Comparing Top RCM & Prior Authorization Solutions
Revenue Cycle Management (RCM) and prior authorizations (PA) are critical yet challenging areas for healthcare providers. From the perspective of a CFO, practice manager, or revenue cycle director, choosing the right solution can greatly impact financial health and efficiency. In this post, we compare our unified RCM + electronic prior auth platform against leading alternatives in the market. We’ll look at both broad end-to-end RCM systems and specialized PA/automation solutions, highlighting their strengths, limitations, and ideal use cases – and why our platform offers a compelling choice for many provider organizations.
Solution Categories in RCM and Prior Auth
General RCM Platforms: These are comprehensive systems handling the entire billing cycle – patient access (eligibility, estimation), claims submission, payment posting, denials management, reporting, and more. Examples include Waystar ([1]), R1 RCM ([2]), and Experian Health ([3]). They are widely used by hospitals and practices to manage revenue cycles end-to-end, often integrating with or as part of EHR systems.
Specialized Automation & PA Solutions: These focus on automating specific RCM processes (especially prior authorizations) and often layer on top of existing systems. Examples include Rhyme (formerly PriorAuthNow) ([4]), Infinx ([5]), and AKASA ([6]). They excel at streamlining prior auth workflows (and sometimes other RCM tasks like coding or status checks) using AI, robotic process automation (RPA), and integration with payers and EHRs.
Our Platform – Unified RCM + ePA: We built our solution to bridge both worlds – providing end-to-end RCM functionality with built-in prior authorization automation. It’s essentially a full RCM platform (like the first category) that also natively automates prior auth (like the second category), powered by modern AI and seamless integration. The goal is to eliminate manual work across the board: coding, claims submission, error scrubbing, denial handling, and prior auth requests all in one system.
Before diving deeper into each vendor, the comparison table below provides a quick overview:
| Solution | Type | RCM Coverage | Prior Auth Handling | Ideal For |
|---|---|---|---|---|
| Waystar | Cloud RCM Platform (SaaS) | End-to-end suite: eligibility, claims, payments, denials, analytics | Authorization Manager automates PA submissions & status tracking | Providers of all sizes needing comprehensive, EHR-integrated RCM |
| R1 RCM | RCM Outsourcing Service | Full-cycle RCM services (technology + staff) | PAs handled within outsourced workflow by R1 team/tools | Large hospitals/health systems wanting to outsource RCM operations |
| Experian Health | RCM Software Suite | End-to-end modules; top-ranked clearinghouse; strong denials/contract mgmt | Automated PA determination, submission, and tracking | Enterprise providers needing a robust, data-driven suite |
| Rhyme (PriorAuthNow) | Prior Auth Network (SaaS) | Narrow (PA only); not a billing system | Purpose-built EHR-integrated PA submissions with real-time status | Orgs with heavy PA volume wanting best-of-breed inside existing EHR |
| Infinx | RCM Automation + Services | Patient Access Plus (eligibility, estimates, PA) + coding/billing/A/R options | AI-driven PA with electronic submission & status; specialists for exceptions | Mid-sized providers/specialty groups wanting automation + optional services |
| AKASA | AI Automation for RCM | Targeted modules (coding assist, claim status, auth status) that overlay existing systems | Auth Status + Authorization Advisor (AI + human-in-loop) | Large systems augmenting existing EHR RCM with AI (not replacing it) |
| Foresight (Unified RCM + ePA) | Unified RCM Software (SaaS) | End-to-end automation: AI coding suggestions, rules-based pre-bill edits, 837P submit, 277CA listen, 835/ERA posting, denial playbooks | Native ePA: determine need, pre-fill from chart with provenance, submit, track, policy-based retries; can gate Rx/claim until approval | Telemedicine & specialty clinics; small–mid providers needing one system to automate RCM and ePA; also works as a bolt-on for gaps |
(Sources: Vendor websites and industry reports. See footnote links for details on each platform.)
