Top 8 Experity Alternatives and Competitors 2024

Revenue cycle management (RCM) software streamlines the financial processes within healthcare organizations. It automates patient eligibility verification, patient payments generation and send, claims, billing, and underpayments recovery. Automation of financial operations not only boosts net revenue and simplifies workflows but also alleviates staff workloads. Experity creates the automation to run some of these tasks with little to no staff involvement. Even partial revenue cycle management helps providers improve net revenue, reduce staff workload, and streamline workflows.  

What is Experity revenue cycle management and what market does it serve? 

Experity Health offers a comprehensive suite of software solutions engineered specifically for the urgent care sector. Their software includes:

• Electronic Medical Records (EMR) 
• Practice Management (PM)
• Revenue Cycle Management
• Patient Engagement
• Teleradiology
• Consulting services

These products streamline operations, enhance patient experiences, optimize revenue, and support the growth and efficiency of urgent care clinics.  

Experity Health was established in 2019 through the merger of  DocuTAP and Practice Velocity, two companies working to transition urgent care clinics from paper-based to digital records. Today, the company employs nearly 700 people across multiple locations. Its EHR software product has an average rating of 2.5 / 5 on G2 and 4.3 / 5 on GetApp. There is no rating for its revenue cycle management software.

Experity RCM serves on-demand care providers of all sizes and specialties including occupational medicine, pediatrics, and primary care. It has developed workflows to meet urgent care needs. 

Experity’s revenue cycle management solution 

Experity claims to be an end-to-end solution, but its website focuses on eligibility verification, coding, and compliance, suggesting otherwise. There is no mention of good faith estimates, prior authorizations, or charge capture solutions – other important aspects of the revenue cycle. The focus on EHR technology and documentation accuracy speaks to its core EHR product as well as its eligibility functions. 

Beyond eligibility verification, Experity software also tackles urgent care billing, coding, payer contracts, and compliance. It guides staff and billers through the claims process by providing coding recommendations based on the latest regulations and payer restrictions. This oversight helps to achieve a higher rate of clean claims. 

Experity’s other RCM focus is contracts. Its software helps you research payer plans, develop fee schedule rates and contract language, and negotiate contract terms. 

Although Experity provides an array of RCM solutions, its offerings may not necessarily align with what your organization needs most right now. 

List of 8 Top Experity Alternatives

• MD Clarity
• TriZetto
• Change Healthcare
• R1 RCM
• TruBridge
• Health Here
• AZZLY
• Dentrix

Experts in good faith estimates and underpayment detection

MD Clarity

Description

Unlike most RCM companies, MD Clarity has been providing revenue cycle solutions for over 10 years. A social-impact-driven software company, MD Clarity serves forward-looking provider groups, health systems, and managed service organizations that realize that greater transparency can enhance both patient experience and provider revenue.

MD Clarity has partnered with 3,000+ facilities, 150,000+ providers, and facilitated 20,000,000+ patient encounters across the United States. Its client base spans dozens of specialties. It has recently been recognized as a Built-In Best Place to Work. G2 reviewers have given MD Clarity an average of 4.7 / 5 stars.   

MD Clarity features in common with Experity RCM 

While MD Clarity and Experity both optimize revenue cycle improvement via front- and back-end administrative processes, they focus on different RCM areas. Of course, Experity only focuses on urgent care space whereas MD Clarity serves providers of all specialties. 

Patient pay or good faith estimate generation

MD Clarity specializes in automating and optimizing all steps involved in good faith and patient pay estimates and contract management. For patient estimates, its Clarity Flow handles eligibility verifications, the generation of a range of estimate letters that meet the organization’s patient segments, automated send of estimates upon scheduling, care deposit collection (if needed), and transfer of funds to your organization’s account.  

For contract management, MD Clarity’s RevFind uploads all contracts to a centralized platform, and then ingests all data, and analyzes that data. With sources of denials uncovered, you can change workflows to prevent them going forward. RevFind dashboards and reports also reveal which payers pay their full contracted rates and which do not. For payers who are shortchanging you, you can drill down into service types and CPT codes for complete information. Share this information with the payer to get the full remittance. You can find steps to underpayment recovery here. 

