Top CAQH Alternatives, Competitors & Similar Software

Core Administrative Processing Systems Software

HealthAxis is at the forefront of transforming healthcare delivery in the United States through state-of-the-art technological solutions. AxisCore™, our cutting-edge core administrative processing system (CAPS) technology, alongside AxisConnect™, our modern suite of business process as a service (BPaaS), business process outsourcing (BPO), staff augmentation, and consulting capabilities, empowers payers, risk-bearing providers, and third-party administrators to optimize their operations, elevate efficiency, and enhance member engagement. By addressing pivotal challenges faced by payers, we are committed to improving member and provider experiences, thereby fostering more positive outcomes and contributing to the advancement of a healthier future.

Core Administrative Processing Systems Software

Developer of a payment processing software designed to help healthcare providers collect more patient payments. The company's software offers real-time payment solutions with flexible payment options allowing them to capture more revenue at multiple points of the revenue cycle and provide a more positive patient experience, enabling government agencies, hospital systems and other commercial businesses to collect payments.

Core Administrative Processing Systems Software

Inovaare is a trusted leader in AI-powered compliance solutions for U.S. healthcare payers. Our AI-powered automation solutions empower health plans to streamline operations, achieve regulatory compliance, and enhance both employee and member experiences. Our specialized healthcare cloud platform, with all current federal and state regulatory protocols built in, mitigates risks, automates workflows, and reduces cost for healthcare stakeholders. Our Core Solutions 1. Usher AI – Intelligent Compliance Assistant • Conversational AI trained in CMS regulations • Real-time CMS universe analysis & interpretation • Natural language regulatory search 2. Appeals & Grievances Management – Automate with Precision • Automated intake & triage • Built-in compliance workflows • Letter module for outreach • One-click regulatory & universe reporting One-click regulatory & universe reporting 3. Regulatory Compliance – Stay Audit-Ready • Centralized CMS regulatory libraries • Auto-generated policies to close gaps • Issue detection & remediation Automated Corrective Action Plan workflows 4. Delegation Oversight – Stronger Vendor Management • Centralized delegate oversight • Automated monitoring dashboards • Real-time compliance tracking & audit trails 5. Universe Management System (UMS) – Automate CMS Prep • Auto-generation of CMS universe files • Alignment with changing rules • Built-in validation to reduce errors • Early visibility into compliance risks 6. Audit & Monitoring – Continuous Oversight • Automated workflows for audits • Real-time KPI dashboards • AI-powered audit co-pilot assistance Why Healthcare Leaders Choose Inovaare • Purpose-Built for Healthcare Compliance – Designed to meet CMS standards today & tomorrow • AI-Driven Efficiency – Intelligence that improves accuracy and productivity • Secure & Scalable – HIPAA-compliant, HITRUST-certified, built for organizations of all sizes

Core Administrative Processing Systems Software

PLEXIS Healthcare Systems is a leading payer technology company delivering trusted enterprise core administration and claims management solutions to healthcare payers and delivery systems worldwide. More than 100 organizations trust PLEXIS core administrative enterprise solutions to manage over 55 million lives in all 50 states and around the world. PLEXIS provides mission-critical solutions that catalyze efficiencies and connect evolving business ecosystems to a wide range of payer organizations.

Core Administrative Processing Systems Software

NantHealth, a member of the NantWorks ecosystem of companies, provides enterprise solutions that help businesses transform complex data into actionable insights. By offering efficient ways to move, interpret, and visualize complex and highly sensitive information, we enable customers in healthcare, life sciences, logistics, telecommunications and other industries to automate, understand and act on data while keeping it secure and scalable. Our product portfolio comprises the latest technology in payer-provider collaboration platforms for real-time coverage decision support, and data solutions that provide multi-data analysis, reporting and professional services offerings.

Core Administrative Processing Systems Software

By designing a next-generation clinical NLP engine supporting advanced documentation and coding functions, EZDI turned their vision to reality. Their CAC and CDI solutions received tremendous feedback, providing system accuracy and ease of use. EZDI removes the data complexity and highlights what matters for healthcare professionals.

