2023 Best In KLAS Claims Management & Clearinghouse

To reduce the manual work associated with claims monitoring, the partners in this case study collaborated to combine API technology from the payer with robotic process automation (RPA) technology from Waystar. Claims statuses are then normalized and delivered directly into the healthcare organization’s EMR workflows, resulting in greater claims visibility and a reduced administrative burden for all parties. As a result of this collaboration, the healthcare organization has also seen reduced denials and faster payment collection.

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)	Trend (2022-2023)	Total evaluations	Culture	Loyalty	Operations	Product	Relationship	Value

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

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

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

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

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

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

Optum Change Healthcare Assurance Reimbursement Management	76.0	-3%	n=37	C-	B-	C+	C+	C+	C
	50.0	100.0

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+

Claims Management & Clearinghouse

Past Claims Management & Clearinghouse Awards

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