Medical Claim Software Buyers Guide

Medical claim software buyers guide and features explained. Before you make such an important investment, learn what questions to ask and features to consider for your practice or billing service.

The importance of choosing the best medical billing or practice management software for your needs is one that has lasting implications. That’s why we’ve compiled this buyers guide to help you think about all issues associated with selecting the best software for your situation.

Most people start out looking for a cheap medical billing software. But the billing software is something used on a daily basis – typically by several people. Savings up front can quickly be lost in poor productivity. However are many affordable software applications available that will meet the needs of almost all practices or billing services.

Many of our providers regularly use the reporting features to see what the financial performance of their practice. The medical practice billing software is typically used by many people; the provider, office manager, biller, coder, receptionist, consultants – a wide variety of people with different backgrounds, training, perspectives, and agendas.

So although this purchase can mean several thousand dollars, its important to remember that its a key business tool for the income of your practice or billing service. Some features while they may cost more, can ultimately save you greatly in the long run with increased productivity, fewer rejected claims, or tools to identify issues with the billing.

If you already have experience using a medical claim billing software, think about the features of the systems you have used that were helpful. Also think about the features you wish the software had that would have made your work easier.

We’ve also compiled the form below to help you in selecting the best medical claim software. Feel free to use as you wish – add to it, modify, mark-up, etc. It’s in both PDF and Excel format:

Medical Claim Billing Software Comparison – PDF

Medical Claims Billing Software Comparison – Excel format (ZIP file)

Another good resource in finding the best medical claim software is the Software Advice Buyers Guide. Their expertise is determining the best software based on a users needs – they provide free and un-biased recommendations. This can save you a lot of time and effort by narrowing down the best software solution based on your needs and budget.

When you demo a medical claim software program, think about these issues:


  • Scheduling – The scheduling features should Is it graphic, color codes, and intuitive? Does it work for practices with different locations, different providers? Can you set up reoccurring appointments? Does it have patient reminders, wait lists, and notes. Think of your scheduling needs.
  • Being able to efficiently process claims is fundamental to the medical claim software. If claims aren’t being paid promptly the financial health of the practice is in jeopardy. Assuming all applications send claims electronically you want to think about features that make the billing process more efficient.
  • How easy is it to create and submit claims. What about resubmissions – if you need to correct and resubmit claims look at how easy the medical claim software is to use for these tasks.
  • Can you choose the clearinghouse? Some cheap medical billing software will tie you to using their clearinghouse services – for a not so cheap price. A good medical practice billing software will allow you to create a claim print image file and upload to the clearinghouse of your choice.
  • Support – every medical billing software vendor will tell you they have the best support available. So you can’t rely on the vendor to answer that. What you can do is ask those who have used their product for a while. Ask the vendor for references. Search the internet for user experiences.
  • Training – most medical claims billing software is pretty intuitive – especially for those experienced in billing. If you have users who will need training, explore what training is available and what the cost is – is it included in the initial purchase?
  • Do you have to go through several menu’s to perform basic tasks or access important information.
  • Keyboard shortcuts – these can be a real time saver.
  • Creation and customizing of superbills.
  • Timely filing – does the medical claim software have the ability to prove you submitted claims within the timely filing limits of the insurer? Make sure the application provides adequate proof to satisfy the requirements for timely filing of insurance companies.
  • User access – can you customize the access for each user to limit functions. For example if you hire a consultant, you may not want them viewing certain data not related to their tasks.
  • Electronic remittance – when electronic remittance files (ERA’s) are available from the insurance carrier, this feature can be a real time saver for posting payment information. The electronic remittance file is and electronic version of the EOB (Explanation of Benefits). Many medical claim software programs now have the capability to import this electronic file and post the payment information for all the associated claims paid by the insurer.

