Every step a medical claim takes from the moment it arrives to the moment the provider is paid — EDI intake, eligibility, pricing, adjudication, remittance, and payment — in one platform instead of five. Built for self-funded plans, healthshares, and TPAs. Published pricing, zero per-claim fees.
Search this category and you get two unrelated products on the same results page. Medical billing suites help a clinic submit claims and chase payment. Payer-side platforms receive claims and decide what the plan owes. Buyers routinely get three demos deep before noticing the vendor solves the opposite side of the transaction. Claimaro is payer-side: if bills arrive at you and you are on the hook for the dollars, this is your category. If you are a practice trying to get paid faster, you want the provider-side tools — we lay out the difference in payer-side vs. provider-side.
Bought separately, this sequence is five to seven vendors and an integration project. Here it is one system.
Native 837 claim files from your clearinghouse, plus paper and portal-entered claims, all landing in one queue rather than three separate inboxes.
Was the member covered on the date of service, at what tier, with which dependents — then matched to the benefit plan that actually applies. Eligibility is checked against the record, not a stale export.
What the claim is worth under your fee schedule, with a usual-and-customary fallback and support for reference-based arrangements.
Deductible, coinsurance, and copay applied, with accumulators updating in real time so the next claim prices against current balances. The adjudication engine in detail.
Duplicates and near-duplicates flagged before money moves — including the same service arriving once by EDI and again through the member portal. Anything needing a human pends with the reason attached.
835 remittance to the provider, EOB to the member, provider disbursement, and 1099-MISC and W-9 tracking for everyone you pay.
Most platforms in this category bill per transaction, which means the price of processing claims rises with the number of claims you process. That is a tax on throughput: clearing the queue costs you more than letting it sit. Claimaro is base plus PMPM only. Your volume can double and your platform cost does not move a dollar. Whatever else you compare, get every vendor's per-claim and per-seat pricing in writing.
A stitched-together stack loses claims in the seams. Eligibility lives in the enrollment system, so the adjudicator prices against yesterday's roster. Accumulators batch overnight, so a member clears their out-of-pocket maximum twice in a day and nobody finds out until morning. Provider payments sit in a finance tool that has never heard of the claim it is paying. Every one of those is an integration someone owns and a reconciliation someone runs.
When intake, eligibility, pricing, adjudication, remittance, and payment are one platform on one database, those handoffs stop existing. There is nothing to reconcile between systems, because there is one system.
Healthcare claims processing software is the system a health plan uses to take a medical claim from arrival to payment: intake from EDI, paper, or a portal; eligibility verification for the date of service; matching to the right benefit plan; pricing against a fee schedule; applying cost-sharing and updating accumulators; the pay, deny, or pend decision; then the 835 remittance to the provider and the EOB to the member. It is the payer side of the transaction — the software that decides what is owed and pays it.
No, and this is the most common mix-up in the category. Medical billing software is provider-side — it helps a clinic or hospital create and submit claims to get paid. Claimaro is payer-side — it receives claims and decides what the plan owes. Same document, opposite ends of the transaction. If your question is "did we get paid," you want billing software. If it is "should we pay this," you want claims processing software. We wrote the full breakdown in payer-side vs. provider-side health claims software.
Adjudication is the decision step — the rules engine that prices a claim and applies cost-sharing. Processing is the whole lifecycle around it: intake, eligibility, the adjudication decision, remittance, provider payment, and reporting. Claimaro does all of it in one platform. If you want the detail on the decision itself, that is the claims adjudication engine.
Yes, natively. 837 claim intake, 835 remittance generation, and eligibility transactions, with clearinghouse connectivity built into the platform rather than sold as a separate module or a middleware contract. Paper and portal-entered claims land in the same queue as EDI claims.
The organizations that hold the risk on the medical spend: self-funded employers, health sharing ministries, and small-to-mid TPAs administering plans for clients. It is not built for enterprise carrier IT estates, and it is not provider-side revenue cycle software.
Claimaro is published, flat pricing: from $3,500/month + $5 PMPM with a $15,000 setup, and zero per-claim fees. Much of this market prices per claim processed, which makes the cost of processing rise with your volume — the one line item worth pinning down in writing with any vendor you evaluate.
Book a 20-minute demo and we'll process real claims from your plan — intake to remittance — so you can see the whole lifecycle rather than a feature list. Or see how Claimaro compares to the incumbent claims platforms.