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In your search for revenue cycle management (RCM) solutions, you've likely encountered comprehensive, end-to-end RCM providers like Experian and Waystar. PMMC is another end-to-end RCM solution. For some healthcare organizations, adopting a single, integrated system for all revenue cycle management works best to boost efficiency, increase net revenue, and enhance employee and patient satisfaction.
However, you might hesitate to commit all your RCM processes to a single technology provider, wary of the potential drawbacks of such a comprehensive approach. This caution is understandable, given the diverse and complex nature of revenue cycle tasks.
Specialized RCM point solutions offer targeted technologies that address specific aspects or a limited set of revenue cycle functions, presenting an alternative to the all-encompassing approach of end-to-end RCM platforms. Healthcare providers that choose these more limited solutions tend to have RCM technology that they like in place. They’re simply looking to get a few additional tasks done.
Here, you can review exactly what PMMC and its alternatives offer and how they can help you improve revenue, streamline operations, and control costs to collect. As the healthcare industry modernizes via the adoption of advanced technology, choosing between end-to-end or point solutions should be your first step.
What is PMMC and what markets does it serve?
PMMC was established in 1986 and provides comprehensive RCM AI- and automation-driven solutions to hospitals and health systems, academic physician organizations, and multi-specialty physician groups.
PMMC solutions aim to improve the financial performance of these healthcare organizations. Their solutions support various aspects of revenue cycle management, including:
- identifying underpayments and denials
- increasing price transparency
- managing bundled payments
- contract management
- payment verification
- cost accounting
- financial decision support
As of today, PMMC serves over 550 hospitals and health systems nationwide. The company's long-standing presence in the healthcare industry, coupled with its focus on accurate reimbursement calculations and data-driven insights, has contributed to its 40-year track record of providing healthcare revenue cycle management.
The PMMC product suite includes:
Contract Management
- Contract PRO: a contract management solution that enables accurate reimbursement calculations and contract modeling for improved payer negotiations.
- Estimator PRO: an advanced tool for generating accurate patient cost estimates, enhancing pricing transparency and patient engagement.
Pricing Transparency
- Charge PRO: a strategic pricing solution that helps hospitals set competitive rates and understand the impact on contracts and net patient revenue. While primarily a pricing tool, Charge PRO also assists in managing and optimizing the hospital chargemaster for strategic pricing decisions.
- Consumer PRO: a patient-facing tool that provides accurate out-of-pocket cost estimates, meeting CMS requirements for price transparency.
Managed Care
- Revenue PRO: an integrated platform for revenue cycle management and managed care, driving financial improvement across the revenue cycle.
- Value PRO: a solution designed to support healthcare providers in the transition to value-based reimbursement models.
These products collectively form PMMC's Revenue Maturity Matrix, an integrated approach to revenue cycle management that addresses contract governance, payer negotiations, pricing transparency, and value-based reimbursement. As an end-to-end RCM solution for hospitals and health systems, it provides a comprehensive approach to RCM.
The company's solutions are built on a highly accurate calculation engine, which is core to all their offerings and ensures precise reimbursement from all payers.
Despite its 40-year history as an RCM platform, PMMC does not have reviews on the online platforms at this time.
List of top 5 PMMC alternatives
- MD Clarity
- Experian
- Trizetto
- R1 RCM
- Change Healthcare
A contract management and patient payment estimate expert
MD Clarity
Description
MD Clarity helps healthcare organizations amplify revenue, improve their negotiation position, monitor contracts, and cut costs. Launched over 10 years ago, it has built its solutions from the ground up to document and parse all contract details. Contract management and patient payment experts, MD Clarity counts some of the largest American healthcare systems among its clients.
Contract management
MD Clarity's RevFind is a sophisticated contract management and marketing platform designed for complex healthcare environments. This tool streamlines contract centralization, analysis, task management, and reporting processes, making it indispensable for large provider groups and management services organizations that operate across multiple locations and states.
A key RevFind differentiator is its hands-on approach to contract uploading. By handling this task themselves, they significantly reduce the administrative burden on their clients.
RevFind's reporting capabilities include:
- payer contract performance measurement
- payer ranking based on true value derived
- comprehensive underpayment identification
- denial identification
- revenue forecast
- payer mix analysis
- operating and total margin reports
The platform's underpayment detection feature automatically compares actual payer reimbursements against contracted rates. It generates detailed revenue cycle reports that equip staff with the necessary information to address discrepancies with payers efficiently.
