With provider operating costs soaring, healthcare leaders are urging providers to fight for their revenue using – among other strategies – technical solutions. Research shows that healthcare revenue cycle automation and analysis reliably:
- verifies patients' eligibility for health benefits, reducing manual, time-consuming research
- estimates patient payments, streamlining and increasing upfront collections
- detects underpayments, improving revenue
- reduces denials, cutting labor costs and improving revenue
- improves workflows and productivity, creating a better work environment and lower labor costs
Given the revenue improvements and cost-cutting power technology provides, it’s no wonder the revenue cycle technology market is forecast to grow by more than 10% each year up until 2030.
Experian Health Revenue Cycle Management Solutions is one of many revenue cycle solution providers that provide revenue cycle automation. Some of these vendors serve large health systems, while others focus on specialty niches like orthopedics or radiology. As you research RCM software partners, sift through the features that would be most critical to your organization's success. These Experian alternatives all have advantages and drawbacks depending on your vision of how you’ll optimize your revenue.
What Is Experian RCM and what market does it serve?
You’re probably familiar with Experian as one of the big three credit card bureaus. Founded in 1968, it is a global data analytics and consumer credit reporting company headquartered in Dublin, Ireland. In addition to its credit services, Experian also sells decision analytic and marketing assistance to businesses, services that include fingerprinting and targeting. Its Experian RCM division provides revenue cycle management, patient engagement, identity management, and care management.
Experian Revenue Cycle Management Solutions serves not only hospitals and health systems, and physician groups, but pharmacies, diagnostic services, and payers. Its front-end solutions tackle everything from eligibility verification and scheduling to patient estimates. Its back-end solutions automate and optimize accounts receivable and claims management. Its revenue cycle optimization solution is engineered to cross-reference dozens of data streams to create one thread for the reporting and analysis required for actionable insights.
Revenue cycle analytics’ dashboards and reports deliver the data executives need to fuel process improvement.
Experian has earned recognition for its claims management and clearinghouse software, ClaimSource, an automated and scalable claims management system that reduces denials and increases revenue.
Unlike solutions like Infinx, it does not use onshore or offshore specialists to code, process prior authorizations, or facilitate any other revenue cycle task.
List of Top Experian Revenue Cycle Management Solutions Alternatives
- MD Clarity
- Change Healthcare
- R1 RCM
An Experian RCM alternative with a proven track record
Founded in 2010, MD Clarity is a trailblazer in the revenue cycle management (RCM) software industry. With years of experience tackling providers' revenue challenges, it offers robust and fully custom software solutions to various groups including provider groups, managed service organizations, and health systems.
MD Clarity operates on a noble mission to, first, empower patients with an understanding of their financial obligations stemming from their healthcare choices. The company also advocates for fair compensation to healthcare providers. The company is committed to creating a healthcare system where transparency and fairness guarantee the success of all participants.
For more than a decade, MDClarity has supported 3,000+ facilities, 150,000+ providers, and 20,000,000+ patient encounters across the United States.
Features in common with Experian RCM
MD Clarity and Experian both offer tools that automate eligibility verification, provide accurate patient pay estimates, and examine and pursue payer underpayments. MD Clarity’s products include:
MD Clarity has engineered its product Clarity Flow which determines eligibility and generates good faith estimates for patients. The process starts with an insurance eligibility and verification process which reviews, ingests, and analyzes all current provider contracts to produce highly accurate benefits and coverage.
Next, it composes custom patient cost estimate letters that include deductibles, copays, and any available co-insurance. These letters also provide a convenient link to an online portal so patients can make upfront deposits. With cash on the line, patients are reluctant to miss appointments. Fully custom and based on individual provider preferences, these patient cost estimates get sent via text, email, or letter. All comply with the No Surprises Act as a good faith estimate solution (GFE).
Experian, on the other hand, doesn’t separate its insurance eligibility or patient estimate into a named product. Still, its automation is similar, combing payer contract terms, data from the provider’s chargemaster, and claims history with the patient’s insurance benefits. For self-pay patients, it shares financial assistance policies, including prompt-pay discounts, state-mandated discounts, and payment plans. MD Clarity’s Clarity Flow contains these features as well.
