Alternatives to Virtual Benefits Administrator (VBA)
Compare Virtual Benefits Administrator (VBA) alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to Virtual Benefits Administrator (VBA) in 2026. Compare features, ratings, user reviews, pricing, and more from Virtual Benefits Administrator (VBA) competitors and alternatives in order to make an informed decision for your business.
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1
Service Center
Office Ally
Service Center by Office Ally is a trusted Revenue Cycle Management and patient payments platform used by more than 80,000 healthcare providers and health services organizations, which process more than 950 million transactions annually. Service Center is a cost-effective solution enabling providers to control their revenue cycle. With a user-friendly interface, Service Center helps providers check and verify patients’ eligibility and benefits, submit, correct, and check the status of their claims online, and receive remittance advice. Accepting standard ANSI formats, data entry and pipe-delimited formats, Service Center helps streamline administrative tasks and create more efficient workflows for providers. -
2
Hi-Tech Series 3000
Hi-Tech Health
Series 3000 is a cloud-based claims administration solution for businesses within the healthcare industry. No matter what your adjudication, reporting, or plan needs are, this platform reduces time processing claims and increases productivity as it assists with: •Client management •Benefits input •Electronic claim submissions •Claims processing •Real-time status tracking Our built-in database efficiently manages clients and employee benefits. This platform allows users to make real-time updates including: •Claims statuses •Currency conversion •ACH deposits and disbursements •Document printing No matter what happens, our cloud-based software is reliable, and we pride ourselves on 99 percent up time. Series 3000 is HIPAA compliant and ensures secure data management and backup. We upgrade our communications and IBM hardware every two to three years and maintain System Critical Support with all our vendors, keeping our technology up to date.Starting Price: $3500 per month -
3
HEALTHsuite
RAM Technologies
HEALTHsuite is a comprehensive benefit administration system and claims processing software solution designed for health plans administering Medicaid and / or Medicare Advantage benefits. HEALTHsuite is a rules-based auto adjudication software solution designed to automate all aspects of enrollment / eligibility, benefit administration, provider contracting / reimbursement, premium billing, medical management, care management, claims adjudication, customer service, reporting and more. RAM’s Medicare Advantage-in-a-Box offering is unique in the industry; the product of RAM’s extensive experience in Medicare Advantage and an unwavering commitment to changing our industry. HEALTHsuite Advantage™ and eHealthsuite™ are the cornerstones of our pre-configured Medicare Advantage-in-a-Box offering. HEALTHsuite Advantage is a fully integrated suite of modules providing our clients with an unmatched solution to administer their Medicare Advantage and Special Needs Plans (SNP’s). -
4
Context 4 Health Plans Suite
Context4 Healthcare
Protect the integrity of your health plan and determine accurate pricing with the Context4 Health Plans Suite, our modular, cloud‑based technology platform. Immediate, actionable, and defensible Fraud, Waste, and Abuse (FWA) detection built by our team of certified clinical, dental, and health benefits experts. Accurate data and cutting-edge cloud technology combine to create a proven and defensible medicare reference-based pricing (RBP) solution. More than 100 healthcare data sets, with professional support to optimize efficiency and compliance. Advanced medical coding software designed to expedite claim submission and minimize denials. Our cloud based Payment Integrity Platform utilizes our proprietary analytics engine to identify coding errors, medical necessity, unbundling, fraud-waste-abuse, audit risks, pricing and other aberrations that can impact your business. -
5
Summit
DataPath
DataPath Summit is an all-in-one cloud-based benefits administration software designed to help third-party administrators (TPAs) manage and fulfill employer-sponsored benefits within the United States. Secure and scalable, Summit supports the administration of health savings accounts (HSAs), flexible spending accounts (FSAs), transit accounts, health reimbursement accounts (HRAs), and premium billing arrangements including COBRA, CDH, retiree billing, and more. -
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Evolent Health
Evolent Health
Driving breakthrough clinical and administrative results. Evolent Care Partners, Midwest health system ranked third in the nation for both total shared savings and percentage of savings off of benchmark. Evolent Care Partners enables independent primary care physicians with the capital and resources needed to participate and succeed within two-sided payer contracts, while limiting their financial risk. New Century Health delivers cost and quality improvements in oncology and cardiology by using clinical evidence to guide care decisions that are supported by both payers and providers. Evolent Health Services simplifies health plan operations through comprehensive services that are powered by a modern and integrated platform, and a true strategic partnership model. Explore insights and news on value-based care, population health, health plan administration and other health care transformation topics. -
7
Complete Claims
Complete Health Systems