Hardware Platform

  • What are the hardware requirements for the medical claim software application? Hardware upgrades can cost as much as the software.
  • Is a server required? If so where will it be located? Who will maintain the server and back it up? Off site backup is important.
  • Will you have to replace your current hardware? If it’s a server based system are your existing PC’s adequate? Are they compatible – Windows vs. Mac.
  • Operating system – will a new operating system be required? This can be expensive and disruptive if it involves upgrading existing hardware. Do you have Macs, Windows based PC’s, UNIX based? If the provider or office manager uses a Mac or iPad at home and wants to access remotely, will it work?
  • Locations – Do you only need to access on site or is remote access to the billing claim medical software necessary?
  • Remote access – is it possible and whats required? Any upgrades to hardware or additional software necessary.
  • How many users – are there license limitations to the number of users? As you expand as a practice or billing service will this be a constraint? Its very frustrating to be confronted with denied access messages when someone needs to log on.
  • Network – will it require additional network devices or wiring? Remember the network must be secure per HIPAA. Also consider bandwidth requirements and the impact to the existing network.
  • How many concurrent users? What are licensing options and costs?
  • Think about the configuration that best suits your needs – PC based, server, online. PC based may be best for a small practice or billing service with low volume. Server for several users at one location. Online if you want to minimize upfront cost and not have to worry with backup and software maintenance.

HIPAA Compliant Medical Billing Software

The billing compliant hipaa medical software features are extremely important with regard to the HIPAA privacy standard and HIPAA security standard.

By now most all medical claim software accommodates the provider NPI. However HIPAA is being implemented over several years so it’s important the software be able to accommodate the changes introduced by HIPAA.

HIPAA compliant medical billing software should have the following features:

  • User Access – Medical billing claim software must have the ability to assign a user logon and password for each user. The user permissions should be set depending on their “Need To Know” and responsibilities.
  • Medical billing codes – in particular the transition to ICD-10 in 2013. The software must be able to accommodate the 7 digit ICD-10 codes.
  • Data Backup – Practice data must be backed up on a regular schedule and placed in a secure location – preferably off site. Procedures should be established for the backup and recovery of data.
  • Plan and Healthcare ID’s – The capability to accommodate future ID numbers such as the Healthcare Plan Identifier to identify the contract between the insurance carrier and the provider.
  • Audit logs that show who logged on, when, and what they did.

Online Medical Claim Software
Online or web based medical claim software is becoming increasingly popular with the advent of “Cloud Computing” in other businesses. As online providers become more reliable and secure, this is certainly more attractive.

Vendors who provide online medical practice billing software are also referred to as application service providers (ASP’s) or Software As A Service (SaaS) providers. These applications actually run on a remote server host.

Online medical claim software is a good option for just about any practice with single or multiple locations. It’s especially well suited for access from many locations by many parties. For example if a practice uses a billing service, they may consider an integrated online solution that offers medical claim software, electronic medical records, and scheduling.

The advantages that make online medical practice billing software attractive are:

  • Access you information from anywhere – home, office, wireless devices. Real time data from anywhere you have Internet access and a browser.
  • Subscription plans with no long term commitments. Many online medical billing software providers require no long term commitments or contracts.
  • Lower upfront costs. Because there is no initial installation, upfront fees are not necessary. No servers, operating system upgrades, new hardware, etc. The application is available anywhere you have Internet access and a browser. Many providers have reasonable upfront fees – if any.
  • Secure. All the reputable online medical claim billing software providers are compliant with the HIPAA security requirements.
  • No backups. This is all managed by the application provider automatically. Many services offer the ability to export the practice database in a neutral format. It’s a good idea to perform this periodically for your own protection.
  • No maintenance costs. Imagine not having to worry about upgrading your software every few years. And with with new HIPAA mandates that require upgrades, that’s your ASP’s problem. No more compatibility issues! The maintenance issues alone can be justification to using an online medical claims billing software.

The disadvantages of online medical claim software are:

  • Dependence on an internet connection. Internet connections aren’t 100% reliable so when you loose your connection, you don’t have access to your data. If you have several user in one location, it may tax the bandwidth and require upgrading the internet service to a higher speed.
  • Location of database – since the practice data is located on a remote server in a data center, you don’t physically have it. However many online medical billing software providers do offer the capability to export your data in a neutral format.
  • Pricing – some providers of billing claim medical software price their services such that you have to pay per user. If you have a lot of users this can add up and reduce the economic benefits of going web based. Or if you are a billing service with several providers, a service that charges per provider – instead of user – is preferred. With competition this is becoming less of an issue.