Deep Dive: Vendor-by-Vendor Comparison
Below we discuss each solution in more detail, including what they offer and how they compare to our approach.
Waystar – Wide-Reaching RCM Platform
Waystar is one of the most widely-used RCM software platforms, known for its cloud-based end-to-end solution covering eligibility checks, claims management, payments, denials, and reporting. It’s used across many provider types from small practices to large health systems[21]. Waystar’s platform is unified and emphasizes automation: it leverages AI-driven workflows to streamline payments and improve accuracy across the revenue cycle[1]. For example, it can automatically verify insurance, scrub claims for errors, manage electronic remits, and provide analytics – all within one system.
Prior Authorization: Waystar offers an Authorization Manager suite (recently including an “AuthAccelerate” feature) to overhaul the PA process[22]. This tool automates many steps of prior auth – verifying if an auth is needed, submitting requests electronically where possible, checking status updates, and alerting staff when intervention is required[23][24]. In short, Waystar doesn’t only handle claims; it recognizes PAs as a big pain point and provides workflow automation to ease that burden.
Why you’d choose Waystar: If you want a proven, full-featured RCM system that integrates with your EHR and has broad industry adoption, Waystar is a safe bet. It’s often the backbone clearinghouse for many EHR vendors and has a track record of reliability and scale. For organizations that prefer an all-in-one vendor and are comfortable with a traditional enterprise software setup, Waystar delivers comprehensive functionality (and has the client base to prove its credibility).
Considerations: Waystar’s breadth can also mean complexity. Implementing it across all RCM functions requires configuration of many modules and training for staff to use its dashboards. Smaller clinics might not need every feature, yet pricing is usually enterprise-level (and often quote-based). Additionally, while Waystar does have automation (RPA and some AI), the user experience might feel more like a classic enterprise system; our platform, in contrast, was designed with a modern UX and AI-first approach for specific tasks like coding suggestions and interactive denial playbooks. Also, Waystar’s prior auth capabilities, while strong, are part of a larger suite – whereas we built prior-auth into the core workflow, ensuring that, for example, a prescription can be automatically held until its auth is approved, and then instantly released (preventing unwitting denials). This kind of tight coupling between billing and PA is our focus.
R1 RCM – Outsourced RCM Services
R1 RCM takes a different approach: rather than just selling software, R1 becomes a full-service partner managing your revenue cycle operations. Hospitals and large clinics contract with R1 to handle everything from patient registration and coding to claims submission, collections, and even patient billing call centers. They bring their own technology and large teams of RCM experts. In fact, R1 RCM is working with 95 of the top 100 U.S. health systems[2], making it a leading choice for enterprise outsourcing. They’ve been recognized as the top-performing RCM outsourcing provider by industry surveys[25].
Prior Authorization: As part of their end-to-end service, R1 will manage prior authorizations on the provider’s behalf. This typically means R1 staff (often augmented by R1’s tech tools) will check requirements, submit auth requests, follow up with payers, and ensure auth numbers are in place for scheduled procedures. R1 has invested in AI as well – partnering with tools like Palantir’s AI platform for analytics[26] – but the core model is “we handle it for you.” From the provider’s perspective, much of the PA workflow becomes invisible; R1 aims to return an approved auth or resolved denial back to the hospital without the hospital’s own staff doing that work.
Why you’d choose R1: For very large, complex organizations, outsourcing can be appealing. R1 essentially allows a hospital C-suite to say, “take over our revenue cycle and run it better than we could.” They tout improvements in financial performance, cost reductions (through labor arbitrage and tech), and high quality – evidenced by high satisfaction in surveys[27]. If a health system is struggling with billing efficiency or wants to focus on core clinical operations, R1 can step in with a ready-made operation and economies of scale.
