2023 Best In KLAS Claims Management & Clearinghouse

When making a core HIT purchasing decision, ambulatory healthcare organizations must take into account how prospective partners deliver across a variety of key technology areas beyond core EMR and PM solutions. This athenahealth “complete look” provides a high-level analysis of the key IT components that make up athenahealth’s comprehensive suite. (Other reports in the series do the same for eClinicalWorks, Greenway Health, NextGen Healthcare, and Veradigm.)

The financial well-being of healthcare organizations is critical, especially given the macroeconomic pressures they face today. Many are looking at claims management and clearinghouse technology to maximize cash collections and reduce administrative burdens. To better understand what factors are influencing purchase decisions and which vendors are seen as capable of driving success, this report examines 24 recent purchase decisions validated by KLAS between February 2020 and November 2022. For additional context, satisfaction data from current customers is also included. It should be noted that the decisions in this report are not a comprehensive representation of all claims management purchase decisions made in the last several years.

Perception

Optum/Change Healthcare Merger

16 August 22 | Boyd Stewart and Sam Eaquinto

In January 2021, Optum announced their intentions to acquire Change Healthcare. The merger remains unfinalized, however, as the US Department of Justice blocked the deal in February 2022 due to anticompetition concerns—such a merger would give UnitedHealth Group, Optum’s parent company and the nation’s largest insurer, access to rivals’ sensitive data. The legal proceeding is ongoing and scheduled to go to trial August 1, 2022. This report shares Optum and Change Healthcare customers’ reactions to the merger and their perceptions of its impact. Between March 2021 and April 2022, KLAS interviewed 48 individuals from 46 unique organizations; of these respondents, 9% are Optum customers, 56% are Change Healthcare customers, and 35% are customers of both vendors.

Company/solution	Overall performance score (100-point scale)	Total evaluations	Trend (2022-2023)	Culture	Loyalty	Operations	Product	Relationship	Value

Experian Health ClaimSource	90.9	n=28	+2%	B+	A	A-	A-	A-	A-

The SSI Group SSI Claims Management	88.4	n=22	+2%	A-	A-	B+	A-	A-	B+

Quadax Xpeditor	88.3	n=58	-3%	A	A-	A-	B+	A-	B+

Availity Revenue Cycle Management	86.6	n=18	-2%	B	A-	B+	B	B	A-

Waystar Claims Management	85.6	n=49	-5%	B	A-	B+	B+	B	B

FinThrive Claims Manager	82.7	n=34	-3%	B	B	B+	B+	B-	C+

Change Healthcare Assurance Reimbursement Management	76	n=37	-3%	C-	B-	C+	C+	C+	C
	50.0	100.0

Company/solution	Trend (2022-2023)	Culture	Loyalty	Operations	Product	Relationship	Value

Experian Health ClaimSource 90.9 n=28 COMMENTS	+2%	B+	A	A-	A-	A-	A-
The SSI Group SSI Claims Management 88.4 n=22 COMMENTS	+2%	A-	A-	B+	A-	A-	B+
Quadax Xpeditor 88.3 n=58 COMMENTS	-3%	A	A-	A-	B+	A-	B+
Availity Revenue Cycle Management 86.6 n=18 COMMENTS	-2%	B	A-	B+	B	B	A-
Waystar Claims Management 85.6 n=49 COMMENTS	-5%	B	A-	B+	B+	B	B
FinThrive Claims Manager 82.7 n=34 COMMENTS	-3%	B	B	B+	B+	B-	C+
Change Healthcare Assurance Reimbursement Management 76 n=37 COMMENTS	-3%	C-	B-	C+	C+	C+	C

Company/solution	Overall performance score (100-point scale)	Total evaluations	Culture	Loyalty	Operations	Product	Relationship	Value

athenahealth athenaEDI [C] C	89.2	n=19	A-	A	A-	B+	A-	B+

Optum Claims Manager * L	94.1	n=7	A+	A+	A	A	A+	A-

TruBridge Claims Management * [NR] L C	87.7	n=12	B	A-	B+	A-	A-	B+

Company/solution	Overall performance score (100-point scale)	Total evaluations

athenahealth athenaEDI [C] C culture A- loyalty A operations A- product B+ relationship A- value B+	89.2	n=19

Optum Claims Manager * L culture A+ loyalty A+ operations A product A relationship A+ value A-	94.1	n=7

TruBridge Claims Management * [NR] L C culture B loyalty A- operations B+ product A- relationship A- value B+	87.7	n=12

Claims Management & Clearinghouse

Past Claims Management & Clearinghouse Awards

Contact KLAS

Tell us about your organization

How can we help you?