MediClaims - 2026 Pricing, Features, Reviews & Alternatives

MediClaims is a claims management software that helps organizations manage claims processing across several healthcare sectors, including medical, dental, vision, disability, prescription drugs, and consumer-driven healthcare. It enables supervisors to streamline benefit administration processes for flexible spending accounts (FSA), Health Reimbursement Arrangements (HRA), and Health Savings Accounts (HSA).

MediClaims allows staff members to handle claim pre-certifications, track referrals, process payments, manage capitation, and track agent commissions on a centralized platform. The compliance management module lets business leaders manage operations related to W-2 forms and electronic filing, HIPAA EDI compliance tracking, 835 RARC code mapping, PCORI and transitional reporting, and more. It also enables administrators to define user roles and configure access rights, restricting individuals from viewing and updating specific information.

Healthcare organizations can utilize the built-in electronic data interchange (EDI) capabilities to send and receive information, such as accumulator data, provider files, claims, and eligibility details. With the web-based user portals, clients can automate enrollment, registration, call tracking, and other benefit or claims management processes.