Considerations: The outsourcing model isn’t for everyone. Mid-size and small providers typically won’t find R1 viable – it’s geared to big contracts. Also, outsourcing means less direct control: you’re trusting a third party with your cash flow processes. Changes can be slower and tailored less, since R1 uses standardized processes for efficiency. In contrast, our platform is for organizations that want to retain control in-house but supercharge their team with automation. Rather than handing off your coding and billing to another company, our users keep a lean internal team that oversees the AI-driven workflows. This can preserve institutional knowledge and agility. So, if you have the resources to outsource entire departments, R1 is an option; if you prefer a software solution that augments your existing staff (and doesn’t require massive scale to justify), then a solution like ours or other software platforms makes more sense.
Experian Health – Enterprise RCM Suite with Strength in Claims
Experian Health (the healthcare arm of the well-known credit bureau Experian) offers a comprehensive suite of RCM solutions, and it’s particularly acclaimed for its claims management and clearinghouse services. In fact, Experian’s ClaimSource® system has been ranked #1 Best in KLAS in the Claims Management & Clearinghouse category for multiple years[4][5]. Experian Health also leads in Contract Management tools (for managing payer contracts and underpayments). Overall, they serve over 60% of U.S. hospitals and thousands of clinics/labs[3], making them one of the most prevalent RCM vendors in the hospital market.
Experian’s solutions span patient access (eligibility verification, insurance discovery, prior-auth checks), claims and denials, patient collections, and a variety of data-driven analytics. A hallmark of Experian’s approach is leveraging their vast data assets – e.g., credit data for patient propensity-to-pay, and robust payer data for claims and authorization rules. They also emphasize what they call a “Touchless Workflow™,” aiming to automate as many steps as possible without human intervention[28].
Prior Authorization: Experian offers an Automated Prior Authorization software solution that integrates into patient access workflows. It can determine if an auth is required for an order, based on payer rules and the procedure, and then either automatically submit the request through available electronic channels or guide staff through the submission. It also tracks auth status and brings back the approval information to the provider. Experian’s thought leadership highlights that automating PAs can reduce manual work and prevent downstream denials[6][29]. In 2025, with many new regulatory pushes for electronic prior auth, Experian has been positioning its tool as helping providers meet those mandates[30].
Why you’d choose Experian: For organizations that want top-tier clearinghouse performance and a full array of RCM capabilities, Experian is a strong contender. The fact that it’s KLAS-rated and used by many peers gives confidence. Their tools are especially powerful in claims denial prevention (they even introduced AI modules to predict and triage denials, getting clients to an average <4% denial rate, which is stellar[31]). If you already use some Experian products (for example, many hospitals use Experian for patient identity/eligibility checks or collections scoring), adopting their RCM suite can offer integration benefits.
Considerations: Experian’s platform is module-based – you might implement separate pieces like ClaimSource, Contract Manager, Patient Access tools, etc. Achieving a truly seamless flow might require significant IT integration work. Also, as an enterprise vendor, their solutions (and pricing) are often oriented towards large scale deployments. Smaller practices might find it too heavy-weight. In comparison, our solution is more pre-integrated – by design, the coding, auth, claim submission, and denial resolution features all work out-of-the-box in one system, with one implementation. We target a leaner deployment, focusing initially on niches like telehealth providers, specialty clinics, and others that may not have extensive IT departments to manage multiple vendors. Additionally, while Experian excels at automating within its modules, a provider might still need to connect the dots (e.g., ensure their EHR triggers the Experian PA check, and then separately manage claim submission if not using Experian for claims). Our approach was to have a unified workflow – for example, when a provider documents an order in the EHR, our system can simultaneously extract the coding for the claim and initiate the prior auth, and the claim won’t be submitted until the auth is confirmed (all handled automatically in sequence). This kind of tight coupling can reduce slip-ups like forgetting to obtain an auth. That said, for large health systems with complex needs and existing investments, Experian’s suite is a proven, data-rich option.