RevFind's analytical prowess extends to breaking down underpayments by various factors like payer, CPT code, provider, location, and combinations of these factors. This granular analysis reveals significant revenue opportunities for healthcare providers, allowing them to optimize their revenue cycle management strategies.
RevFind uncovers significant revenue opportunities, even achieving underpayment identification of $10 million or more.
Patient payment or good faith estimates
MD Clarity's patient payment estimate platform Clarity Flow has become particularly valuable in light of the No Surprises Act of 2022, which requires healthcare providers to furnish good faith estimates for self-paying and uninsured patients.
Clarity Flow automates several key functions previously handled by revenue cycle management (RCM) staff:
- eligibility verification through clearinghouses
- patient-specific benefit checks
- creation of customized estimate letters
- automatic estimate delivery upon appointment scheduling
- tracking of care deposit collections
- direct transfer of collected funds to the provider's account
This automation significantly reduces staff workload, allowing them to focus on more complex cases that require a personal touch. By automating eligibility verification and estimate generation, Clarity Flow helps healthcare organizations streamline their operations and improve efficiency.
Complex estimates that require staff review go to the provider for manual processing. A high level of automation in eligibility verification and estimate generation alleviates the operational burden on healthcare organizations and makes additional hires unnecessary.
MD Clarity features in common with PMMC
Both MD Clarity and PMMC offer contract management and modeling solutions, upfront patient payment estimates, and compliance solutions. Both platforms also provide tools for forecasting to support healthcare organizations' financial planning.
Differences between MD Clarity and PMMC
While MD Clarity and PMMC both offer contract management and modeling and patient payment estimates, MD Clarity is a point solution and PMMC is an end-to-end platform. PMMC offers A/R collections, population health and pricing tools among other products.
As a point solution, MD Clarity products offer thorough expertise and service on just contract management and modeling and patient payment estimates. As mentioned above, end-to-end solutions work on all the points in the revenue cycle, but superficially. MD Clarity began its journey determined to get accurate care cost estimates to patients and fair payer reimbursements to providers. It updates its software constantly to make sure to meet those two goals. Further, PMMC focuses on the large hospital and healthcare system markets while MD Clarity mostly serves physician groups and management services organizations (MSOs).
Take a quick, self-guided tour through MD Clarity’s powerful contract management and underpayments identification tool, RevFind:
Ratings
Recently, Built-In recognized MD Clarity as a Best Place to Work. MD Clarity also made Inc. Magazine’s 2024 list of the 5000 fastest-growing private companies in America.
G2 reviewers have given MD Clarity an average of 4.2 / 5 stars from 31 reviews.
A PMMC competitor with a respected clearinghouse
Experian
Description
Experian Revenue Cycle Management Solutions offers a comprehensive suite of services catering to hospitals, health systems, physician groups, pharmacies, diagnostic services, and payers. An end-to-end platform, their solutions span the entire revenue cycle, addressing crucial front-end tasks such as eligibility verification, scheduling, and patient estimates, while also automating and optimizing back-end processes like accounts receivable and claims management.
The platform's revenue cycle optimization solution integrates multiple data streams to create a unified thread for reporting and analysis, enabling actionable insights. Through its analytics and reporting capabilities, Experian provides executives with essential data to drive process improvements.
Experian's claims management and clearinghouse software, ClaimSource, has gained recognition for its automated and scalable approach to reducing denials and increasing revenue. Unlike some competitors, Experian's solution adopts a fully automated system. It does not use onshore or offshore specialists for coding, processing prior authorizations, or other revenue cycle tasks.
Experian’s main products are:
- Claims Management and Clearinghouse: This product automates claims workflows and improves healthcare claims management processes, streamlining the entire billing cycle.
- Contract Management: This solution audits payer compliance against contract terms to maximize revenue, addressing issues of missed payments and underpayments that can stress the revenue cycle.
- Collections Optimization Manager: Used by organizations like Stanford's Operations team, this tool reduces the cost to collect and automates processes such as bad debt assignments and charitable write-offs.
- Coverage Discovery: This product helps healthcare providers find coverage for patients who appear to be self-pay or uninsured at the point of pre-service, as demonstrated by Essentia Health's success in finding coverage for 67% of such accounts.
- Patient Access Solutions: While not explicitly named, Experian offers tools to strengthen the revenue cycle process by ensuring correct patient information on the front end, reducing errors that cause rework in the back office.
