Medical Claims Management Software Development Company
Arkenea is a trusted medical claims management software development company since 2011, delivering AI-powered claims processing solutions that reduce denials by 85%, accelerate reimbursements by 70%, and maximize revenue cycle efficiency for healthcare providers, payers, and HealthTech startups.
Awarded Best Healthcare Software Development Company in 2024 and 2025
Some of Our Clients
Transform Your Healthcare Claims Processing Into a Revenue Generating Engine
Arkenea specializes in developing comprehensive medical claims management systems that transform how healthcare organizations handle the entire claims lifecycle. Our solutions encompass automated claim submission, real-time eligibility verification, intelligent denial management, and advanced analytics to optimize revenue cycles.
- 4.9 Clutch review rating with a 5.0 average referral rating.
- HIPAA-compliant, AI-driven claims management solutions that integrate seamlessly with EHRs, practice management systems, and clearinghouses.
- End-to-end development from claim submission automation to denial management and revenue optimization.
- Proven track record: Our custom healthcare software solutions have helped clients scale revenues beyond $1.6M within 18 months.
Our Medical Claims Management System Expertise
Automated Claims Processing & Submission
We develop intelligent claims processing engines that automatically generate, validate, and submit claims using X12 837 EDI standards. Our systems integrate with major clearinghouses and payer portals, ensuring 99.9% accuracy in claim formatting and reducing submission errors by up to 90%.
request a quoteAI-Powered Claims Review & Coding Validation
Our custom software incorporates machine learning algorithms that review claims for ICD-10, CPT, and HCPCS coding accuracy before submission. The AI engines flag potential denials, suggest corrections, and ensure compliance with payer-specific requirements, resulting in 85% fewer denials.
request a quoteReal Time Eligibility Verification
We build integrated eligibility verification modules that check patient coverage, benefits, and authorization requirements in real-time. This prevents claim rejections due to eligibility issues and ensures providers have accurate benefit information before service delivery.
request a quoteIntelligent Denial Management Systems
Our denial management solutions automatically categorize denials by reason codes, prioritize high-value claims for rework, and provide guided workflows for appeals processing. The system tracks denial patterns and provides actionable insights to prevent future rejections.
request a quoteElectronic Remittance Advice (ERA) Processing
We develop automated ERA processing modules that capture and post payment information directly into billing systems. Our solutions handle 835 EDI transactions, automatic payment posting, and variance tracking, reducing manual effort by 80%.
request a quoteAdvanced Claims Analytics & Reporting
Our custom analytics dashboards provide real-time visibility into claims performance, denial trends, payer-specific metrics, and revenue cycle KPIs. Healthcare organizations can identify bottlenecks, optimize workflows, and make data-driven decisions to improve financial performance.
request a quoteWhy Healthcare Organizations Choose Arkenea
With over 14 years exclusively focused on healthcare software development, we understand the complexities of medical claims processing, regulatory requirements, and the unique challenges facing providers and payers. Our team speaks your language and can quickly translate business requirements into technical solutions.
Proven ROI and Performance Improvements
Our medical claims management solutions deliver measurable results: 85% reduction in claim denials through AI-powered pre-submission validation. 70% faster reimbursement cycles with automated follow-up and status tracking. 90% improvement in first-pass claim acceptance rates through intelligent coding validation. 50% reduction in accounts receivable days with streamlined denial management.
Comprehensive Integration Capabilities
We build claims management systems that seamlessly integrate with: EHR/EMR Systems: Epic, Cerner, Athena Health, NextGen, and custom systems. Practice Management Software: Leading PM solutions and proprietary systems. Clearinghouses: Change Healthcare, Availity, RelayHealth, and regional clearinghouses. Payer Portals: Direct API connections with major insurance companies. Financial Systems: Integration with accounting and revenue cycle management platforms.
Enterprise-Grade Security & Compliance
All our medical claims management software solutions are built with security-first architecture: HIPAA, HITECH, and SOC 2 compliance End-to-end encryption for PHI and financial data. Role-based access controls and audit logging. Regular security assessments and vulnerability testing.