Rhyme (PriorAuthNow) – EHR-Integrated Prior Auth Network
Rhyme (formerly PriorAuthNow) is a specialist in prior authorization automation. Unlike full RCM companies, Rhyme’s sole mission is to make prior auth easier by connecting providers and payers. Think of Rhyme as a network or middleware: it integrates with the provider’s EHR on one side and with payer systems on the other side, acting as a conduit to submit and retrieve auth information.
The platform can automatically generate PA requests using the clinical data from the EHR, submit them electronically (or even via fax if a payer is old-school), and then bring back the auth status into the EHR. It provides real-time status updates and collaboration tools to manage any additional info requests. Essentially, Rhyme aims for a mostly hands-off prior auth: the provider’s staff might just review or address exceptions, while routine approvals go through “in the background.” According to a product overview, Rhyme uses intelligent workflows to optimize approval success and even flags cases eligible for gold-carding (where prior auth can be skipped due to history)[8].
Why you’d choose Rhyme: If prior authorizations are a major bottleneck – e.g., your clinics are constantly faxing forms or checking payer portals – Rhyme offers immediate relief. It is EHR-integrated, meaning users can often trigger and track auths from within their native system (Athena, Epic, Cerner, etc., as supported) without toggling to a separate interface. Large health systems with thousands of auths per month have adopted Rhyme to handle that volume efficiently. It’s a best-of-breed solution for PA management, which can complement whatever billing system you use for claims.
Considerations: Rhyme does not handle the rest of the revenue cycle. You’ll still need a claims clearinghouse or billing software for everything after the prior auth (claims submission, coding, payments, etc.). So it adds another vendor to your stack. For smaller practices, implementing and maintaining an additional integration (and paying for it) just for prior auth may or may not be worthwhile depending on auth volume. Our strategy with our platform is to incorporate prior auth into the overall RCM workflow so you don’t have to procure something separate. That means if you’re using us, you get a unified work queue where, for example, one encounter might show “claim ready to submit” and another encounter needs “prior auth approval” – all in one list – rather than juggling a billing system and a PA system.
Additionally, Rhyme’s effectiveness can depend on how many payers it has direct connections with – it strives to unite payers/providers, but if some payers aren’t on the network, it may fall back to robotic automation (screen-scraping portals or faxing). It’s still a huge improvement over fully manual processes, but it’s not magic for every single scenario. We acknowledge a similar reality: automating prior auth is complex, and while we have it built-in, some edge cases will still require human oversight. The key difference is in workflow cohesion – we ensure no auth-required service slips through without an auth, by linking it to our billing flow. If you already have a great billing system and just need PA help, Rhyme is a great choice. If you need an overhaul of your whole revenue cycle process (and don’t want to manage multiple tools), a unified solution like ours might be more appealing.
Infinx – AI-Powered Prior Auth + RCM Support
Infinx positions itself as both a technology provider and a services partner for revenue cycle. They offer a cloud platform called Patient Access Plus that tackles prior authorizations, insurance verification, and patient cost estimates (the front-end pieces of RCM)[32]. Infinx heavily emphasizes AI and automation in this platform – for instance, their Authorization Determination Engine automatically checks if an auth is needed for a given procedure and payer with over 98% accuracy by referencing payer guidelines[11]. Once a case is identified as needing prior auth, the system can auto-initiate the request electronically to many payers, perform continuous status follow-ups, and update both its own dashboard and the provider’s EHR with the results[12][13]. If a payer can’t accept electronic submissions or if the case is complex (e.g. requires clinical documents), Infinx can either hand it to the provider’s staff or – if the provider chooses – to Infinx’s in-house specialists to handle manually[33]. This hybrid “software + service” option means the provider’s team only deals with exceptions; Infinx’s team can serve as an extension to handle tedious work.
Beyond prior auth, Infinx also provides solutions for medical coding support, billing, A/R follow-up, and analytics[9][10]. In some cases, clients use Infinx as a one-stop-shop to automate front-end tasks and outsource back-end tasks like denial management. They market their approach as “digital agents” (automation bots) plus human experts, orchestrated together[34][35].