- Healthcare Revenue Cycle Analytics: This business intelligence tool analyzes, tracks, and optimizes revenue cycle management, providing insights into performance, identifying revenue leakage, and monitoring key performance indicators.
Differences between PMMC and Experian
While both PMMC and Experian offer revenue cycle management (RCM) solutions for healthcare providers, PMMC is a more specialized, focused player in the RCM market. Experian is part of a larger, global data analytics and consumer credit reporting company, potentially offering more resources and a broader scope of services.
The differences between their approaches and offerings are:
Market Focus
PMMC primarily serves hospitals and health systems, with a focus on contract management and patient estimation. On the other hand, Experian serves a broader market including hospitals, health systems, physician groups, pharmacies, diagnostic services, and payers.
Product Specialization
PMMC emphasizes contract governance and payer negotiations as the foundation of their RCM strategy. Experian offers a wider range of RCM solutions, including claims management, patient access, and analytics.
Technology
PMMC provides an integrated RCM software platform that aims to break down departmental silos. Experian focuses on cloud-based solutions and emphasizes the integration of advanced AI and data analytics in their tools.
These differences highlight how PMMC and Experian cater to different needs within the healthcare RCM market, with PMMC focusing more on contract-centric solutions for hospitals and Experian offering a broader suite of RCM tools across various healthcare segments.
Ratings
Experian Revenue Cycle Management Solutions has no public reviews at this time.
A PMMC competitor with a broad market
Trizetto Provider Solutions
Description
Like PMMC, TriZetto Provider Solutions offers a comprehensive or end-to-end suite of revenue cycle management (RCM) solutions. Founded in 1984 as Gateway EDI, TriZetto Provider Solutions distinguishes itself in the healthcare technology market through several key factors. Its comprehensive integration approach combines finance, operations, customer care, and claims management, offering a holistic solution for healthcare management. The scalability of TriZetto's EDI transaction management allows payers to maintain their unique trading partner governance while TriZetto manages provider connectivity.
The RCM company doesn’t name individual products but covers the following revenue cycle areas under the Trizetto Provider Solutions umbrella.
- Claims Management: Accelerates payment and reduces administrative burdens.
- Patient Engagement: Clear explanations of amounts owed and convenient digital payment options.
- Rejection & Denials Management: AI-powered denial defense and automated eligibility checks.
- Revenue Cycle Management: Revenue cycle process and cost optimization.
- Credentialing: Automated platform that centralizes document storage and management.
- Analytics: Web-based analytics to help improve cash flow and drive revenue
- NextGen Integration: Strategic alignment with NextGen to provide complete revenue cycle management solutions across various specialties.
Similarities between PMMC and Trizetto Provider Solutions
Both PMMC and Trizetto Provider are end-to-end RCM solutions offering a comprehensive suite of services. Beyond this commonality, both companies:
- Focus on accuracy: TriZetto Provider Solutions aims for high claims acceptance rates, while PMMC emphasizes contract accuracy, both striving to maximize revenue for healthcare providers.
- Data analytics capabilities: Both platforms provide advanced analytics and reporting tools.
- Contract management: Both companies provide solutions for managing and optimizing payer contracts, including modeling and negotiation tools.
- Long-standing industry presence: Both companies have been in the healthcare space for decades.
- Value-based reimbursement support: Both platforms offer solutions to help healthcare providers adapt to alternative payment models and value-based care initiatives.
Differences between PMMC and Trizetto Provider Solutions
One of the few differences between TriZetto Provider Solutions and PMMC is that Trizetto serves a broader range of healthcare organizations, including hospitals, health systems, physician practices, and payers. PMMC, on the other hand, focuses primarily on hospitals and health systems.
In addition, TriZetto Provider Solutions emphasizes comprehensive revenue cycle management solutions, where PMMC's core competency is centered around payer contract management and negotiations. PMMC prioritizes contract negotiations.
Ratings
Trizetto Provider Solutions has earned a 4.3 / 5 rating on G2 from 13 reviewers.
A PMMC alternative with an offshore workforce
R1 RCM
Description
R1 RCM was initially established as Accretive Health in 2003 and re-branded as R1 RCM in 2017. Now a leading RCM company based in Salt Lake City, Utah, R1 RCM’s primary market is hospitals and healthcare systems.