MD Clarity is one of the few RCM vendors that auto-sends estimates based on a trigger (e.g. scheduling). Staff need only touch estimates in cases of exceptions. This automation relieves staff of repetitive busy work and helps organizations avoid new hires. 

Contract management

Contract Analytics: Both Experity and MDClarity centralize and digitize payer contracts, a necessary step to verify eligibility, create patient payment estimates, and detect payer underpayments.  

Unlike MD Clarity, however, Experity does not analyze payer contract performance, most likely because they are relatively new to the contract management space. 

MD Clarity's RevFind tool goes beyond analyzing performance. It also enables users to evaluate the financial effects of any proposed changes in payer contracts on their cash flow and net revenue. With the analysis process taking only a few minutes, staff can quickly respond to and negotiate against any unfavorable alterations suggested by payers. This quick and efficient analysis relieves the heavy workload and time constraints faced by healthcare providers and their staff. The time-saving advantage makes a real difference in managing financial operations.

Underpayments: Both Experity and MD Clarity use their contract management modules to recover payer underpayments. MD Clarity’s tool RevFind, compares all payments to payer contract terms and alerts staff to discrepancies. 

Due to the labor involved in tracking and addressing them, underpayments are often overlooked. As staff can often recover them easily once they’re discovered, they can be a meaningful source of additional net revenue for physician groups and healthcare organizations. With automated underpayment discovery, providers can find the trends that amount to significant revenue recovery. RevFind also helps ensure you’ve set your chargemaster optimally. Its work queues feature assigns appeals and investigations to a range of team members automatically per your settings so users can review their task statuses in one place. 

Tracking and resolving underpayments often gets neglected due to the intensive manual effort required. Experity and MD Clarity both utilize their contract management systems to identify and reclaim underpayments from payers. Specifically, MD Clarity's RevFind tool scrutinizes each payment against the agreed terms in payer contracts, raising any variances to the team. Once these underpayments are pinpointed, they present a significant opportunity for additional net revenue for healthcare providers and physician groups. Automated detection of underpayments enables providers to uncover patterns leading to substantial revenue recuperation. 

Additionally, RevFind assists in ensuring the chargemaster is accurately set. It includes a feature for work queues that automatically distributes tasks to team members for underpayment inquiries based on predefined settings. These features centralize work progress.

Denials Management: RevFind reveals the sources and types of denials your organization receives so you can tackle root causes and adjust workflows to prevent them. RevFind generates clear reports that help your team understand the codes and payers triggering these costly denials.  

Ratings

MD Clarity has earned an average of 4.7 / 5 stars on G2. 

An Experity competitor that's end-to-end RCM, but open to all specialties

TriZetto

Description

Similar to Experity, TriZetto positions itself as a comprehensive provider of revenue cycle management solutions but caters to a range of specialty healthcare organizations as well as hospitals, health systems, and insurance companies. Its suite of software products tackles these areas of the revenue cycle: prior authorizations, eligibility checks, contract management, billing, and coding. Like all RCM vendors, TriZetto’s aims to streamline operations and improve net revenue for healthcare providers.

Features TriZetto shares with Experity 

Like Experity, TriZetto assures providers that they will provide end-to-end RCM automation. Neither TriZetto nor Experity offer on- or off-shore labor to handle exceptions and overflows that arise in the revenue cycle. 

Trizetto offers a feature known as Patient Responsibility Estimations, designed to set clear payment expectations for patients, thereby enhancing patient payment contributions and reducing instances of unpaid debt. Additionally, their contract management tools streamline the identification and analysis of underpayments and include contract modeling capabilities. These features are especially useful for those looking to assess the financial implications of changes in pricing or contract terms on their overall revenue.

Ratings

TriZetto has an average rating of 4.3/5 stars on G2.  