Claims Adjudication for medical, dental, vision, prescription, short and long-term disability claims. Available for on-site license or as a hosted application (ASP). Microsoft technology: SQLServer database with a Windows front end. Acclaimed Customer service staffed by health care claims experts with a minimum of 12 years’ experience in the field. Support calls are logged with status available via the internet. Plan copy and modification feature enable quick setup of plans. Auto-adjudication using benefit codes built using business rules based on over 25 variables from both the claim and the claimant records made available to the adjudication engine. Inbound claims can be scanned images, EDI or paper. HIPAA EDI 5010 transaction sets. Re-pricing fee and UCR Schedules can be loaded on the system in advance of the effective date. The date-driven logic will re-price based on the date of service. -
8
ConnectYourCare
ConnectYourCare
Simplify tax-advantaged benefits and COBRA administration with our flexible program design and dedicated support program. Curb costs while preserving the benefits that workers need with a traditional HSA or our revolutionary HSA On Demand® solution. COBRA Administration Services enable employees to avoid insurance coverage interruption—providing peace of mind. Help employees take a consumer-directed approach to care with Health Care FSAs, Limited Purpose FSAs, and Dependent Care FSAs. Empower employees and their families with corporate Health & Wellness, Adoption, and Education reimbursement programs. Offer an HRA to maximize your control over covered expenses and portability while satisfying employees’ needs. Our Commuter Benefits program allow individuals to set aside pre-tax funds to pay for eligible transit and parking expenses. -
9
Ebix FACTS
Ebix
The FACTS® family of products supports multiple lines of business within a single information system: Health, Indemnity, TPA, PPO, HMO, PHO, IPA, MSO, Group Administration, COBRA, Section 125-Integrated Flexible Benefits, and Workers' Compensation with Integrated Managed Care for 24-hour coverage. From the inception of HIPAA, the FACTS® system infrastructure has been based on HIPAA-compliant solutions. FACTS® is fully committed to ensuring a clear and easy path to HIPAA readiness - well ahead of the federally mandated compliance deadlines. FACTS® fully integrated, interactive Internet and voice-based systems empower healthcare administrators and professionals with 24 x 7 access to claims and benefit information, and real-time transactions such as EDI claim uploads, through the Internet. Improve your risk and insurance management.Starting Price: $25000 one-time payment -
10
Conexia
Conexia
Provide authorizations, claims processing and payment in real-time at the point of care. Enhance care coordination and improved outcomes to lower medical cost while streamlining administrative processes. Engage providers at the point of care to capture and share data in real-time resulting in an unparalleled exchange of health information. We partner with our clients to implement risk management strategies that result in better outcomes with lower costs. We strive to improve the user experience for everyone involved in the ecosystem. We deliver a minimum 3:1 ROI for our clients to allow them to optimize their resources. Conexia has developed a core technology platform (ONE) that is customizable to meet the diverse regulatory requirements and operational processes for each client in each geography. In most cases, our initial implementation is an overlay on the payer’s existing technology ecosystem to create real-time processes. -
11
MediClaims
WLT Software
WLT’s MediClaims system offers a cost-effective, straightforward, and efficient approach to benefit and claims administration. WLT’s rules-based architecture and integrated EDI processes allow claims to be processed quickly, easily, and accurately. MediClaims’ administration and processing capabilities encompass a range of benefit and claim types, from Medical, Dental, Vision, and Prescription Drugs, to Consumer-Driven Healthcare, Disability, and Capitation processing. With WLT’s MediClaims system, you have the flexibility to configure your groups for a single line of coverage or for complex benefit packages with multiple lines of coverage. No plan can work efficiently without support from reliable information systems. WLT makes a point of always working with the most advanced technologies, providing you with the most sophisticated and flexible systems available today.Starting Price: $1 one-time payment -
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PLEXIS Payer Platforms
PLEXIS Healthcare Systems
PLEXIS’ suite of best-in-class apps has a proven record of giving payers the extended functionality necessary for modern core administrative ecosystems. From real-time benefit administration and adjudication to automatic EDI transmission and self-service customer portals, PLEXIS Business Apps have you covered. Passport provides essential connectivity from the core admin and claims management engines to PLEXIS business apps, your own apps, and existing in-house systems. With its flexible API layer, Passport delivers real-time integration with portals, automated workflow toolsets, and business apps. Connectivity is limitless. Streamline workflows with a centralized, modern core administration & claims management platform. Process claims in a timely and accurate manner, and automate the complexities of benefit administration to capture a quick ROI and deliver superior customer service. -
13
Picwell DX
Picwell