Why you’d choose Infinx: Flexibility and breadth. If you’re a radiology group, for example, dealing with heaps of imaging authorizations and also struggling with coding or A/R, Infinx can step in on multiple fronts. You can start with their PA software, and if your staff is overwhelmed, you can tap their service team to take over parts of the workflow. Infinx’s technology is quite advanced – the fact that it can submit PAs and follow up automatically means it’s not just telling your staff what to do, it’s doing it. They also tout high accuracy and adherence to turnaround times, leveraging integrations with payer systems (they have pre-built bots for specific payers like eviCore, Carelon, etc., which handle those payers’ nuances)[36][37].
Considerations: Infinx, as a company, often works with mid-sized to large organizations. For a small practice, their solutions might be overkill or priced accordingly. Also, using Infinx in its fullest capacity can start to resemble an outsourcing relationship (even though you’re buying software, once you add on their specialists handling your queues, it’s a bit like R1’s model but for specific tasks). Some organizations may hesitate to rely on an external team for something like authorization follow-ups due to concerns about communication or accountability. Culturally, it’s a different model than keeping everything in-house. With our platform, we’ve aimed to give you the automation tools so that your existing team can accomplish more with less effort, rather than providing a parallel workforce. It’s more of a DIY approach with a supercharged platform versus a concierge approach with Infinx.
Additionally, integrating Infinx’s outputs into your broader RCM process requires some coordination – e.g., ensuring authorization numbers from their system make it onto claims if you’re using a separate billing system. Since our system handles both sides, an auth approval automatically links to the claim in our interface without you doing extra integration work. Nonetheless, if a provider’s main pain is prior auth and they want a quick fix with heavy automation, Infinx’s module can be very attractive, and it can coexist with your current billing setup. It really shines in high-volume prior auth environments like imaging centers, where time to approval directly affects patient scheduling.
AKASA – AI-Driven Automation for the Modern Revenue Cycle
AKASA is a newer entrant (founded 2018) focusing on applying AI (especially generative AI) to revenue cycle tasks. Rather than offering a monolithic software suite, AKASA delivers targeted solutions that overlay onto existing systems. For example, their products include Coding (AI to suggest or even auto-assign medical codes), Claim Status (automating the checking of claim status with payers), and Auth Status (automating prior authorization status checks)[14][15]. They also have an “Authorization Advisor” that assists staff in submitting and following up on PAs within major EHRs[18]. Essentially, AKASA identifies labor-intensive, repetitive workflows in hospital revenue cycles and builds AI/ML-driven bots to take those over, always with an expert-in-the-loop philosophy (meaning if the AI is unsure or an exception arises, a human at AKASA intervenes to handle it, so the hospital staff doesn’t have to).
For prior auth specifically, AKASA’s Auth Status product stands out: it logs into payer portals like a human would (using RPA), checks the status of outstanding auth requests, interprets the results (using ML to read the portal messages), and then documents the status back in the system along with any notes or screenshots[16][17]. This saves staff from repeatedly checking websites or making calls just to see if an auth is approved yet. Their Authorization Advisor likely goes a step further by helping generate the initial auth request content (possibly using GenAI to extract relevant clinical info for the form). AKASA has case studies showing significant reduction in auth-related workload for health system clients by using these tools.
Why you’d choose AKASA: If you’re a large provider with a mature RCM operation (e.g., you use Epic or Cerner and have established processes), and you’re specifically looking to reduce manual work through AI, AKASA is a strong partner. You don’t have to replace any of your core systems – they integrate on top, so it’s less disruptive. CFOs and revenue cycle VPs at big health systems might choose AKASA to drive down costs and improve efficiency in targeted areas without waiting for their main IT vendors to deliver new automation. AKASA’s focus on generative AI is also a differentiator; for example, they’ve talked about using GenAI to draft appeal letters for denied claims automatically[38] – tasks that are currently very human-intensive.
