from health plans.

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Leaders

Leaders are the most established service providers in the market and possess the breadth to address various customer needs.

See why these companies made it as leaders for Claims Optimization Platforms. These companies include Encoda and Stellar Health.

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Encoda

United States / Founded Year: 2006

Encoda offers a new way to manage medical claims and remittances, and the myriad of financial transactions flowing to and from insurance companies. BackOffice, its cloud-based software, enables Encoda clients to transact directly with their major payers and eliminate the need for a clearinghouse (and the associated costs). The company's patented technology streamlines the revenue cycle process ensuring fast and efficient claims processing.

Key People

Robert Lee, Michael Kallish, William Cox

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Stellar Health

United States / Founded Year: 2018

Stellar Health is a point-of-care platform that activates primary care providers to achieve value-based care (VBC) goals that improve patient outcomes, such as improving quality scores and optimizing the patient care journey through transitions of care and high-value referrals. The Stellar platform helps providers continually engage with their patients by providing them real-time information and tangible action-based incentives for improving quality of care.

Key People

Michael Meng, Ben Kraus, Ned Schwartz, and 2 more

Highfliers

Highfliers are the most innovative service providers in the market and possess the resources to address evolving customer needs.

See why these companies made it as highfliers for Claims Optimization Platforms. These companies include OODA Health.

OODA Health logo
OODA Health

United States / Founded Year: 2017

OODA Health collaborates with providers and payers to build an administrative platform that enables people to work together to overcome healthcare's greatest challenges.On May 13th, 2021, OODA Health was acquired by Cedar at a valuation of $425M.

Key People

Giovanni Colella, Usama Fayad, Midori Uehara, and 2 more

Outperformers

Outperformers are the most specialized service providers in the market and possess the expertise to address unique customer needs.

See why these companies made it as outperformers for Claims Optimization Platforms. These companies include Gentem.

Gentem logo
Gentem

United States / Founded Year: 2019

Gentem offers instant claims reimbursements for physicians.

Key People

Fisayo Ositelu MD, Emmanuel Akintayo

Challengers

Challengers are the most promising service providers in the market and possess the agility to address emerging customer needs.

See why these companies made it as challengers for Claims Optimization Platforms. These companies include Sift Medical Data and CoreCare.

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Sift Medical Data

United States / Founded Year: 2017

Sift Healthcare is a healthcare analytics platform that holistically leverages data sources, both structured and unstructured, to reduce claim denials, increase patient collection rates, and capture insights.

Key People

Justin Nicols, Kenneth Cunningham

CoreCare logo
CoreCare

United States / Founded Year: 2019

CoreCare's single access platform enables providers to easily view their patient data across all systems in one location and to automatically monitor that data for errors. Providers that use CoreCare experience improved financial results, reduction in administrative work, and more time with their patients all without having to hire additional personnel.

Key People

Dennis Antonelos, Mehrdad Shafaie, Travis Dockter, and 1 more

What is Claims Optimization Platforms?

These companies develop platforms that automate claim submissions and optimize them for higher probability of avoiding denials or underpayments from health plans. Performance analytics are captured over time to identify claim patterns and avoid future denials. Companies in this market also identify and prioritize claim denials by the likelihood of being paid. Some offer expedited reimbursement payments to providers in advance, allowing providers to bypass the typically monthslong procedure to process claims and collect payment from health plans.

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Reach more buyers.

Your future customers are researching their next tech solution on CB Insights. Make sure they can find you.

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