Picwell exists to ensure people get the direction they need to make wise employee benefit decisions. We give HR & Benefits teams and their workforce benefits partners the tools they need to drive long-term results. Give your employees access to intelligent, personalized benefits guidance anytime, anywhere, from any device. Help Your Employees Make Wise Medical Plan Choices. Within minutes, each employee will see which health plan best fits their personal situation based on their unique health status, personal preferences, and risk tolerance. Offer Interactive HSA Education. The interactive Health Savings Account module allows you to illustrate the power of HSAs with interactive education. Offer Employees Personalized Education on All Benefits. Configure Picwell DX beyond medical decisions and offer personalized educational modules on any supplemental benefit, from dental insurance and voluntary benefits to a 401(k) or other wellness programs. -
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Anagram
Anagram
Anagram Prosper puts money back in the hands of your patients — at no cost to your practice. Increase your margins, delight your patients, and forget courtesy discounts. We partnered with the best vendors to develop wholesale price lists that better align with the needs of you and your patients. Provide rebates on the same products you already stock. Incentivize your patients, drive more conversions, and collect more revenue. With Anagram Prosper, you can save patients money without offering discounts or lowering your margins. Use our rebate program to drive more sales and make your patients happy. Most patients don’t know about their out-of-network benefits. Anagram Access can pull real-time vision plan eligibility to maximize savings for your patients. With Anagram Access, you can quickly calculate how much your patient owes and how much their vision plan reimburses. -
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InsurancePlus Software Series
United Systems and Software
USSI is proud to present its entire line of professional insurance software solutions designed and developed as an all-encompassing turnkey administration offering. USSI's comprehensive software solutions ensure that your insurance company is operating at the highest level in an ever changing and competitive marketplace. USSI's InsurancePlus Individual Life and Health Administration software solution manages books of business for traditional and non-traditional Life and Health insurance companies. Product lines supported include Whole and Term Life, Interest Sensitive, Final Expense, Annuities, Supplemental Health, etc. USSI's InsurancePlus Group Life and Health Administration software solution manages books of business for Group Health insurance companies, Self-Insured Funds, and TPA's. Supported plan offerings include Point of Service, Major Medical, Term Life, High Deductible, Traditional Indemnity, etc. -
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ClaimScape
DataGenix
Emerged in the year 2000, DataGenix is strongly resolved to provide TPAs, adjusters, and insurance companies with modern claims processing solutions. We understand that claims processing and health benefits management can include several complications. So that your business does not suffer any losses, our experts have created the advanced ClaimScape software that can automate the entire adjudication process. The goal of our business and the Claims software is to resolve the perplexities that hinder the reach of unmatched customer experience for your clientele network. Keeping in mind the modern trends and requirements, we can assure your business's optimum growth with our software products. We have won the trust of top TPAs of the nation and are willing to serve more. -
17
V3locity
Vitech Systems Group
V3locity®, Vitech’s cloud-native administration, engagement, and analytics platform, is a transformative suite of complementary applications that offers full life cycle business functionality and robust enterprise capabilities. It marries core administration with a revolutionary digital experience. Its modular design enables flexible, agile deployment strategies. V3locity employs an advanced, cloud-native architecture that leverages the unique capabilities of AWS to deliver a solution with unparalleled security, scalability, and resiliency. -
18
HealthAxis
HealthAxis
HealthAxis equips payers, providers and health organizations with integrated solutions from an advanced claims processing system and TPA services to actionable analytics. We streamline operations and improve client and patient outcomes. As healthcare becomes more technologically enabled, it remains inhibited by coordination challenges, legacy technology, and information management. We strive to bring innovation and a growth mindset to all struggling with these challenges. Our client philosophy is to serve as a complete business partner. HealthAxis believes our success does not stem from selling our solutions but from our business partners’ sustained success and growth. We enable our partners to add value to the communities they serve. As they build their membership and scope, we flourish with them. Every level of our team understands our responsibility to help unlock our partners’ potential. -
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TL LeadManager
TargetLeads
TL LeadManager® is our lead management system designed exclusively for Life and Health Insurance Agents. Managing your Medicare Supplement, Long Term Care, Final Expense and Annuity leads has never been easier. If you don't have or don't love your current lead/contact management system, you need to check out TL LeadManager. This feature rich, easy to use contact management system, CRM, is designed to minimize the time you spend working leads and maximize your selling time. Reduce your paperwork, be more organized than ever before and start selling more policies. Used in conjunction with TargetLeads® we can make your direct mail marketing efforts as seamless as possible. Whether using Turning 65 lists for Medicare Supplement or any other kind of insurance leads, TLLM will allow you to manage, follow-up and run reports on all of your campaigns.Starting Price: $40 per month -