Core Administrative Processing Systems Software

At Simple Fractal, we take pride in being the premier automation partner for ABA providers. With nearly a decade of collaboration with the industry's largest providers, our in-depth understanding of the specific processes and technology platforms in the ABA sector sets us apart. Our team's extensive operational and automation experience is further enriched by industry veterans, including the former CIO of Autism Learning Partners and former Director of Strategic Initiatives at LEARN Behavioral, bringing unparalleled subject matter expertise to our solutions. At Simple Fractal, we've mastered the art of tailoring automation solutions that perfectly fit the nuanced needs of ABA therapy providers. Our stellar engineering and dedicated maintenance teams have developed over 100 bots that efficiently handle essential functions in Revenue Cycle Management (RCM), Client Services, and HR compliance, ensuring our clients can focus more on delivering exceptional care and serving more families in need of their services. The effectiveness of our solutions is proven by our track record: with ROIs exceeding 10X and bots in continuous operation for 6+ years, we have earned 4.9 out of 5-star rating on G2. An independent report by KLAS Research further validates our success, with 100% of our clients meeting all expected outcomes from our engagements, all of which are now expanding their partnership with us. Building on our achievements with the largest ABA providers, Simple Fractal is committed to making our cutting-edge automation solutions accessible to mid-market providers. We are also exploring expansion into related verticals within the health and human services sector, aiming to leverage our automation expertise to benefit a broader range of organizations. Our approach of combining deep industry knowledge with technical excellence and dedicated support has stood the test of time. For ABA providers looking to level up and grow, Simple Fractal is your dedicated partner.

Core Administrative Processing Systems Software

26+ YEARS OF INNOVATION IN HEALTHCARE We are at the forefront of the industry, offering fully integrated, customizable workflow solutions, revenue cycle management, and patient management software. Our specialty lies in the optimization of organizational workflows and the application of Robotic Process Automation (RPA) to healthcare processes. Our commitment to innovation and excellence is driven by our mission to empower healthcare organizations with the tools they need to provide efficient, cost-effective, and patient-centric care.

Core Administrative Processing Systems Software

Health plan administration involves many moving parts. We help Healthcare Payers organize their data, vendors, and business processes behind one login so they can efficiently manage the different pieces of the health plan in one place. For more than 25 years, Third Party Administrators, Health Plans, International Insurance Carriers, Government Payers, Employers, and Health Trusts worldwide have achieved greater efficiencies and greater marketability through their partnership with Health Portal Solutions. Schedule your demo at www.hpsglobal.net.

Core Administrative Processing Systems Software

Strategic Healthcare Management Systems (SHMS) is a Medicare Advantage Health Plan software and services company which streamlines and strengthens core business processes in today’s challenging, competitive, and changing healthcare payer industry. The SHMS software is ideal to manage CMS contracts for Medicare Advantage, ACOs, Dual Eligible, and other single beneficiary products.

Core Administrative Processing Systems Software

Techdynamics is a leading global information technology services and business process solution provider. Today, Techdynamics delivers one of the industry’s broadest portfolios of information technology, applications and business process outsourcing services to clients in the manufacturing; financial services; healthcare; communications, media and entertainment; energy; transportation; and consumer and retail industries; and to governments around the world. At Techdynamics, we strive to lead in the invention, development and manufacture of the industry's most advanced information technologies, including computer systems, software. We translate these advanced technologies into value for our customers through our professional solutions, services and consulting businesses worldwide. Tech Dynamics is IT enabled Consultancy/Solution Builder Company Expertise in: 1. Web Application Development 2. Enterprise Application Development. 3. Website Hosting. 4. Software Design / Development. 5. Network Designing.

Core Administrative Processing Systems Software

Vālenz Health® is the platform to simplify healthcare – the destination for employers, payers, providers, and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey – from member experience to payment integrity, plan performance, and provider quality. Valenz elevates expectations to a new level of efficiency, effectiveness, and transparency where smarter, better, faster healthcare is possible. For more information, visit valenzhealth.com.

Core Administrative Processing Systems Software

IntegriChain is a provider of pharmaceutical data and related cloud software. The company provides a channel management cloud software used by life sciences suppliers to drive channel collaboration and to improve the efficiency of how products reach customers by embedding big-data customer insights into daily business processes. The company was founded in 2005 and is headquartered in Philadelphia, Pennsylvania. It seeks to expand its core operations through mergers and acquisitions.