Considerations: AKASA’s solutions are not standalone – you can’t use Auth Status if you don’t already have a system that’s submitting auths. It assumes you have, say, Epic’s auth module or a team doing that, and AKASA just takes over the checking/updating part. So for a provider that lacks any prior auth infrastructure, AKASA isn’t a full answer. It’s also largely aimed at hospitals and large clinics (their marketing references CFOs of health systems, and their integration with Epic/Cerner confirms that focus). If you’re a smaller provider without those systems, AKASA might not cater to you.
By contrast, our platform is a standalone system (albeit one that connects to your EHR). We designed it so that if you don’t have any fancy RCM software, we become your primary tool – handling everything from the point an encounter is documented to the point you get paid. We also use AI, but in a targeted way similar to AKASA’s ethos (for instance, using an LLM to read clinical notes and suggest diagnoses or to extract answers for auth forms). The difference is, we embed those capabilities directly into a unified workflow, whereas AKASA’s AI might operate in the background of someone else’s system.
For a large hospital that’s not going to rip out their Epic billing, AKASA makes total sense to incrementally automate. For a tech-forward smaller provider that wants a complete solution now, adopting our platform might leapfrog them to a highly automated state without needing multiple tools. In summary, AKASA is like a smart add-on brain for big RCM departments; our solution is like giving a smaller RCM team an entire “AI brain + muscle” in one package. Both approaches leverage AI to solve similar problems, but the scale and implementation differ.
Our Unified RCM & ePA Platform – Bringing It All Together
Finally, let’s talk about our platform (we’ll call it Foresight RCM for illustration). We’ve taken the approach of building a unified, AI-powered RCM system that inherently includes electronic prior authorization workflows. Here’s a recap of what it does and how it differs:
End-to-End RCM Automation: From the moment a provider finishes documenting a visit, our system can take over by extracting the relevant billing codes (ICD-10, CPT, HCPCS) from the clinical note. We use a combination of rules and AI: for straightforward scenarios we apply deterministic rules (ensuring all telehealth modifiers are present, for example, or matching diagnoses to treatments), and for more complex coding we use an AI engine to suggest codes with confidence scores, all while showing the source of each suggestion (e.g., “suggested ICD-10 G20.A1 – Parkinson’s disease, found in assessment line 1”[39][40]). This assists coders or billers rather than replacing their judgment, and it greatly speeds up the coding process.
Claim Scrubbing and Submission: Before a claim ever leaves our system, we perform pre-bill scrubbing using rule packs. These can catch issues earlier than a clearinghouse would – for instance, missing a required modifier or a mismatch between place-of-service and procedure (common with telehealth vs in-person coding)[41]. By intercepting errors upfront, we aim to raise the first-pass acceptance rate. Once a claim is clean, our platform submits it electronically (we connect either directly to clearinghouses or via standards like 837 files). Then our “Submit & Listen” engine literally listens for the electronic acknowledgment (277CA) from the payer – if the claim was rejected at clearinghouse or payer front-end, we flag that instantly and even attempt auto-corrections for certain common rejections[42][43]. For example, if the rejection says “pre-cert required” and we see there was no auth attached, we can automatically route that encounter into the prior auth workflow (instead of just denying outright)[44][45].
Denials Management: Our platform provides a worklist of denied claims with the CARC/RARC codes and reasons, and – here’s where we use AI + rules again – it suggests playbook actions to resolve each denial. For instance, if a claim was denied for “Place of service inconsistent with modifier,” the system might suggest “Change POS to 10 (home) and add Modifier 95, then resubmit”[46][45]. With one click, billers can apply the suggested fix and re-submit the corrected claim. Over time, the system learns which denial patterns are most frequent and can adjust the suggestions or even preempt them next time (continuous improvement).