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benefitexpress
benefitexpress
Born from benefits experts, benefitexpress delivers industry leading cloud-based benefits administration software, solutions and services to employers and broker partners. Our fully outsourced solution, My Benefit Express™, simplifies your benefits administration responsibilities and helps employees make informed decisions–enhancing employee engagement and satisfaction. Software and services span a suite of end-to-end solutions including a full-service call center, daily administration, integrated ACA administration, reimbursement account administration, dependent eligibility audits, and total compensation statements. Our commitment to creative problem solving, scalable systems, and full accountability helps assure our clients’ success, including healthcare organizations, major universities and educational institutions, large enterprises, and growing businesses. -
21
KMR Medical Claims Manager
KMR Systems
KMR Claims Processing Manager is a state-of-the-art, fully integrated, customizable claims processing solution for TPAs, Self Insured and Claims Administrators. Our system includes a comprehensive Medical & Dental Reimbursement module, allows for electronic claims, integrates with Document Imaging systems, has the ability for debit card processing and is totally HIPAA compliant. -
22
PlanXpand
Acero Health Technologies
PlanXpand™ is Acero’s proprietary transaction processing engine, one that powers each of our products for health benefits administrators. Leveraging this engine, clients may choose to implement Acero’s products concurrently or incrementally. In addition to selecting one of our standard products, administrators also may choose to utilize PlanXpand™ to develop a custom solution to extend existing system capabilities. Acero’s unique, integrated solutions feature Service-Oriented Architecture, allowing health benefits administrators and insurers to add features and functions to existing adjudication platforms. At the same time, our sophisticated design and engineering enables real-time adjudication of every type of claim, all in direct interaction with the core claims system, resulting in more accurate processing, more satisfied customers and less need for claims adjustments. -
23
Centauri Health Solutions
Centauri Health Solutions
Centauri Health Solutions is a healthcare technology and services company driven by our desire to make the healthcare system work better for our clients and to provide compassionate support for individuals in need. Our analytics-powered software enables hospitals and health plans (Medicare, Medicaid, Exchange and Commercial) to manage their variable revenue through a custom-built workflow platform. While our tailored support of their patients and members provides them with access to life-enhancing benefits. Our solutions include Risk Adjustment (Medical Record Retrieval, Medical Record Coding, Analytics and RAPS/EDPS Submissions), HEDIS® and Stars Quality Program Management, Clinical Data Exchange, Eligibility and Enrollment, Out-of-State Medicaid Account Management, Revenue Cycle Analytics, Referral Management & Analytics, and Social Determinants of Health. -
24
IMPACT
Managed Care Systems
IMPACT is the core to our suite of Healthcare administration software that supports all facets of health care related data transactions. Our customers use Impact to manage enrollment, provider contracts and re-pricing, benefit plans, authorizations/referrals, claims payment and the various complications that surround these functions. IMPACT has tremendous flexibility and provides a wide offering of industry-specific features. Nothing makes us happier than gratitude and accolades from our customers. We enjoy our client interactions and the delivery of software that makes their work lives easier. Technology is meant to serve the customer. MCSI focuses on the development of solutions that fit well within a client's enterprise allowing them to grow and change with their market. We have experience in all aspects of healthcare data management and solutions deployment. We pride ourselves in creating software that focuses on automation, accuracy and reliability. -
25
BRMS
Benefit and Risk Management Services
BRMS processes and manages all Medical, Dental, Vision and Retiree claims efficiently and accurately with an impeccable turnaround time. With eligibility transferred from our MyHealthBenefits system nightly, eligibility is completely current. And, with PPO negotiation expertise, we specialize in reducing employer claims costs. From receipt to eligibility to negotiation and payment, we handle the entire claims administration process. Completely centralized, all claims, medical management, PPO network management, and billing is managed in-house, allowing us to provide you with flexible and quick service with a personal touch. For self-insured organizations, BRMS provides an excellent resource to process Medical, Dental and Vision claims efficiently and accurately. -
26
FundOfficeXG
basys
