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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Claim your CB Insights ProfileLeaders 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.
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.
United Skin Specialists, Alabama Orthopedic Clinic, JWM Neurology
Robert Lee, Michael Kallish, William Cox
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.
Primary Care Development Corporation, Harvard Pilgrim Health Care
Highmark, Highmark Health, BlueCross BlueShield of Minnesota, and 1 more
Michael Meng, Ben Kraus, Ned Schwartz, and 2 more
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.
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.
Blue Cross Blue Shield of Arizona, Blue Cross Blue Shield Institute, Dignity Health, and 1 more
Giovanni Colella, Usama Fayad, Midori Uehara, and 2 more
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.
United States / Founded Year: 2019
Gentem offers instant claims reimbursements for physicians.
Fisayo Ositelu MD, Emmanuel Akintayo
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.
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.
Huron Consulting Group, State Collection Service, Wind River Financial
Justin Nicols, Kenneth Cunningham
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.
Dennis Antonelos, Mehrdad Shafaie, Travis Dockter, and 1 more
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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Claim your CB Insights Profile