Best Automated ERA/EFT remittance posting and reconciliation solutions for integrated delivery networks to reconcile payments across payers, locations, and service lines in the USA

Uncover missing revenue through better data. Between missing charges, coding mistakes, and DRG underpayments, many healthcare organizations are losing out on a significant amount of revenue they’re owed. Powered by predictive analytics and machine learning — and supported by a dedicated team of certified coding experts — our suite of Revenue Capture solutions can help you identify and correct these errors. With Waystar, your team can easily recover more revenue and save hours of work.

Almost half of all Medicare discharges are coded as transfer DRGs, and identifying Medicare transfer DRG underpayments can be a costly challenge. While you work to receive underpayments, you may not find 100% of them. Waystar’s technology quickly identifies transfer DRG underpayments with little to no extra work from your team.

Want to see what our Revenue Capture solutions could mean for your organization? Input a few details and see what your potential ROI could be.

Benefit range accounts for benefit to be attained through missing charges, CPT coding errors and DRG assignment errors. This calculator is designed to be educational in nature based upon limited information. It is therefore not a guarantee of performance.

Health systems use Waystar Revenue Capture to uncover missed charges and underpayments — improving financial performance while reducing administrative burden.

By partnering with Waystar, AnMed captures critical revenue opportunities and directly adds to their bottom line.

Leveraging Waystar’s end-to-end platform, Piedmont simplifies operations, enhances the patient financial experience, and improves outcomes across the revenue cycle.

Learn more about our family of Revenue Capture tools as well as proven strategies you can put in play to streamline workflows and improve financials. Explore the materials below.

• An integrated, data-driven approach to charge capture
• 2 keys to better DRG accuracy
• Transfer DRG from Waystar
• Recovering transfer DRG underpayments

• Charge Integrity
• DRG Anomaly Detection
• Transfer DRG

We’d love to hear more about the challenges you’re up against and what you’re hoping to accomplish when it comes to revenue capture. Fill out the form below and one of our solution experts will be in touch soon.

Automated and data-driven revenue cycle management solutions to streamline operations, enhance efficiency, and boost reimbursement levels.

Quadax helps health systems achieve a 99.7% first-pass claims acceptance rate. A four-time recipient of the Best in KLAS award for Claims Management, our innovative RCM solutions use smart automation and analytics to speed up billing, boost reimbursement, and give you better control—so you can focus on patient care.

• Patient Access
• Claims Management
• Reimbursement Management
• Denials & Appeals Management
• Patient & Client Engagement
• Business Analytics

Advanced Claim Status (ACS) seamlessly incorporates a more detailed and comprehensive claim status update into your workflow, enhancing efficiency for your team and facilitating increased automation.

Contract Management analyzes contract variations and compares expected reimbursement to allowed amounts, enabling organizations to identify underpayments, denials, and shortfalls, and take action to prevent revenue leakage.

Insurance Eligibility confirms a patient’s insurance coverage and benefits, delivering details on copays, coinsurance, and deductibles in real-time to prevent claim rejections, payment delays, or revenue loss.

Quadax’s ICV All-Payer catches coverage issues early—reducing denials and improving visibility across all major payers through one powerful platform.

Quadax’s Xpeditor software streamlines workflow by directing claims efficiently to designated billers based on your criteria, ensuring a precise audit trail, and eliminating reliance on external communication channels. By integrating workflow automation between Claims Management and EHRs or billing applications, processes are optimized to enhance clean claim rates, reduce overhead costs, and empower you with the tools needed to swiftly and effectively recover expected reimbursements.

To improve clean-claim rates, start with proactive measures. With XpressBiller, Quadax’s cutting-edge rules and editing system, automatically pinpoint, address, and reduce errors in real-time before submitting claims to the payer. By tackling the root causes that impede claims and cut into profits, you can take charge of your revenue cycle and satisfy even the most challenging payers without the need for IT involvement and at no extra cost.

Streamline your billing office workflow and saves those hard-earned dollars by eliminating paper with RemitMax by Quadax. Adding RemitMax to your remittance management strategy allows you to get control of all your remittance and correspondence documents—even patient payments—that you or your lockbox now receive on paper. And, the 835s created by RemitMax are subject to the same automation that’s afforded within the Claims Management and Denial Management solutions, such as automated COB claims, denial management workflow and robust data analytics allowing for a more accurate picture of the entire revenue cycle.