FundOfficeXG from basys can dramatically increase your benefits administration efficiency by tracking every aspect of your contributions accounting and eligibility operations. The versatile and powerful FundOfficeXG administration suite from basys, coupled with convenient online self-service portals, provides everything you need to manage, track and calculate eligibility and employer contributions. FundOfficeXG includes a wide range of enhanced processing features, giving you an end-to-end solution for managing both remittance and collection of benefit contributions and eligibility for your members and their families – all built on our secure, time-tested calculation engine with highly configurable parameters you control. FundOfficeXG can simplify even the most complicated tasks, including multiemployer health eligibility, hour bank administration, retiree health benefits, premium billing and COBRA processing. -
27
Collective Health
Collective Health
Collective Health is the first integrated solution that allows self-funded employers to administer plans, control costs, and take care of their people, all in one place. Let us show you how we deliver better benefits with curated programs, connected administration, and smart member experience. From scientists to truck drivers to musicians, we’re proud to serve the happiest clients and members in the health insurance industry. See why leading self-funded employers across the nation choose Collective Health. Are you a broker or consultant working to drive your clients’ healthcare strategy forward? Collective Health simplifies employee healthcare with an integrated technology solution that makes health insurance work for everyone. With nearly a quarter of a million members and over 50 clients, including Driscoll’s, Pinterest, Red Bull, Restoration Hardware (RH), Zendesk, and more, Collective Health is reinventing the healthcare experience for forward-thinking organizations. -
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Fijoya
Fijoya
Employers choose a monthly stipend and we handle the end-to-end administration from selection to payment (and since you only pay for what is used, unspent funds return to your budget). Employees can shop for personalized health and wellness benefits - from lab tests to pet care, fitness, meditation, egg-freezing, and yoga - with a virtual corporate card. With Fijoya, you gain access to thousands of medical, health, and wellness options in a single app. Our smart recommendation engine curates options tailored to your needs, and our virtual cards eliminate the need for traditional reimbursements. -
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PayorLink
PayorLink
PayorLink solutions offer more than just medical claims management on behalf of employers to take on a comprehensive platform approach in providing better employee benefits to reduce healthcare costs, promote healthy lifestyle, lifetime health and improve workforce productivity in the process. Rising employee health costs is a worldwide phenomenon and a growing concern for both payor companies and provider entities alike. PayorLink™ is designed to reduce payor health cost, motivate staff productivity and optimize provider claims quality resulting from in part, information exchange efficiencies directly between payor companies and affiliate provider clinic, medical centre or hospital. Enhanced with Employee Health Profile and Assessment tools for staff wellness and productivity realization. -
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Alan
Alan
Finally simplify your life and take care of your employees. With Alan, goodbye to paperwork and opacity, no need to be an expert to meet all your obligations. Discover the health insurance that saves you a lot of time. A transparent offer. A super simple table of guarantees, 100% online and accessible at any time by your employees. With 0 paper to manage. Goodbye to paperwork, arrivals, departures, portability. Everything is managed from your mobile or your computer. And approved insurance Alan is fully-fledged insurance approved by the ACPR Banque de France and reinsured by CNP and SwissRe. All the protection of your employees in one place, without obligation. Alan green. Health coverage that provides complete protection without exploding your premium. Alan blue. Health coverage that reimburses superbly regardless of the doctor you see or the optician you choose. Alan Foresight. Provident insurance protects your employees against hard knocks: prolonged sick leave or disability, -
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PlanSource
PlanSource
Automate and simplify every aspect of your benefits program with PlanSource Reach employees with targeted messaging and communication campaigns you can customize by group and automate across email, text, mobile app and more. Consolidated self-billing and invoice reconciliation mean less time auditing and adjusting insurance bills each month and more time. Complete compliance solutions and peace of mind for ACA measurement and reporting, COBRA administration, eligibility requirements, and more. Streamlined workflows and real-time integrations deliver an enrollment experience that’s designed to drive higher engagement and plan participation. Our 100% mobile experience – on our app or online – makes it easy to shop for benefits the same way you shop for anything else. Eliminate manual processes and hours of HR admin work with true end-to-end benefits automation.Starting Price: $4 per month -
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Neospin
Sagitec Solutions
