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Decision Insights™ Claims Management & Clearinghouse Commentary

Subject Expert
Dustin Cragun
VP of Revenue Cycle Research
KLAS VP of Revenue Cycle Research - Dustin Cragun
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athenahealth athenaEDI athenaEDI
 

Being Replaced

Manager

Our organization experienced a lot of push from various departments to go toward Epic and away from...

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Availity Essentials Pro Availity Essentials Pro
 

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Director

Availity Essentials Pro isn't part of our long-term plans because it isn't as integrated with our...

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Manager

Our company has entered a partnership with another company, so we will be moving to that company's...

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Decided / Likely Choice

Physician

We are looking to stand Availity Essentials Pro up as a backup once the dust settles with our...

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Manager

We did a demo with Availity, and we liked it. Their system is a strong possibility for our...

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CMO

We looked at Availity. They have an excellent product. However, it is more of a standalone product....

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COO

We looked at Availity's system, but we decided that its technology and price didn't match our needs.

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Director

We were looking for a vendor that was better at communicating about instances of downtime, so we...

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Cognizant ClaimLogic (TriZetto) ClaimLogic (TriZetto)
 

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Manager

Our health system wants to consolidate to just one vendor for claims. The organization is going to...

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Cognizant TriZetto Provider Solutions Clearinghouse (Mostly Ambulatory) TriZetto Provider Solutions Clearinghouse (Mostly Ambulatory)
 

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Unknown

We decided to go with TriZetto Provider Solutions because their clearinghouse solution plays with...

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Experian Health ClaimSource ClaimSource
 

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CIO

We are considering replacing ClaimSource because we have had some issues on the front end.

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COO

Our decision to choose ClaimSource was very close. What really set ClaimSource apart was that we had...

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Manager

We are switching to Epic's platform, and Experian Health's product is the claims management piece...

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Physician

Our decision to go with Experian Health was largely related to patient access. Experian Health had...

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Manager

We are leaning toward Experian Health's offering because Experian Health has a lot of features that...

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Unknown

ClaimSource has functionalities for preadmissions, revisits, check-ins, insurance eligibility,...

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Manager

The decision to go with Experian Health's system was made by our operational team. They chose it...

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COO

We decided to move to Experian Health's system because of the vendor's technology and prices. We...

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Physician

It didn't take a rocket scientist to figure out that ClaimSource would be a good connection on the...

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Manager

We are leaning toward Experian Health because they offer more in terms of client support with claims...

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Manager

Our organization is switching to Epic, and ClaimSource is the product that Epic is encouraging.

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Analyst/Coordinator

We chose Experian Health's system because we were already using the vendors' systems for some other...

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Analyst/Coordinator

We are moving to ClaimSource because the pricepoint is better and the platform will integrate with...

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Analyst/Coordinator

Experian Health's system looked fine. I don't think there was anything wrong with it, but it didn't...

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CIO

We are thinking of staying with ClaimSource because we haven’t had any issues with Experian Health....

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Director

We were looking around the market for claims management vendors who could do the work more quickly...

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FinThrive Claims Manager FinThrive Claims Manager
 

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Analyst/Coordinator

We want to move away from FinThrive because of their customer service. We have had some issues, but...

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Manager

We replaced FinThrive's system due to costs.

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Analyst/Coordinator

We are leaving FinThrive's system because we are trying to reduce the number of vendors we work with....

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Unknown

The big thing that made us decide to go with another vendor was that FinThrive told us they could...

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CIO

We are considering moving to FinThrive because they have everything we need and have a contract...

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Analyst/Coordinator

FinThrive didn't win our RFP because their customers service was poor. We needed a person dedicated...

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Manager

We considered FinThrive because we thought they could do some things more efficiently than our...

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Physician

We looked at FinThrive. FinThrive was probably a little better at the back-end stuff compared to the...

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Unknown

When I looked at KLAS' site, I saw FinThrive's system. I wanted to research that system because I...

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Inovalon Claims Management Pro Inovalon Claims Management Pro
 

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Director

We are moving to Inovalon's system because we are having issues with our current product. We need a...

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Director

We went with Inovalon because their system integrates with and was offered by other vendors we were...

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InstaMed Clearinghouse InstaMed Clearinghouse
 

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Manager

We don't really like InstaMed, but we went with them because they were cheap. Their support is...

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NextGen Healthcare NextGen Clearinghouse NextGen Clearinghouse
 

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Manager

NextGen Healthcare is sunsetting this product, so we are being forced to find another solution.

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Olive Claims Management Olive Claims Management
 

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Physician

When Olive went insolvent, Waystar picked the system up, and then Waystar essentially said the...

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Optum Assurance Reimbursement Management Assurance Reimbursement Management
 

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COO

We flipped from Assurance Reimbursement Management to another solution during the Change Healthcare...

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CMO

During the Change Healthcare incident, we had a lot of problems with posting payments. Within a...

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Unknown

We are looking to make a change to our patient connect program. We used Optum's systems for our...

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Unknown

We moved away from Change Healthcare because of the cyberattack on their clearinghouse solution.