Both Experian Revenue Cycle Management Solutions and MD Clarity offer contract analytics so you can comprehend your payer contracts’ actual performance (including underpayments). These tools also simulate how potential contract changes impact cash flow. Their analytics reports compile data from all payers.
Experian's contract analysis tool utilizes advanced natural language processing (NLP) algorithms to extract critical information from contracts. Experian's tool also offers advanced search and filtering options, allowing users to locate specific clauses or terms within a contract. Additionally, Experian provides customizable templates and predefined rule sets, so that users can perform automated contract review and compliance checks.
MD Clarity's Contract Analytics, on the other hand, has been engineered for simplicity and ease of use, as well as robust capabilities. It offers a user-friendly interface that allows even non-technical users to navigate and analyze contracts effectively. Contract Analytics uses machine learning algorithms to identify key contract provisions, such as payment terms, termination clauses, and indemnification requirements. It also offers basic reporting and visualization features to help users gain insights into their contracts' content and identify any potential risks or opportunities.
As with patient price estimation, Experian’s revenue optimization suite is folded under the Experian Revenue Cycle Management umbrella. It handles performance management, revenue leakage, payer insights, and KPI tracking.
MD Clarity’s revenue optimization tool RevFind detects payment discrepancies by insurance providers, ensures optimal chargemaster setup, and assigns appeals and investigations. Users can view task statuses in a single location. With it, you can quickly find patterns of underpayment by insurance providers, optimally set your charge master, and streamline how you assign appeals and investigations to staff.
With all task statuses in one place, you can quickly review your biggest revenue leakage spots. First launched more than 10 years ago, MDClarity has been refining RevFind features to aggressively pinpoint and pursue all payer obligations.
MD Clarity has a 5/5 rating on G2. Experian Revenue Cycle Management Solutions has no public reviews at this time.
An Experian RCM alternative that features billing and coding services
While TriZetto provides some RCM solutions, its billing, coding, and credentialing services form the center of its product. Experian offers these services via its claims managnement suite through ClaimSource®. At this time Experian does not offer credentialing services, but via ClaimSource does have solutions for billing and coding.
Features TriZetto shares with Experian RCM
Like Experian, TriZetto aims to streamline medical practice management. TriZetto solutions include:
- Claims management: Like Experian, Trizetto Provider Solutions clean and securely send claims statements, simplifying them, and reducing rejections.
- Patient engagement: Experian tackles patient engagement from scheduling, registration, and estimates, to payments. Trizetto improves the patient experience by verifying eligibility, streamlining prior authorizations, creating patient pay estimates, and establishing payment options.
- Denials management: Experian Revenue Cycle Management Solution’s Denial Workflow Manager dovetails workflow, enhanced claim status, remittance detail, and analytics to focus claims managers on the most cost-effective follow-up activities. You can identify denials, zero pays, holds, suspends, as well as appeals won or lost with payers by integration their Electronic Remittance Advice (ERA) and their enhanced claim status transactions.
Trizetto’s denials management solution finds the root cause of denials so that you can monitor trends and develop upstream improvements. It encourages users to take the steps to stop denials before they happen.
Similarly, Trizetto’s Advanced Reimbursement Manager Pro identifies denials and underpayments, quickly makes them available for re-work and automates the appeals involved. Its automated documentation and letter generation process speeds staff work within an intuitive, easy-to-use interface. Its work queues and dashboards make for for simple, intuitive reporting
- Billing and Coding: Experian and Trizetto both provide coding and billing solutions that streamline and speed revenue recovery.
- Credentialling: At this time, Trizetto provides an end-to-end solution for provider credentialing. It speeds compliance so payers reimburse your services as soon as possible. Experian does not provide provider credentialing.
- Analytics: Both Experian and Trizetto provide the analytics that helps providers capture the most revenue. Their revenue cycle transparency features streamline workflows and stop leakages so your organization can grow.
TriZetto has an average rating of 4.3/5 stars on G2. Experian Revenue Cycle Management Solutions has no public reviews at this time.
An API-forward Experian Revenue Cycle Solutions competitor
A publicly traded healthcare software and services giant, Change Healthcare has acquired and merged with several other organizations over the past decade. In 2016, McKesson Corporation and Change combined all of Change Healthcare's business with the majority of McKesson's Information technology unit. With a commitment to accelerating values-based healthcare changes, Change Healthcare provides revenue cycle, payment management, and health information exchange solutions that optimize the operations of value-based healthcare systems. Like Experian, Change also has engineered tools to help payers optimize revenue and cut costs.
