What eProvider Solutions does

eProvider Solutions is a US-based healthcare clearinghouse and revenue cycle management (RCM) technology provider founded in 2005 by BJ Dvorak and headquartered in Orlando, Florida (with operations tied to a South Dakota area code, 605). The company operates an all-payer, all-purpose EDI platform that serves US healthcare practices ranging from single-provider family practice offices to large multi-hospital health systems. Its core product is eClaims, an internet-based claims processing and management platform that submits and tracks each claim from initial transmission to final payment, supplemented by eDirect (stand-alone claims submission), ClaimStaker (clinical claim scrubbing using a 30+ year proprietary medical necessity database), DataPort (multi-format claim conversion between Print Image, 4010, and 5010 ANSI X12), and IQ Eligibility (real-time eligibility verification across 450+ payers). Patient-facing modules include eStatements, Automated Communications, and Payment Manager, while EDI Boost and General Consulting provide hands-on billing office optimization and revenue recovery services.

Name

eProvider Solutions

Legal name

E PROVIDER SOLUTIONS, L.L.C.

Website

https://eprovidersolutions.com

Company type

Private

Founded year

2005

Operating status

Operating

Headcount range

11–50 employees

Short description

eProvider Solutions is a US healthcare clearinghouse founded in 2005 that provides all-payer EDI claims processing, eligibility verification, clinical claim scrubbing, and patient billing tools to small practices through multi-hospital health systems.

Ownership category

akta.pro rank

Product category

Healthcare Claims Processing & EDI Clearinghouse

NAICS

Software Publishers (5132)

SIC

Services-Prepackaged Software (7372)

akta.pro primary industry

Claims Management, Scrubbing & Clearinghouse (HLACACAB)

akta.pro secondary industry

Healthcare Billing & Patient Payments Presentment (FSAMAJAH)

Keywords

• Healthcare claims processing
• EDI clearinghouse services
• Medical billing software
• Insurance eligibility verification
• Revenue cycle management

Headquarters

HQ city

Sioux Falls

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Software

Cost components

Personnel, Technology or R&D, Operations, Marketing or Sales

Revenue model

1. EDI Transaction Services: Processing fees for EDI transactions including claim submission, eligibility verification, and claim status queries. Revenue generated through transaction volume with healthcare practices as the primary customers.
2. Software Subscription Services: Monthly subscription fees for cloud-based claims management software (eClaims), eligibility verification (IQ Eligibility), and other SaaS products. Includes free updates for ANSI version changes and payer requirement updates.
3. EDI Boost Consulting: Hands-on, tailored short-term consulting service to solve billing office problems. Four-step approach including issue identification, recommendations, progress tracking, and follow-up training.
4. General Consulting Services: Consulting services ranging from software selection guidance to large-scale revenue recovery analysis for healthcare networks. Expertise in claims processing, revenue cycle management, and healthcare transactions.
5. Patient Statement Services: Print and mail service for patient statements with online payment integration, digital print-image viewing, and automated communication services.

Pricing tiers

Go-to-market motion2 records

Distribution channels3 records

Marketing channels4 records

Core offering

eProvider Solutions sells web-based electronic claims processing, clinical claim scrubbing, multi-format claim conversion, and real-time insurance eligibility verification software to U.S. healthcare practices of all sizes. Core revenue is driven by recurring subscriptions to its eClaims platform and the EDI Transactions Suite, supplemented by per-transaction processing fees and professional services such as EDI Boost optimization and general consulting.

Product overview

eProvider Solutions offers a diversified suite of healthcare revenue cycle management solutions built around EDI transactions and claims processing. The core platform is eClaims, an internet-based claims processing and management system that integrates with multiple add-on modules including eDirect (stand-alone claims submission), ClaimStaker (clinical claim scrubbing), DataPort (format conversion between 4010/5010), IQ Eligibility (real-time eligibility verification across 450+ payers), and EDI Boost (billing office optimization). Patient-facing services include eStatements (print/mail with online payment), Automated Communications, and Payment Manager. The company was founded in 2005 and provides all solutions with free updates to maintain compliance with changing healthcare standards and payer requirements.