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COO

We are replacing Change Healthcare's system because of the Change Healthcare data breach. Change...

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Director

Before the Change Healthcare disaster, we decided that we were going to switch to another vendor's...

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Unknown

We were affected by the Change Healthcare ransomware attack very significantly. Nobody can work with...

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Physician

We are replacing Change Healthcare after their cybersecurity incident. The confidence factor is nil....

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Manager

Change Healthcare performed well in the space, and if we had to make the choice again, I would...

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Manager

We want to switch away from Assurance Reimbursement Management for a number of reasons. Change...

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Manager

We are looking at Change Healthcare because they are preferred by our EHR vendor.

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Director

We were looking for a vendor with a more efficient workflow than the one we were with, so we looked...

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Optum Claims Manager Claims Manager
 

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Manager

The product is not part of our long-term plans, unfortunately. We are switching to a new EHR, so...

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Director

We switched clearinghouses because Change Healthcare went down, and we couldn’t submit anything...

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Manager

We decided to move away from Optum along with other solutions that could be replaced by Epic's...

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Director

We were looking for vendors that had a vision for making long-term goals, and we considered Optum....

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Quadax Xpeditor Xpeditor
 

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Unknown

Because we have had such high denial and authorization issues with Xpeditor where things are just...

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Manager

We aren't happy with the customer service that we have been receiving lately from Quadax. We have...

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Director

We decided Quadax was no longer a good fit for our organization. We saw a lack of vision with...

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Analyst/Coordinator

We were looking for a new claims management and clearinghouse vendor, so we searched for some of the...

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Manager

We are looking at Xpeditor because the solution is not complicated to use. We like that everything...

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COO

We looked at Quadax's system, but we decided to go with another vendor's system that had better technology....

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The Craneware Group Medessary (ClaimTrust) Medessary (ClaimTrust)
 

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Unknown

We did not look at any other vendors before deciding to go with The Craneware Group. Their system...

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The SSI Group SSI Claims Management SSI Claims Management
 

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Manager

We are moving away from The SSI Group because of inefficiencies.

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Manager

Our potential move away from The SSI Group has a lot to do with a lack of satisfaction with our...

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Manager

We are replacing The SSI Group due to a lack of a client relationship between the vendor and us. We...

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Analyst/Coordinator

We are leaving SSI Claims Management because our organization is moving to an EMR, and we needed...

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Analyst/Coordinator

SSI Claims Management wasn't something that I expected us to be interested in. SSI Claims Management...

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Manager

We are looking at The SSI Group because they were highly rated by KLAS.

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Director

We did not like that our previous vendor would charge us every time we requested a report, so we...

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TruBridge Claims Management TruBridge Claims Management
 

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CNO

We are leaving TruBridge Claims Management because our parent company is forcing us to.

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Manager

TruBridge is one of the vendors we are leaning toward because their product is user friendly. And...

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Waystar Claims Management Waystar Claims Management
 

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Manager

We are unsure whether Waystar is in our long-term plans because our organization may consolidate...

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CMO

We went with Waystar because their ownership model aligned with our desires for alignment. The...

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Analyst/Coordinator

We wanted to go with whoever was going to be best in class, and for most of the areas we were...

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Manager

We are going with Waystar because they can drive more efficiencies than our current vendor.

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CNO

We are moving to Waystar Claims Management because it is the solution that our new EHR primarily supports....

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Manager

We are switching to Waystar because we are doing a certain component with our EHR vendor, and that...

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Manager

I was at a NextGen Healthcare user group meeting, and Waystar was there. They said they were...

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Unknown

We were having to use different clearinghouses for our different needs because one of the...

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Director

We are switching all of our systems to Waystar's systems, including our clearing house, real-time...

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Unknown

We have had such high denial and authorization issues within our facility. Things are just being...

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Manager

We decided to move to Wastar in order to have multiple products under one entity and vendor. We came...

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Director

We did not like our previous vendor’s lack of vision. And we didn't like the product's reporting...

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COO

We looked at Waystar's system. We also looked at a couple of other systems, but our choice came down...

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Physician

Waystar wanted customers to move to their newer platform. We were not just going to move over to...

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COO

We considered Waystar's system, but we chose a system from another vendor who offered a better price...

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Manager

We have Waystar right now, but in the future, our health system will be doing vendor consolidations,...

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Waystar Clearinghouse Waystar Clearinghouse
 

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Analyst/Coordinator

We looked at Waystar in our search for a new clearinghouse vendor. Waystar is huge and wasn’t a good...

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Related ReportsView All Reports
Point of Light
KLAS article icon
Points of Light 2023 Case Study 6
13 April 23    |   Aurene Wilford and Boyd Stewart
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.
Decision Insights
KLAS article icon
Claims Management 2023
25 January 23    |   Dustin Cragun and Jaren Day
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
KLAS article icon
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.


Subject Expert
Dustin Cragun
VP of Revenue Cycle Research
KLAS VP of Revenue Cycle Research - Dustin Cragun



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