Built-in Prior Authorization (ePA): Unlike most RCM platforms, we have a dedicated Prior Auth queue intertwined with the billing workflow. Our system knows, for each order or service, whether an auth is required (we integrate with insurance eligibility and authorization requirements data). If needed, it will initiate an electronic prior auth request. We pull the necessary info from the EHR – patient details, diagnosis, clinical notes, etc. – and even use our AI to answer clinical questionnaires in the auth form (with transparency, showing which answers came directly from rules vs which the AI inferred from the notes[47][20]). For example, if a question asks “Have other therapies been tried and failed?” our AI can scan the patient’s history and find that “Patient tried Medication X for 8 weeks” and fill that in, so the doctor doesn’t have to manually compile that history. The auth request is then submitted (via integration to payer ePA portals or EDI channels). Our system continuously checks the status – similar to AKASA or Infinx, we use automation to log into payer systems for updates. When the auth is approved, we update our encounter and it seamlessly links the authorization number to the claim. If denied, we can trigger an auto-resubmit policy or alert staff to intervene. We even allow for policy-based retries (e.g., try to submit to an alternative payer program if available, sequence A→B→C)[48][49]. Crucially, our platform can hold the claim or even the prescription until the auth is complete (ensuring compliance and no lost revenue)[49].
Analytics and Insights: Because all these processes live in one system, we provide unified analytics dashboards: you can see your first-pass acceptance rate, denial rate, average days from service to submission, and how prior auth is affecting those timelines. We break it down by program, payer, specialty, etc., to pinpoint bottlenecks[50][51]. For instance, maybe Cardiology claims have a lot of auth-related delays – our system will highlight that so you can address it. This level of insight across both claims and prior auth isn't easily attainable when those functions are split among different tools.
Why choose our platform: If the above sounds like a lot – it is! We built it to be a holistic solution for revenue cycle inefficiencies. The benefit to a provider is that you’re dealing with one vendor, one login, one source of truth for everything from coding to cash posting. The platform is modern (cloud-based, API-driven) and can integrate with your EHR to pull data or push updates (for example, writing back the auth number or claim status to the EHR so clinicians see when things are approved or paid).
For organizations that don’t have an end-to-end RCM setup or are currently doing many steps manually (perhaps using a basic billing software plus a lot of spreadsheets and payer portal logins), our solution can be transformative – reducing turnaround times from days to hours for claims submission, improving first-pass acceptance into the 90+% range, and cutting denial rates significantly (our demo targets show an average ~4-5% denial rate, comparable to industry best-in-class[52][53]). It especially shines for telehealth and multi-state practices where rules like telehealth billing, varying state licensure, and numerous payer policies add complexity – our rules engine handles those nuances, so providers get paid faster and with fewer back-and-forths.
Another reason to choose us is the cost-benefit: instead of paying for an EHR-integrated clearinghouse, a separate prior auth service, and perhaps extra staff or contractors for coding and billing, you invest in one platform that automates a large portion of that work. It’s like getting an RCM team augmented with “digital workers.” For a growing practice, this means you can scale your patient volume without linearly scaling your billing department.
Considerations: We are candid that for very large health systems with entrenched RCM systems, ripping and replacing everything with a newer platform may not be immediately feasible. Those organizations might instead look at us to fill specific gaps (for example, they could use just our prior auth automation alongside Epic). We can modularize our offering, but our real power is when used as a unified system. So, our sweet spot tends to be small-to-mid size provider organizations or new entities (like digital health startups, telehealth companies) that have the agility to adopt a fresh platform. They might not yet be locked into a big iron system, or they’re frustrated with the limitations of their current billing software. If you’re a sophisticated hospital that already has near-fully-optimized RCM processes, you might not see as dramatic a benefit (although even top hospitals struggle with prior auth and could use help there, as evidenced by all the interest in the other solutions we discussed!).
In summary, we’re proud to say our platform offers an all-in-one approach that covers the capabilities of many of the above vendors in a single package, with a focus on ease of use, intelligent automation, and unified workflow. We put a lot of emphasis on user experience – something a busy billing specialist or office manager would appreciate. Instead of jumping between systems for coding, claims, auth, and denials, it’s all right there, with AI highlighting what to do next.