Sagitec’s Neospin™ pension administration software is a fully integrated, browser-based software system with comprehensive functionality for administering pension benefits. Sagitec Neosurance ™ is a fully integrated, browser-based application providing comprehensive functionality for unemployment insurance, disability insurance, and paid family leave. Sagitec HealthConnect is an enterprise SaaS platform for Medicaid member engagement, empowering your members to engage in their health. It is deployed on HITRUST certified Microsoft’s Azure cloud. Xelence™ is Sagitec's low-code/no-code platform. It is a visual software development environment that allows citizen developers and IT professionals to design, test, and deploy complex applications. Build simple consumer to complex enterprise applications without traditional programming. It is a visual environment, offering drag and drop features, and incorporates in-built enterprise architecture. -
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TPA Stream
TPA Stream
TPA Stream automates employee benefits and solves communication challenges across all benefit types, making it simpler, safer, and more cost effective for everyone that helps make employee benefits happen. TPA Stream is an insurtech software company based in Cleveland, OH. We work with health insurance brokers and third-party administrators to help them win business and streamline operations. Our customers tell us they love working with TPA Stream because we are flexible, easy to work with, and constantly developing new and innovative solutions. Win new business, streamline claims processing, and increase employee engagement. Experience easy automation for the employer invoicing process for CDH and COBRA. Automate the process to consume files, transform, and integrate with administrative systems. -
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SpyGlass
Beacon Technologies
SpyGlass, our enterprise-class health claims management software, offers a powerful, flexible solution for precise and timely claims processing. SpyGlass makes benefit and plan setup remarkably straightforward. BenefitDriven, fully-integrated with SpyGlass, delivers eligibility, contribution accounting, and pension management to the Taft-Hartley industry with the full range of data and processes for Participants and Employers. HIPAA Director, our all-in-one EDI gateway & scheduler, works as a hub by allowing you to directly connect with vendor partners to help avoid transaction costs, manage batch transfers, and automate transfers. SpyGlass provides a deep, landscape view of your population, with the ability to easily drill down to the higher resolution details. Hundreds of unique reports, fully customizable dashboards, and total control over your system are at your fingertips. -
35
SSG Digital
iPipeline
Innovator, connector and leader for the insurance industry. We have the most extensive straight-through processing platform within the UK. Explore how our digital platform addresses your business needs. Business transformation powered by increased agility and a digital end-to-end experience. Improved productivity fueled by adviser and consumer self-service capabilities. Higher customer lifetime value through proactive ongoing engagement with customers. Customer and Adviser Portals – users access policy documentation and update personal and policy details and features digitally, in real time. Components cover every facet of the user experience including full reinsurance reporting, external portal integration, and automated and clerical underwriting. Flexible deployment – from full end-to-end SSG Digital platform deployment, to discrete integrated individual components (e.g. underwriting only, New Business only). -
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PeopleStrategy
PeopleStrategy
A full-service broker, PeopleStrategy offers expert benefits consulting, intuitive HR software and comprehensive administrative services to provide employers with a single source for the tools and resources to attract, manage and retain talent. PeopleStrategy’s cloud-based HR platform is ideal for companies with 50 to 500 employees, but is designed with flexibility to scale up or down. It features HRIS, Payroll, Benefits Administration, Time, Attendance, Onboarding, Applicant Tracking, Performance, Compensation Planning, Compliance, Reporting & Analytics in a single platform. PeopleStrategy Insurance Services works with employers to develop a long-term, sustainable benefits strategy. Experienced benefits consultants identify the right mix of health plans, wellness programs and non-insured benefits options to the needs of employees and their families.Starting Price: $24 per user per month -
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HealthRules Payer
HealthEdge Software
HealthRules® Payer is a next-generation core administrative processing system that provides transformational capabilities to health plans of all types and sizes. For more than ten years, health plans implementing HealthRules Payer have been able to quickly address market opportunities and stay in front of their competition. HealthRules Payer is unlike any other core administrative solution because of its use of the patented HealthRules Language™, an English-like vernacular that delivers a revolutionary new approach to configuration, claims processing and transparency of information. HealthRules Payer helps transform health plans looking to grow, innovate and compete beyond any other core system today. -
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Workpartners
Workpartners
Workpartners’ philosophy is to help optimize your company’s benefit engagement rate while reducing your total human capital costs. Our approach is to take an employee-level focus using data-driven insights to deliver personalized tools and solutions to optimize engagement. Helping your employees navigate their benefits to be their best, do their best, and achieve their best while helping your company thrive—we call that People Activation. A true employee-level view of your human capital extends beyond medical and pharmacy claims and incorporates the impact of time away from work. Our measures include long- and short-term disability, workers’ compensation, FMLA, sick leave, and paid time off, as well as benefit design, benefits administration data, compensation structure, employee demographics, and policies. All are key health and productivity performance indicators. -