An API-forward Experity competitor 

Change Healthcare / Optum

Description

For more than 10 years, Change Healthcare acted independently in the healthcare industry until it was acquired by United Healthcare in 2022 and subsequently became part of Optum, its affiliate. Change Healthcare is known for its comprehensive suite of revenue cycle management solutions. Its clients range from specialty physician groups to hospitals and healthcare systems. Their services encompass:

• RCM analytics powered by data to identify trends and areas needing enhancement
• Self-service clearinghouses that facilitate efficient claims processing
• Tools designed to ensure accurate payment for healthcare services, thereby guaranteeing proper reimbursement

Change uses an API platform which means it is not just software. Instead,  it's a set of rules and protocols that allows different software applications to communicate with each other. APIs enable the integration of distinct systems, allowing them to share data and functionalities in a seamless manner. This makes it possible for developers to leverage existing services and platforms to build new applications or enhance the capabilities of existing ones without starting from scratch. More than the “tech stack,” APIs act as bridges between systems, enabling them to work together seamlessly.  

In addition to its software, Change offers services conducted by specialists in billing, prior authorizations, charge capture, and more. A two-pronged approach to healthcare organization revenue cycle challenges lands it in the “software plus services” category. This approach ensures hospitals and health systems cover all patients, including “exceptions” that the software cannot process. 

Change Healthcare and Experity overlap

As with Trizetto, both Experity and Change Healthcare provide eligibility verification, coding and billing technology, contract management technology along with analytics. Experity does not offer these Change services, however: patient pay estimator, CDSM, charge capture, and analytics-driven claims management. 

Both also offer consulting and advisory services to clients.  

Ratings

Change Healthcare and Optum both have scores of 3.7/5 stars on G2.

An Experity competitor known for outsourced revenue cycle management

R1 RCM

Description

Originally founded as Accretive Health in 2003, the company transformed to become R1 RCM in 2017. Now headquartered in Salt Lake City, Utah, R1 RCM is recognized as a fierce competitor in the revenue cycle management (RCM) arena, primarily serving hospitals and healthcare systems. Where Experity targets urgent health organizations, R1 RCM targets hospitals, health systems, and physician groups across the United States. It serves all medical specialties. 

Several key distinctions differentiate Experity and R1 RCM's offerings:

• Comprehensive RCM Solutions: Similar to Change, R1 RCM integrates its software solutions with a digital workforce. This synergy allows for seamless execution of a wide range of RCM tasks, with R1 RCM utilizing AI-driven analytics to promptly identify and address payment discrepancies.
• Patient Engagement Tools: Like Experity, R1 RCM's EntriPay does not generate payment estimates. Instead, R1 RCM enhances the patient experience by combining functions such as registration, intake, clearance, scheduling, and payment into a cohesive tool.
• Claim Management Expertise: Because of its seasoned claims experts, R1 RCM can deliver proficiency in claim management.

These elements underscore the tailored approaches of Experity and R1 RCM in addressing the diverse needs of healthcare providers, with each offering unique strengths in the competitive RCM landscape.

R1 RCM has one score of 0/5 stars on G2.

An Experity alternative that provides outsourced RCM consulting

TruBridge

Description 

Founded in 2013, TruBridge caters specifically to rural and community hospitals. Its suite of software tools is designed to optimize revenue cycle processes, maintain coding compliance, and boost patient interactions. At the heart of TruBridge's service lineup is its all-encompassing RCM software, which provides live analytics and features aimed at enhancing revenue cycle efficiency, simplifying billing operations, and reducing the workload for staff.

TruBridge tailors its RCM systems to the needs of large hospitals and complex healthcare systems. Experity promotes its RCM solutions only to urgent care providers.

Some key services offered by TruBridge include:

• Claim scrubbing and submission: This feature detects and highlights errors in claims before submission.
• Denial and audit management: Targets and identifies denied and audited claims to accelerate payments from payers, while automation in this area boosts staff efficiency and reduces monotonous tasks.
• Contract management: Assists in retrieving underpayments and ensures contracts are updated, safeguarding financial health.
• Patient pay estimations: Ensuring patients know their financial responsibilities up front and have options for making payments. 
• Electronic health records: Accurate records and data that limit denials and prevent confusion.
• Staffing: the backup to restore stability to your organization. 

These solutions address the main challenges healthcare institutions in rural and community settings face.  