Similarities between PMMC and R1 RCM
TriZetto Provider Solutions and PMMC are both end-to-end RCM platforms, offering a comprehensive suite of services. They also share these features:
- focus on accuracy
- data analytics capabilities
- price transparency solutions
- contract management and modeling
- long-standing industry presence
- large client bases
- value-based reimbursement support
These similarities demonstrate that both TriZetto Provider Solutions and PMMC are comprehensive, data-driven RCM platforms designed to address the complex financial needs of modern healthcare organizations.
Differences between PMMC and R1 RCM solutions
While both companies are end-to-end solutions, they have some significant differences.
R1 RCM serves hospitals, health systems, and physician groups. In contrast, PMMC primarily caters to hospitals and health systems and has a smaller client base. R1 RCM extensively utilizes offshore workers, primarily in India. In contrast, while PMMC uses some offshore workers as is common in the industry, it does not advertise an offshore workforce or strategy. PMMC focuses more on contract management and pricing transparency software rather than a human workforce.
The scope of services also differs between the two companies. R1 RCM provides a more comprehensive suite of revenue cycle management services, encompassing patient access, charge capture and coding, claims management, denial management, and revenue cycle analytics. While PMMC also offers RCM solutions, their focus appears to be more concentrated on contract management and pricing transparency tools.
Ratings
R1 RCM has one review with a rating of 0/5 stars on G2.
A PMMC competitor focused closely on contracts
Change Healthcare / Optum
Description
Founded in 2007, Change Healthcare is a leading healthcare technology company that provides a comprehensive, end-to-end suite of solutions for revenue cycle management, payment management, and health information exchange. Headquartered in Nashville, Tennessee, the company has grown through acquisitions and mergers to become a major player in the healthcare technology sector. On October 3, 2022, UnitedHealth Group's Optum division acquired Change Healthcare.
Change Healthcare was hit by a ransomware attack from the BlackCat/ALPHV group in February 2024, which exploited vulnerabilities in the company's network security. The attack has cost UnitedHealth Group, Change Healthcare's parent company, $2.457 billion as of October 2024 and affected approximately 100 million individuals' data, making it the largest healthcare data breach in U.S. history. The security breach significantly disrupted healthcare services across the country, with many providers unable to process claims, verify patient eligibility, or receive payments, leading to widespread financial strain and, in some cases, limited patient access to care.
Change Healthcare's key differentiator is that it operates the largest financial and administrative information exchange (or clearinghouse) in the United States, processing about 15 billion medical claims each year ( 40% of all claims in the U.S.) Its offerings include software and analytics, network solutions, and technology-enabled services, all designed to improve operational efficiency, clinical decision-making, and patient outcomes.
Similarities between PMMC and Change Healthcare
Both PMMC and Change Healthcare emphasize their ability to determine accurate reimbursement, boasting a high contract accuracy rate. Similarly, both leverage advanced technology, including artificial intelligence and machine learning, to improve financial performance and reduce revenue leakage for healthcare organizations.
Differences between PMMC and Change Healthcare
With 550 hospital and health system clients, PMMC can be considered large but Change Healthcare is far larger. The biggest difference between the two is the range of services. Change Healthcare offers a broader range of services, including clinical decision support and health information exchange, in addition to revenue cycle management. PMMC, on the other hand, has a more specialized focus on revenue cycle management, contract governance, and pricing transparency, without the same extent of clinical and health information services.
In addition, Change Healthcare heavily emphasizes advanced technologies such as artificial intelligence, machine learning, and cloud-based solutions. PMMC, on the other hand, focuses more on its calculation engine for accurate reimbursement and contract management.
Reviewers have given Change Healthcare a rating of 3.9 / 5 on G2.
How MD Clarity’s contract management & modeling solution optimizes your revenue
PMMC and its competitors provide end-to-end RCM platforms that modernize hospitals and health systems so that more can access transparent, affordable, and convenient care. Still, if you’re happy with your current technology that manages individual aspects of your revenue cycle, a bolt-on or point solution will deliver more accuracy at a lower cost.
MD Clarity's RevFind is an automated contract management solution that streamlines the entire contract lifecycle. It compares every payment coming into the payer rates and terms in your contracts. Should a difference arise, you can quickly notify payers and recoup that revenue. By digitizing and centralizing agreements, RevFind accesses the data that reveals contract performance, ranking payers from highest to lowest on items like payment accuracy, timeliness, and overall hassle factor.
By generating automated reports, RevFind empowers healthcare providers to address current pricing discrepancies and prevent future underpayments, maximizing revenue and maintaining fair pricing.
Interested in seeing firsthand how MD Clarity stacks against PMMC? Schedule a demo today!
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