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Coronis Health
Coronis Health
Through our personal, high-touch service, Coronis Health can provide an unparalleled level of professionalism you won’t find anywhere else. We won’t just help you collect your revenue. We will help you financially grow while progressing this industry into the modern technological age. Coronis Health is a global revenue cycle management company offering specialized solutions to healthcare practices and facilities. By using industry-leading technology combined with high-touch relationship building, Coronis Health allows healthcare practitioners to focus on patient care, maintain financial independence, and cultivate financial success. Coronis Health is comprised of the best of the best in medical billing. Thoughts leaders and experts in every practice area utilize global resources, technology, and best practices to provide successful partnerships for customers. -
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PeopleKeep
PeopleKeep
PeopleKeep offers health reimbursement arrangement (HRA) and employee stipend administration software that allows organizations to create individualized benefits packages to improve employee engagement and strengthen workplace culture. Employees increasingly expect more customized and diverse benefits from today’s employers. In order to recruit and retain top talent, employers need to incorporate more flexibility and inclusivity into their benefits packages. With PeopleKeep, employers can develop a personalized benefit plan that increases employee satisfaction, reduces administration tasks, and serves as an essential tool in retention and recruitment. -
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Enterprise Health Solution
HM Health Solutions
HM Health Solutions provides an end-to-end solution to health plans. Get the support you need and business outcomes you want from one comprehensive health plan administration platform: the Enterprise Health Solution. Platform applications and tools manage functions from sales through enrollment and billing, including claims, provider and clinical management, and customer service. The Enterprise Health Solution (EHS) is the only proven end-to-end solution, and can move your member seamlessly from enrollment to claims payment. You’ve heard others claim to offer a fully integrated solution. What they don’t specify is that you may need to purchase all modules in sequence to achieve this integration. On the Enterprise Health Solution, health plan administration has always been the one and only focus. No other company rivals our expertise in the health plan payer space. -
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Web Benefits Design
Web Benefits Design
Web Benefits Design (WBD) is a leading national employee benefits technology, communication, and administration firm. WBD works with companies of all sizes to develop employee benefit solutions on the cutting edge of technology and value. We provide a one stop solution for employees and Human Resources to manage benefits. Customized benefits website with company logo, colors, images, and branding. The Supersite creates a single access point for enrollment, benefit comparisons, plan documents, forms, contacts, and decision support tools. For an engaging, high impact experience, our interactive decision support tool helps employees calculate future care considerations, annual premium cost, and benefit design to specifically recommend the right plan. WBD offers best in class COBRA and ACA! Our ben-admin platform provides fully integrated eligibility logic with real-time COBRA and ACA data updates and reports. One team. One eligibility source. One solution. -
43
Warp
Warp
Easy-to-use payroll, compliance, and benefits management for startups save an average of $20K. Full-service payroll for employees and contractors in all 50 states. Automate tax deductions, and filing, and consolidate dozens of compliance accounts in one place. Obtain small group or ICHRA coverage and automatically sync your health benefits deductions with payroll. Pay global contractors in over 150 countries in US dollars or in their local currency. With automated compliance and monitoring, startups using Warp save up to 6 hours per month and $20K in annual fines. When you add employees in Warp, we open all the right tax accounts in every jurisdiction, pay taxes to those agencies, and make all the quarterly filings. Send employment contracts, set up payroll, add health coverage, and more in just a few clicks. Get medical, dental, and vision coverage from top carriers.Starting Price: $20 per month -
44
Sana Benefits
Sana
We’ve made it simple. Benefit packages for employers with full medical, dental, vision and more without the headaches or hidden fees. Get real savings and top notch, modern benefits for you and your employees. If your employees love free smart toothbrushes and great dental coverage, they will love our partnership with beam dental. We took the traditional health plan and made it better. From co-insurance to referrals, our motivation has been simple: give it all and then some. We’ve done away with the old-school network. All of our plans are PPO Plus. This means you get access to our extensive Sana Care ecosystem and provider network, plus you can invite any provider you want without paying out-of-network fees. We break it down so you understand exactly what you’re getting, how much you’re paying, and why. All the info you want and nothing you don’t. Manage your organization’s benefits more easily than ever before. -