Medical Claims Management Software Features
Claim Creation & Validation
- Automated claim generation from EHR data
- Real-time coding validation and error detection
- Duplicate claim prevention
- Multi-payer claim formatting
Intelligent Submission Management
- Batch and real-time claim submission
- Clearinghouse integration and routing
- Submission status tracking
- Automatic resubmission for rejected claims
Status Tracking & Follow-up
- Real-time claim status monitoring
- Automated follow-up scheduling
- Aging reports and prioritization
- Payer communication tracking
AI-Powered Fraud Detection
- Pattern recognition for suspicious claims
- Real-time fraud scoring
- Automated flagging and review workflows
- Compliance reporting and audit trails
Predictive Analytics
- Denial prediction modeling
- Revenue forecasting
- Performance benchmarking
- Trend analysis and recommendations
Multi-Payer Management
- Payer-specific rule engines
- Contract management integration
- Prior authorization tracking
- Coordination of benefits handling
Industries We Serve
Healthcare Providers
- Hospitals & Health Systems: Enterprise-scale claims processing for multi-location organizations.
- Specialty Clinics: Tailored solutions for cardiology, orthopedics, oncology, and other specialties.
- Physician Practices: Streamlined claims management for solo and group practices.
- Ambulatory Surgery Centers: Specialized claims processing for outpatient procedures.
HealthTech Companies
- Revenue Cycle Management Companies: White-label claims processing platforms.
- Healthcare SaaS Providers: Embedded claims management modules.
- Medical Billing Companies: Scalable claims processing infrastructure.
- Healthcare Startups: MVP and full scale claims management solutions.
Healthcare Payers
- Insurance Companies: Claims adjudication and processing automation.
- Managed Care Organizations: Member benefit verification and claims management.
- Third-Party Administrators: Multi-client claims processing platforms.
- Government Programs: Medicare and Medicaid claims processing solutions.
Our Claims Management Software Development Process
1. Discovery and Requirement Analysis
We conduct comprehensive stakeholder interviews to understand your claims workflows, integration requirements, and performance goals. Our healthcare business analysts map existing processes and identify optimization opportunities while ensuring compliance with industry regulations.
2. System Architecture & Design
Our architects design scalable, secure, and interoperable claims management systems. We create detailed technical specifications, integration mappings, and user experience designs that prioritize both functionality and ease of use.
3. Agile Development & Integration
Using proven development methodologies, we build your claims management software in iterative sprints. Our development includes extensive integration testing with EHRs, clearinghouses, and payer systems to ensure seamless data flow.
4. Quality Assurance & Compliance Testing
We conduct rigorous testing including functional testing, integration testing, security testing, and compliance validation. Our QA process includes testing with real claims data in sandbox environments to ensure accuracy and reliability.
5. Deployment & Go-Live Support
We provide comprehensive deployment support including data migration, staff training, and go-live assistance. Our team ensures minimal disruption to your revenue cycle during the transition to the new system.
6. Ongoing Maintenance & Optimization
Post-deployment, we provide continuous support, regular updates for regulatory changes, and performance optimization. Our maintenance includes monitoring, troubleshooting, and feature enhancements based on user feedback and industry changes.
Integration Capabilities
01.
EHR/EMR Integration
- Epic Integration: Certified integration with Epic’s revenue cycle modules.
- Cerner Integration: Seamless data exchange through Cerner APIs.
- Athena Health: Direct integration with Athena’s practice management platform.
- Custom EHR Integration: APIs and HL7/FHIR standards for proprietary systems.
02.
Clearinghouse Connectivity
- Change Healthcare: Complete EDI transaction processing.
- Availity: Real-time eligibility and claim status checking.
- RelayHealth: Multi-payer claim submission and tracking.
- Regional Clearinghouses: Custom connections for specialized markets.
03.
Payer Portal Integration
- Major Insurance Companies: Direct API connections for real-time processing.
- Medicare/Medicaid: Integration with CMS systems and state Medicaid programs.
- Commercial Payers: Standardized connections with leading insurance providers.
- Workers’ Compensation: Specialized integration for work-related claims.