Conclusion: Choosing the Right Solution for Your Needs
Selecting an RCM and prior authorization solution is not one-size-fits-all. Each of the options above has legitimate strengths:
If you want established, comprehensive RCM software and have the scale to support it, platforms like Waystar or Experian Health bring a broad feature set and proven track records. They’re especially suited for organizations that need enterprise reliability and are already integrated with those ecosystems.
If your organization’s strategy is to offload revenue cycle completely, then an outsourcing partner like R1 RCM might be appealing (albeit mainly for very large providers). It trades direct control for turnkey management and can leverage its expertise across many clients.
If prior authorization is your number one headache, a targeted solution like Rhyme can plug into your EHR and dramatically cut down the manual work for auths. Similarly, Infinx can rapidly automate PAs (and more) with the option to use their staff for tedious tasks – a great choice if you want quick wins in patient access and don’t mind a hybrid service model.
If you’re a big health system looking to inject AI automation into your existing processes, AKASA offers innovative tools that act as force-multipliers for your current team and systems. They shine when you already have volume and infrastructure, and you just need to make them smarter and more efficient.
Now, where does our platform fit in this landscape? We designed it for those who feel limited by legacy RCM solutions or disjointed processes, especially in small to medium-sized organizations. Our value proposition is giving you the best of both worlds – the breadth of a full RCM system and the depth of specialized automation (for prior auth, coding, and more) – without having to integrate and manage multiple vendors. It’s all truthful and transparent: we leverage the latest technology (yes, even GPT-type AI under the hood for reading notes and generating answers) but with guardrails to ensure compliance (we won’t, for example, ever auto-change a code to a higher level unless it’s validated; no “black box” upcoding risk).
If you are, say, a telemedicine clinic expanding nationwide, or a surgical group that wants to streamline billing across dozens of payers, or any provider that doesn’t want to spend 40% of your time on admin, we built this for you. By using our platform, clients can often avoid hiring additional billing staff as they grow, shorten their revenue cycle (meaning better cash flow), and reduce those aggravating claim denials and payment delays that plague healthcare finance. And importantly, it frees your team to focus on exceptions and complex cases, rather than shuffling paper for every single claim or auth.
In conclusion, all the solutions discussed aim to solve the core problem of getting providers paid faster and with less hassle – but they do so in different ways. We encourage you to consider factors like organization size, existing systems, pain points, and strategic goals:
· Do you want a fully outsourced approach, or do you prefer in-house control with the aid of software?
· Are you mainly trying to fix one part of the process (like PAs or denials), or do you need an overhaul of the entire revenue cycle workflow?
· How important is a unified system vs. best-of-breed components that you integrate?
By answering these questions, the right choice often becomes clearer. We’re confident that for many forward-thinking provider groups, our unified RCM + ePA platform will check all the boxes. It’s accurate and truthful in what it delivers – we won’t claim to magically eliminate 100% of manual work, but we genuinely automate a very large portion and provide tools to handle the rest efficiently. And we continuously improve with each denial and each new payer rule learned, so the system gets smarter over time.
Ultimately, the goal is to spend less time chasing codes and approvals, and more time on patient care (or simply have a smoother-running business!). Whether you choose a major incumbent or a new innovative platform like ours, we hope this comparison has given you a richer understanding of the options available. If you’re interested in seeing what our approach can do for your organization, we’d be happy to discuss it further – sometimes the best way to appreciate these differences is through a real demo tailored to your workflow. Here’s to a more efficient revenue cycle and fewer headaches on the road to getting paid.
[2]: R1 RCM – End-to-End Revenue Cycle Management (Outsourced Services)
[3]: Experian Health – Revenue Cycle Management Solutions
[4]: Rhyme (formerly PriorAuthNow) – Prior Authorization Automation Network
[5]: Infinx – Prior Authorization Solution with AI & Automation
[6]: AKASA – AI-powered Prior Authorization and RCM Automation Solutions*