Where Experian's revenue cycle management solutions encompass a wide range of services, Change Healthcare, focuses heavily on claims management and reimbursement, offering ideal claim scrubber solutions to improve the accuracy and efficiency of claim submissions.
Change Healthcare Features Shared with Experian RCM
Change and Experian share some features. Like Experian, some Change features are in the form of APIs which help companies improve interoperability by avoiding data silos. However, some companies prefer to avoid APIs due to possible breaches like an SQL injection attack.
Change features shared with Experian include:
- Healthcare application programming interfaces (APIs): API-based systems allow you to create custom applications that integrate with your existing PMS, EHR, and any other revenue software. It aims to organize and streamline transactions by consolidating benefits verification, eligibility, claims submission, processing, and payments. This format helps staff reduce their manual workload.
- Reimbursement solutions: Both Change and Experian offer solutions that help you track and manage claims and denials by payer and procedure. Their data analysis functions identify denial triggers before you submit. Streamlining the revenue cycle speeds up claims submission and payment receipt.
- Data access APIs: These tools help you better manage risk adjustments, improve Healthcare Effectiveness Data and Information Set (HEDIS) scores. They also increase accurate payments.
Change Healthcare has a score of 3.8/5 stars on G2.
An Experian RCM competitor known for outsourced services
Initially founded as Accretive Health, R1 RCM re-branded in 2017. Based in Salt Lake City, R1 RCM is one of the United States’ largest revenue cycle solution companies. Unlike Experian, however, it serves hospitals and healthcare systems, but not payers.
Features in common with Experian RCM
R1 shares some features with Experian. These include:
- End-to-End Revenue Cycle: While Experian offers only software, R1’s software is backed by a digital workforce that partners with provider staff. Together, they carry out revenue cycle tasks like scheduling, insurance verification, intake, billing, accounts receivable, denials, and more. R1 and Experian both leverage robotic process automation (RPA) and machine learning (ML) to find and correct revenue leakage and staff errors, as well as reduce days in A/R, denials, and underpayments. Both also use AI-powered analytics solutions to identify and resolve payment-related issues.
- Patient Experience: While Experian bundles its patient pay estimate features into its end-to-end revenue cycle services, R1’s EntriPay does not include pay estimates at all. Instead, EntriPay includes just clearance, scheduling, registration, intake, and payment into one tool that streamlines patient information in a digital self-service platform.
- Claim Management: Where R1 brings experienced coders to your claims projects, Experian supports your in-house claims with software. It discovers which claims platforms you may already have and implements an appropriate solution. For both, proactive claims management leads to lower denials rates, automated claim monitoring, and simplified attachments.
An Experian RCM alternative that provides RCM consulting
Founded in 2013, TruBridge’s main market is rural and community hospitals. It provides software solutions that help these facilities manage their revenue cycle, coding and compliance, and patient access and engagement. In contrast, Experian focuses on larger healthcare systems, provider groups, as well as payers. TruBridge provides both consulting services and software solutions.
Features similar to those of Experian RCM
While TruBridge and Experian aim to improve healthcare workflows. Their features in common include:
- Revenue Cycle Management - Like Experian, TruBridge's flagship product is its revenue cycle management software. Both provide real-time data analysis and revenue cycle performance tools that render revenue cycle insights, optimize billing, and relieve workloads.
- Patient Pay Estimates: TruBridge calls its good faith estimate tool Patient Liability Estimates (PLEs for this company). By providing patients with their estimated cost of care before service, TruBridge's PLEs maximize point-of-service collections and reduce bad debt. Patients avoid surprise bills, and you improve cash flow, reduce no-shows, and avoid the write-offs that degrade EBITDA. Good faith estimates are an integral part of Experian’s services, but the company hasn’t named this tool individually.
- Claim Scrubbing and Submission: TruBridge, like Experian, prides itself on its claim scrubbing solutions that works behind the scenes, identifying anything that needs changing on a claim. TruBridge states its first-pass clean claim rate is 97%.