Core Administrative Processing Systems Software

Simplify Healthcare enables Payers to achieve growth and cost efficiencies with its industry-leading platform, people, and processes. Established in 2008, Simplify Healthcare has taken on some of the toughest challenges facing payers by simplifying payer operations, connecting their front, middle, and back office with a payer-focused platform-centric approach. Our offerings — Benefits1™, Provider1™, Claims1™, and Xperience1™ offer precise solutions to complex challenges in delivering rich products, benefits, and provider data. SimplifyX™ is an AI-first enterprise company pioneering agentic AI to transform how organizations design, operate, and scale solutions by embedding intelligent agents directly into workflows. Benefits1™ — A unified platform for configuring, filing, publishing, and governing benefits across Medicare, Medicaid, ACA, Group, and Medigap. Provider1™ — A unified, yet modular, platform that automates provider roster file management, data management, onboarding, contracting, credentialing, and claims configuration. Claims1™ — The solution standardizes and automates how payers configure claims platforms like TriZetto® Facets® and QNXT™, homegrown systems, and other top 5 Core Admin platforms—reducing rework, ensuring accuracy, and improving data reliability by 99%. Xperience1™ — Enables payers to streamline and elevate benefits communication across the entire member journey, from plan shopping and enrollment to customer service and self-service. Simplify Docs™ — Delivers seamless document generation and language translation workflows for all mandated materials (ANOC, EOC, SB, SBC, etc.) and non-mandated content (Benefit Highlights, Rider Booklets, etc.) across all lines of business. SimplifyX™ — Industry-specific, production-ready enterprise applications with intelligent AI Agents orchestrating every step from requirements to release.

Core Administrative Processing Systems Software

Veradigm is an integrated data systems and services company that combines data-driven clinical insights with actionable tools to help healthcare stakeholders improve the quality, efficiency, and value of healthcare delivery—these stakeholders include biopharma, health plans, healthcare providers, network partners, and most importantly, the patients they serve. We build solutions that are designed to help healthcare stakeholders to improve patient lives through data driven insights. We are dedicated to simplifying the complicated healthcare system with next-generation technology and solutions, transforming healthcare from the point-of-patient care to everyday life. As a result, Veradigm attracts leaders in healthcare, technology, and innovation, seeking to work with us to deliver insights and solutions to the benefit the healthcare ecosystem with the objective being to improve healthcare quality while lowering the cost of healthcare. Veradigm is an organization comprised of passionate and energetic people whose everyday focus is on helping all healthcare stakeholders drive the best care possible for healthier communities. We believe diversity is the foundation of innovation, and we are dedicated to fostering an inclusive environment that supports the talents of all people.

Core Administrative Processing Systems Software

HealthEdge is on a mission to drive a digital transformation in healthcare. We’re connecting health plans, providers, and patients with end-to-end digital technology solutions to support new business models, reduce administrative costs and improve health outcomes. Our growing portfolio of products (HealthRules® Payer, HealthEdge Source™, HealthEdge® Provider Data Management, GuidingCare®, and Wellframe™) provides talented and passionate professionals with opportunities to lead change and make a lasting, global impact in healthcare. Driving our mission are 2,000+ professionals worldwide. Together, we are committed to innovating a world where healthcare can focus on people.

Core Administrative Processing Systems Software

Zelis is modernizing the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. This platform serves more than 750 payers, including the top 5 national health plans, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients. Zelis maintains a transparent, fee-free recruitment process. All genuine offers originate from our Talent Acquisition team using the “@ zelis.com” domain. We do not use WhatsApp or personal emails for recruitment. Forward any suspected fraud to verify-offers[@]zelis.com for prompt investigation. Thank you for staying vigilant.

Core Administrative Processing Systems Software

MHC Products Group is proud to introduce “intellicare” a new generation enterprise core claims system built from the ground up specifically designed to support the healthcare payer market. intellicare was built by healthcare payer professionals for healthcare payer professionals. intellicare is an affordable powerful rules driven, highly customer configurable, flexible, and scalable enterprise core claims administrative system. intellicare includes all the core modules needed to manage the complexities of today’s healthcare payer enterprise. The new generation of "intellicare" stands ready to respond to today's healthcare payer challenges with a new and affordable enterprise core claims system. For more information please contact MHC Products Group at: Corporate Phone Number: (855) 451-5100 Email: [email protected] Website: MHCpg.com