Upgrades & Conversion
Upgrade – the mere mention of the word brings back painful memories. The best advice we can offer is that when you are considering which medical billing software to commit to, do so for the long term. Even if it costs a little more up front, if you can avoid converting to another software or upgrading, its worth it. Don’t purchase a medical claim software with the intent of changing vendors in a few years. Go with something the is robust enough to grow with your practice or business.

When you go through an upgrade or conversion of your medical claim software, plan for the worst. When we went through an upgrade of our medical claim billing software a few years ago, it was the later version of the same product. We verified with the software provider that the existing forms and reports would be compatible with the later version. They assured us it would.

Well when we upgraded the server – and this is a one-way trip – none of the forms or reports would work. And when we called the software tech support folks they were absolutely no help – clueless. We were on our own. None of the forms used to create claims would work so we had to work out re-mapping our electronic claim files with the clearinghouse again – and this took a while. And on top of that we had issues with the licenses that prevented us from logging in.

Luckily all of the database files imported without problems. But if you are converting from one software to another, it can take a lot of “clean up” work. The exported database files from your old medical billing software must be put into a neutral format and order for import into the new medical claim software. And many vendors do not format this information the same. This can be a very labor intensive and time consuming effort – and the new software provider will charge for this.

There is an initiative called HL7 which stands for Health Level 7. This is a not-for-profit, ANSI-accredited standard with the intent of providing standards for the exchange, sharing, and retrieval of electronic health information. However not all software vendors in the health information field have adopted these standards.

If you are dependent on a IT support person or service for upgrades or conversion to another medical claim software, it can be very expensive and disruptive. In our case we couldn’t send claim files for almost a week. Try explaining that to your clients!

Medical Billing Codes & Software
Some medical claim software programs offer an add-on to import or pre-load the ICD-9 and CPT-4 codes most common for many popular specialties. They can also periodically update the medical billing codes so you don’t have to be concerned if you’re using the most current ones. This can be a real time saver. One of the very labor intensive tasks can be entering in all the diagnosis and treatment codes you practice commonly uses.

Of course this comes at a cost. But when you consider the cost of labor and time necessary to perform such maintenance tasks, this option can sometimes be cheaper.

Be wary of software reviews. These are many times thinly veiled promotional ways that vendors use to promote the features of their medical claim software offering.

Who is ultimately making the decision on what medical claim software to purchase. Make sure those using the application the most have a lot of input on the selection. Are the people who use the software the least making all the decisions? Sometimes you have office management or providers deciding what the best medical billing software is based on vendor sales without considering the needs of their staff who have to live with it.

Here’s some other related medical billing software topics that provide more in depth info:

Cheap Medical Billing Software
Looking to save money with a cheap medical claim software? Here’s some of the more affordable medical billing software offerings for starting a medical billing business or small practice. Also learn more about a good free medical billing software and clearinghouse service.

Free Medical Billing Software
Get the real story on Free Medical Billing Software. Learn where to find a free medical claim software and what features to expect. This can be a viable option for the practice or billing service just starting or not in need of a lot of feature options.

Software Eats Medical Billing
A discussion on how the healthcare reimbursement process is ripe for innovation. An opportunity to contribute your thoughts and comments on the topic.

Medical Insurance Billing Software Examples
For those of you unfamiliar with medical billing software, here’s some example screen shots of electronic medical insurance billing software. Hopefully this will give you an introductory idea of what medical claims billing software looks like throughout the billing process.

Best Medical Billing Software
Learn what features are important and how to find the best solution for you. I share my experiences selecting a billing software program.

Online Billing Software
Is web based the way to go? Having no upfront software cost is appealing. Learn what the costs and pros vs. cons for online practice management systems.

Comparing Medical Billing Software
Have you seen the sites that compare medical billing software? What to watch for in medical billing software reviews. Key points in reviewing billing insurance medical software.

Software Platforms To Consider
Here’s an description of the different Health Insurance Claim Software platforms to consider when selecting a medical billing software.

Free Online Medical Billing Software
Is free Online Software available? Where to find free online medical billing software and what to expect.

Medical Coding Software
What are the options for Medical Coding Software and some online coding resources.

Lytec Billing Software
Opinions on Lytec Billing Software from a Medical Billing Business Owner. Gripes and Likes of Lytec Software.

Medical Billing Clearinghouse
The benefits of using a clearinghouse are and what to look for when selecting one.