KLAS: Orgs Value Functionality from Claims Management Vendors

Experian Health and Olive received the highest performance scores in the claims management market, with organizations choosing the vendors for their functionality and pricing, according to a KLAS report.

The report reflects data from 24 organizations that made a claims management purchase between February 2020 and November 2022.

Most organizations (83 percent) cited functionality as a reason for considering or selecting a claims management vendor. Specifically, 55 percent were interested in solutions that save time and simplify claim processing, while 50 percent chose vendors due to their claim scrubbing capabilities.

Experian Health received the top performance score of 90.1 on a 100-point scale and was the most considered and selected vendor. Organizations reported selecting the vendor for its broad functionalities, including its customizable work queue and its reporting and analytics.

Organizations also noted the vendor’s affordable cost and integration capabilities with EMRs and additional systems. Current customers mentioned their satisfaction with the claims management solution’s detailed reporting and said it was easy to use.

Experian Health was considered as a claims management vendor by organizations of all sizes, the report indicated.

Olive’s claims management solution, which the vendor acquired in 2021 from Healthcare IP, received a performance score of 89.2. The current customers reported high satisfaction with the product and brought attention to the vendor’s responsive support team. Additionally, customers mentioned having a strong partnership with the vendor.

Quadax, the 2022 Best in KLAS winner for claims management, received a performance score of 88. Organizations considered the vendor for its end-user capabilities, including coordination of benefits, claim edits, and secondary claim management.

Current customers reported high satisfaction with the vendor, citing how representatives come on-site regularly and a support team that quickly resolves issues. Other customers said the solution was easy to use and acknowledged the functionality for editing claims and attaching records.

Organizations selected Waystar as a claims management vendor due to its pricing and automation features. Current customers were satisfied with the vendor’s custom rules, reporting, and end-to-end revenue cycle suite. The vendor received a performance score of 87.3.

SSI Group, which received an 87.2 for a performance score, was equally selected and replaced by organizations included in the report. Organizations considered the vendor due to the product’s functionality and integration capabilities. Specifically, customers that chose SSI Group praised how the solution advances EMR integration and clearinghouse reporting.

On the other hand, organizations that replaced SSI Group reported that the vendor was not developing the product to meet their specific functionality requests.

Current customers noted their satisfaction with the vendor’s partnership and support. However, some customers want more proactive communication about outages and downtime.

FinThrive (84) and Change Healthcare (76.6) received the lowest performance scores and had several organizations replace them.

Customers that replaced FinThrive cited cost as the main reason. Unsatisfied and satisfied organizations said that the vendor nickel-and-dimes for additional services that were not included in the original contract.

However, some customers mentioned that the solution was easy to use and appreciated the vendor’s comprehensive portfolio of revenue cycle offerings.

Organizations that reported replacing Change Healthcare commonly cited frustrations about rising costs, slow support, and instances of the vendor overpromising and underdelivering product improvements. Customers that left Change Healthcare frequently chose SSI Group and Experian Health instead, the report noted.

Despite being replaced often, Change Healthcare was still the third most-considered vendor. Organizations noted the vendor’s significant market presence, while current customers said the reporting capabilities save time and provide in-depth information.

The vendor’s customer satisfaction ranked low, though, with respondents pointing out nickel-and-diming and recent turnover among support staff and account managers that have hurt customer support.

Change Healthcare finalized its merger with Optum in October 2022. Customer feedback has been mixed, with some worrying the deal will distract the vendor from focusing on customers.