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Functionality is Organizations' Top Priority for Claims Management Vendors

Analysis  |  By Jay Asser  
   February 02, 2023

A KLAS report examines purchase decisions to better understand what organizations value when it comes to claims management.

When choosing vendors for their claims management, healthcare organizations look for functionality first and foremost, according a report by KLAS.

The research compiles claims management purchase decisions of 24 organizations between February 2020 and November 2022 to assess what factors are at play in the search for vendors.

"The financial well-being of healthcare organizations is critical, especially given the macroeconomic pressures they face today," the authors wrote. "Many are looking at claims management and clearinghouse technology to maximize cash collections and reduce administrative burdens."

Functionality was far and away the top reason for consideration or selection of a claims management vendor, chosen by 83% of respondents.

More specifically, 55% of organizations said the functionality they value the most is a solution that saves time and simplifies claims processing. That was followed closely by claims scrubbing, or full control over editing and customizing rules (50%), and reporting/analytics that provide visibility into outcomes and denial prevention (45%).

On the lower end of desired functionalities were help with provider credentialing and payer enrollments (10%), notifications about payer updates (10%), and coordination of benefits and real-time eligibility (7%).

After functionality, "other" was chosen the most often among reasons, selected by half of respondents. "Other" includes consolidation, expertise, reputation, road map, sales experience, and user experience.

Organizations also showed a preference for existing vendor relationship (46%), cost (42%), and integration (33%).

The report also revealed overall performance scores for vendors, based on customer respondents:

Experian Health: 90.1

Olive: 89.2

Quadax: 88.0

Waystar: 87.3

SSI Group: 87.2

Availity: 87.0

FinThrive: 84.0

Change Healthcare: 76.6

A recent survey conducted by Experian Health looked at the state of claims and solutions organizations can utilize.

Among 200 healthcare professionals surveyed, nearly all indicated they had technology in place to help improve claims and reduce denials, with more than half (52%) having updated or replaced their existing claims process technology, and 45% saying they automated tracking of payer policy changes. Providers also invested in patient portals (44%), accurate estimates (40%), and digitizing the registration process (39%).

Jay Asser is the contributing editor for strategy at HealthLeaders. 


Claims management purchase decisions of 24 organizations between February 2020 and November 2022 were compiled in a report by KLAS.

The data reveals that functionality and more specifically solutions that save time and simplify claims processing are what organizations value most when considering or selecting a vendor for claims management.

Experian Health received the top overall performance score among vendors, based on customer respondents.

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