45
myCobraPlan
myCobraPlan
myCobraPlan offers the most user-friendly, comprehensive administration solution available. Our system is a fully automated web-based solution with easy access to all your COBRA information. myCobraPlan eliminates the need to fill out paper forms for submitting COBRA-eligible individuals and allows real-time access to all your company’s data. myCobraPlan assures worry-free compliance with all required notifications. Depending on the event, the proper notification will be sent to the qualified beneficiary or new plan member. The compliance of your company’s COBRA benefits is managed by our administrators and automated by our system. myCobraPlan gives you access to all your information anytime, anywhere through our secure, web-based system. -
46
William
Certifi
Certifi's William is an intelligent automated premium billing and payments platform that performs all the functions of membership accounting, payment management, collections, and remittance for digital benefits-based billing. William enables 100% electronic billing transactions in complex billing scenarios, including payer-sponsored marketplaces for group and individual populations, as well as unique populations like Medicare Advantage and Medicaid. As a true enterprise-class accounting system, William offers GAAP-compliant reporting with clear audit trails for general ledger management. All customer-facing bills, reports, portals, and tools are branded to be consistent with your organization's brand. The platform delivers rules-based delinquency and termination communications, from notification to policy suspension and termination. Consumers and employers can set up individual or recurring payments using their preferred payment methods. -
47
Veritable
314e Corporation
Veritable accelerates patient insurance eligibility verification and claims-status checks by providing instantaneous results in a clean, intuitive interface. It supports real-time, batch uploading of patient lists to verify eligibility across more than 1,000 payers (including national Medicare and all state Medicaid) and multiple service types. It also enables tracking of claims status, from submission through reimbursement, so practices and billing companies can proactively identify issues to reduce payment delays and denials. Key benefits include automating eligibility and claims workflows to reduce manual entry and phone calls, improving front-desk patient experience by validating coverage and copayments at check-in, and offering seamless integration for both technical and non-technical users with strong data-security controls. It includes a “Code Explorer” for instant lookup of ICD-10-CM, ICD-10-PCS, HCPCS Level II, and CPT codes.Starting Price: $50 per month -
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SSI Claims Director
SSI Group
Elevate your claims management process and decrease denials through unmatched edits and an industry-leading clean claim rate. Health systems require access to technology that facilitates accurate claim submission and rapid reimbursement. Claims Director, SSI’s claims management solution, streamlines billing practices and provides visibility by guiding users through the electronic claim submission and reconciliation process from beginning to end. As payers change or modify reimbursement criteria for services, the system actively monitors and incorporates these changes and requirements. And with a comprehensive mix of edits at the industry, payer and provider levels, the solution aids organizations in making the most of reimbursement efforts. -
49
ResolvMD
ResolvMD
ResolvMD is an experienced full-service medical billing company that processes all health service claims (AHCIP etc.) on behalf of physicians. Our goal is to make physicians as confident and competent in their billing as they are in their practice through surfacing data-derived insights and democratized knowledge. We have the most modern, cost-effective, and secure platform on the market for processing claims. Our target audience are physicians (mainly specialists such as emergency physicians, urgent care, plastic surgeons, anesthesiologists, paediatricians, general surgeons etc.). They need a billing agent to process their health service claims. They value time, trust, cost, efficiency and knowledge. We are targeting physicians in Alberta today (mainly in Calgary, Edmonton, Red Deer, Medicine Hat, Lethbridge, Okotoks and any other centre with a population in excess of 25,000. -
50
COBRA Administration Manager
COBRA Solutions
Our software is designed to make COBRA administration easy. Important date notifications, automatic tracking of COBRA qualifiers and dependents, customized letters, over 30 detailed reports, quick coupon creation and more, all with just a few clicks. Whether you are a single company administering COBRA for your employees, or a third party administrator offering benefits service for multiple companies, COBRA administration manager comes in a version to fit your needs. The single company version offers everything you will need to administer COBRA for your own company. The Multi-company version, perfect for TPA's, offers the ability to easily organize and administrate COBRA for up to 9,999 groups. Once employees are entered into the system, the software will track all important events. The things-to-do list will always keep you updated when mandatory action must be taken. Simply double clicking the item in the things-to-do List will launch you into the next step.Starting Price: $690 per license