- Denial and Audit Management: This comprehensive solution identifies and flags denied and audited claims across various departments. The system expedites the payment process, enhances productivity, and minimizes burdensome tasks.
- Contract Management: This tool helps you to recover underpayments, stay updated with contract changes, and avoid random contract audits while ensuring accurate reimbursement. On the other hand, Experian’s underpayment software is wrapped up in its contract auditing and analysis solution.
TruBridge has a rating of 3.4/5 on G2.
An Experian RCM competitor that specializes in behavioral health centers
After launcy from Orlando, Florida in 2009, AZZLY, has grown to be a premier solution for behavioral health and addiction treatment centers. The company offers a comprehensive cloud-based solution for simplifying revenue cycle management, practice management, and electronic health records.
- EHR/RCM Software for real-time data & analytics: Where Experian’s system integrates into your current EHR and PMS, AZZLY offers a “dual” system that combines your RCM and EHR. You can configure its analytics engine to limit access.
- Patient Pay Estimates: AZZLY’s patient pay estimate page has yet to be completed, stating, “more info coming soon!”
- eBilling & Claims: AZZLY offers eBilling & Claims, a comprehensive solution that combines billing and revenue cycle tools for submission and tracking of electronic bills and insurance claims. With features like the auto-population of claims, Utilization Review Alert Report, A/R Billings Report, and Financial Report, AZZLY ensures efficient billing management, claim monitoring, and error prevention. The system facilitates faster claim submissions, reducing reimbursement time. Moreover, AZZLY maintains a respectable first-time pass rate of 98%. Experian’s end-to-end billing services come with a dedicated US-based biller who is chosen based on their experience, expertise, and alignment with your specialty.
- Auto-Claims: AZZLY’s popular automated feature reduces the time it takes billers to submit claims by 75%. The system uses provider patient information to speed claims process and limit errors, leading to faster reimbursements and fewer denials.
Azzly has 3.9/5 stars on Capterra.
An Experian RCM competitor that specializes in physical therapists
StrataPT provides specialized EHR and RCM solutions for physical, occupational, and speech therapists. Established in 2010, the company offers comprehensive practice management software and a dedicated billing team to help optimize revenue for practices and providers.
Features in common with Experian RCM
StrataPT offers comprehensive solutions for physical therapists that are similar to Azzly's combination of behavioral health providers' EHR systems and RCM tools. Some of the shared features include:
- Patient statement clarity and online bill pay: These features provide real-time balance alerts to clients and offer convenient ways to review and pay invoices through email or text.
- Automated Medicare eligibility: This feature automatically integrates patient Medicare eligibility information into your EHR, eliminating the need to log into Medicare's portal.
- Insurance credentialing service: StrataPT offers an insurance credentialing service that includes paper analysis for your local market, submission of payer applications, and regular follow-ups with payers until approval letters are received.
An Experian RCM alternative for dentists
Founded in 1985, Dentrix Dental Systems was acquired by medical and dental supplier Henry Schein, Inc. in 1997. As the first practice management system for Windows (1989) and the first to win approval for Windows 98, Dentrix has a long track record of helping dentists streamline operations and optimize revenues.
Unlike the other Experian competitors, Dentrix limits its client base to dental practices. Dentists find value in Dentrix’s capability to connect financial and clinical into one workflow.
Dentrix offers a range of useful features, including:
Billing and collection tools: Dentrix provides efficient billing tools that help accelerate payment collection, manage debit and credit card payments, expedite payment processing, and generate billing statements. These tools also enable tracking of patient eligibility and insurance claims.
Clinical tools: Dentrix allows dentists to access and view 2D and 3D dental images without leaving the platform. It serves as a centralized hub for all patient information. Dentists can easily record, store, and review data numerically or graphically.
See for yourself how the competition stacks up
If you want a solution like Experian that’s more customizable to your needs, consider MD Clarity. Providing revenue cycle management software since 2010, we have the track record of the largest RCM vendors while maintaining a moderate size to allow us to fully customize each solution specifically to individual need. Dedicated to healthcare transparency and fair provider reimbursement, MD Clarity's products enrich the patient experience and your bottom line. Our products automate patient cost estimates, contract optimization, and payer underpayment detection, all in one place.
Interested in seeing firsthand how MD Clarity stacks against Experian? Book a personalized demo today.