Features similar to those of Experity  

Like Experity, TruBridge offers software solutions for eligibility, coding and billing, compliance, and contract management. Its service providers utilize this technology to help streamline all aspects of rural hospital and physician group revenue cycles. 

Ratings

TruBridge has a rating of 3.4/5 on G2.

An Experity alternative that specializes in behavioral health centers

AZZLY

AZZLY is another RCM provider that specializes in one market vertical – behavioral health and addiction treatment providers. Along with the typical RCM automation solutions, it offers EHR and practice management solutions. By combining the three dimensions of successful organization management, the company frees behavioral health center staff to focus on providing care. Where Experity and Azzly both offer consulting, neither supplies the prior authorization, billing, coding or contract specialists to get the work done for you. 

AZZLY and Experity share these features:

Both AZZLY and Experity offer the “dual” tier of RCM and EHR operations solutions for distinct medical specialties.  

Neither offers a patient pay estimate solution to clients, but AZZLY proclaims theirs is “coming soon!” Neither offers prior authorization automation. Other than that, they both cover eligibility verification, coding and billing, compliance, contract management, analytics, and credentialing. 

Azzly has 3.9/5 stars on Capterra.

HealthHere: An Experity competitor that serves high-value provider networks

HealthHere optimizes healthcare organizations for a value-based model by enhancing patient access and revenue cycle efficiency. It automates payment models, simplifies patient payments, reduces wait times, and improves interactions while easing staff workload.

Their software suite streamlines operations with tools for mobile patient intake, cost estimates, episodic payment automation, a variety of payment options through a patient portal, and collecting patient-reported outcomes to measure satisfaction and quality, supporting value-based care goals.

Their software suite includes:

• Flow - a patient intake solution, this mobile check-in along with in-clinic kiosks & tablets automates intake and relieves front-desk bottlenecks.  
• Q Code - this solution generates pre-service and good faith estimates. 
• Qub - executes automated episodic payment models. Facilitates payment procedures, pricing, and automation.
• Pay – a patient payment facilitation functionality. Their patient portal offers many patient payment options. It also standardizes all communications from pre-check to post-procedure to cut down on patient confusion. 
• Pro - patient-reported outcomes are a critical aspect of value-based care. This functionality collects patient-reported outcomes that measure satisfaction and quality beyond financial measures. 

Solutions Experity RCM shares with HealthHere

Both Experity and HealthHere’s solutions focus closely on patient intake and payments from registration through collections. Neither offers prior authorizations or patient payment estimates. 

Ratings

HealthHere has not accrued enough reviews to publish ratings. 

An Experity alternative built for dental practices

Dentrix

Description

Founded in 1985, Dentrix Dental Systems was acquired by renowned dental and medical supply company Henry Schein in 1997. Dentrix, a pioneer in dental practice management software, was the first of its kind for Windows in 1989 and achieved early endorsement for Windows 98. Its reputation among dentists grew due to its effectiveness in streamlining dental practice operations and enhancing revenue. Dentrix distinguished itself by integrating financial and clinical insights into a single workflow.  

Features

Dentrix’s solutions include:

• RCM: Billing and collection features that assist dental practices in monitoring patient eligibility and managing insurance claims efficiently. Dentrix offers capabilities to generate and dispatch billing statements, expedite the payment process, and handle debit and credit card transactions.
• Clinical: a unified platform for dentists to access a wide range of 2D and 3D images which centralizes patient information for easy storage, recording, and retrieval of data.

Ratings

Dentrix has 4.3/5 stars on Software Advice and GetApp.

Explore MD Clarity’s revenue improvement solutions yourself

For provider groups and MSOs in need of reliable good faith estimate solutions, MD Clarity's Clarity Flow stands out by automatically generating and sending accurate estimates using stored contracts and patient data, requiring no staff effort. Committed to healthcare transparency, MD Clarity enhances patient access to pricing information while improving providers' net revenue. Additionally, MD Clarity’s RevFind specializes in optimizing contracts and identifying underpayments, ensuring maximized reimbursements. 

Schedule a demo to see the benefits firsthand.