Intelligence by Quadax (iQ) is our all-in-one AI framework built to streamline automation, deliver predictive insights, and optimize performance across the entire revenue cycle. From patient access to denial management, iQ empowers healthcare organizations to minimize friction, accelerate processes, and drive better outcomes.

“Quadax stood out because their data goes beyond individual pieces of information and offers a comprehensive view. It allows us to identify areas for improvement and chart a path to increase our reimbursement.” — Chris Hochgraf, Director of Revenue Cycle, Samaritan Medical Center

Quadax revenue cycle experts offer regular on-site visits to help with event management and resolution, ongoing training, customized reporting solutions, industry best practices, and overall issue resolution. With Quadax, you’ll experience a seamless integration of advanced technology and dependable, personalized support.

Availity’s network connectivity enables healthcare trading partners to securely exchange electronic claims and payer data with health plans and providers. Our solution streamlines claim submission, enhances payer connectivity, and ensures compliance with HIPAA and healthcare regulations. Processing over 13 billion transactions annually. Availity provides real-time data exchange, improving efficiency and accelerating reimbursements.

Availity’s EDI transactions support seamless electronic claim submission and payer data exchange, ensuring fast, secure, and HIPAA-compliant transmissions. Our clearinghouse enables:

• Eligibility and Benefits (270): Verify patient coverage in real time
• Remittances (835): Process electronic remittances more effectively
• Claim Submission (837 I, P, D): Send claims to payers faster
• Claim Status (276): Track submitted claims instantly
• Authorization and Referral (278): Execute prior authorization requests efficiently

Availity offers advanced APIs that enhance claims processing, eligibility verification, and prior authorization workflows. These tools provide real-time insights and improve payer-provider connectivity.

• Member ID Card: Access digital ID cards instantly
• Care Reminders: Improve patient engagement with automated alerts
• Is Auth Required: Simplify prior authorization workflows
• Enhanced Claim Status: Get real-time claim updates

Availity simplifies payer connectivity and claim submission with expert support for EDI transactions, payer IDs, and healthcare clearinghouse compliance. Our dedicated team ensures smooth electronic data interchange between providers and payers, reducing errors and improving claim acceptance rates.

Reduce the time it takes to verify funds deposited to your bank account with an auto-reconciling process matching EFTs and ERAs. Identify pending or reconciled remits with a quick, easy reporting feature. Receive 835 posting files once matched.

Manually matching payments to their proper amount in the billing system is a tedious task. MediStreams’ Reconciliation service allows payments to be received through an automated workflow. The payment information is received from EDI 820 or NACHA files and compares them to received 835 ERA files. The payments and the ERAs are matched on specific criteria, to ensure the funds are in the bank. Remove the manual processes of reconciling and let technology do the work for you, saving time and money.

• Analytics for search and retrieval for both pending and reconciled remittances
• Automated process that matches EFTs to ERAs to deliver a funded 835 posting file
• Continuous processing which operates 24/7
• Unmatched EFTs and ERAs remain on the web portal in a pending status for client review

• Configuration Engine: Innovative system platform designed for fast deployment of customer setups and customization.
• Web Portal Archive: Web portal for convenient and secure access to your images and data. Includes a ten-year retention.
• Work Queues: A workflow management module for payments and correspondence.
• User Administration: Administrative module for Admins for user setup, maintenance and assignment of features and tasks for each user.
• Reports: Reports available for access to all data received through the system.

Empowering healthcare providers with a flexible, holistic, and automation-driven approach to revenue cycle management.

SSI helps clients maximize reimbursement and enable positive patient experiences by providing AI-powered revenue cycle solutions that automate processes across the enterprise.

Key solution components: Access Management, Claims Management, RCM Performance Insights, Clearinghouse.

• Access Management
• Claims Management
• RCM Performance Insights
• Clearinghouse

SSI provides industry insights about the most common types of denials and denial prevention strategies. Stopping denials on the front end is better than managing them on the back end.

• Industry average denial rate: 5‑10%
• Clean claim rate: 90%

SSI provides health systems with tools to develop and maintain lean processes, leveraging automation and best practices to decrease denials and identify process improvements. Integrated solutions eliminate the need for multiple systems.

• Decrease denials
• Identify process improvement areas
• Integrated solutions for efficiency

Make your move toward stronger financial results and smarter care.