Differentiator

Problem solved

Functional benefit

Products and services

• eClaims Internet-based all-payer claims processing and management platform that accepts ANSI, NSF, and HCFA print image files, submits and tracks each claim from initial transmission to final payment, and integrates with eligibility checking, claim scrubbing, and patient statement services for healthcare practices.
• eDirect Stand-alone web-based claims submission solution with full claim tracking and reporting that accepts Print Image, NSF, and ANSI formats, functioning as a pass-through clearinghouse replacement without full claims management software.
• ClaimStaker Clinical claim scrubbing software that edits professional and institutional claims from the payer's perspective using a proprietary medical necessity database with 30+ years of clinical edits and standard LCD/NCD coverage rules for ICD-9 and ICD-10/CPT code combinations.
• DataPort Multi-format claim conversion tool that converts claims up or down into Print Image, 4010, and 5010 ANSI X12 formats with HIPAA compliance documentation and unlimited file conversions for a $49.95 monthly fee plus a one-time setup charge.
• IQ Eligibility Real-time insurance eligibility and benefit verification service providing access to over 450 commercial and government payers, returning effective dates, benefit caps, copayments, deductibles, and other coverage information in an easy-to-read format.
• EDI Boost Tailored short-term billing office support service using a 4-step approach (identify issues, recommend solutions, track progress, recurring follow-up) to optimize revenue capture and address claim processing inefficiencies.
• eStatements Patient statement printing and mailing service with online payment integration, email statement options with automatic paper fallback for bounced emails, digital print-image viewing, and a patient portal for online payments.
• Automated Communications Patient communication automation service supporting text, email, and call formats with appointment confirmation, reminder scheduling, and practice notification capabilities.
• Payment Manager Centralized payment management system for point-of-service payments, online payments, mailed checks, and phone payments, with recurring payment plan setup capabilities.
• General Consulting Healthcare claims processing consulting services covering software selection, standards transitions (including ICD-10), and revenue capture optimization for professional providers, institutional providers, healthcare networks, payers, and government agencies.
• EOB to ERA Services (LockBox) Service converting paper EOBs received by mail to electronic remittance advice (ERA) format with automatic posting into practice management software and integration with the eClaims platform.
• ICD-10 Transition Consulting and support service to assist healthcare providers with the ICD-10 code set transition, ensuring smooth compliance with the regulatory change.

Named customers4 records

Segments4 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature5 records

Partnerships

Two partnerships are on record, tiered minor and core.

• Various Healthcare OrganizationsminorOthersThe company works with and/or belongs to various healthcare industry organizations. Logos are displayed but specific organization names are not detailed in the source content.
• 450+ Insurance PayerscoreTechnology or IntegrationDirect payer connections for real-time eligibility verification, claims submission, and ERA processing. Payer list includes commercial and government payers, updated monthly. The company maintains direct EDI connections with payers and builds positive relationships with insurance companies.

Scale indicators5 records

Recent moves6 records

Expansion highlights4 records

Direct peers

• Waystar: Direct clearinghouse and RCM platform competitor formed via Navicure + ZirMed combination, covering claims management, eligibility, and patient payments for healthcare providers — overlapping product suite and customer base with EPS.
• Availity: Healthcare clearinghouse operating a multi-payer network for eligibility, claims, and clinical data exchange — directly competes with EPS's IQ Eligibility and eClaims offerings.
• Office Ally: Healthcare clearinghouse and practice management vendor offering claims submission, scrubbing, and eligibility to small and mid-sized practices — closely matched to EPS in segment and product scope.
• Quadax: Mid-sized healthcare clearinghouse and RCM technology provider focused on claims processing, eligibility, and remittance for hospitals and physician practices — directly comparable to EPS's product set.
• HealthPac: Long-standing healthcare clearinghouse providing claims processing, statement printing, and RCM software to physician practices and billing services — comparable in scale, age, and target customer to EPS.

Broad incumbents

• Change Healthcare (Optum): Largest US clearinghouse and RCM provider, now part of Optum/UnitedHealth Group; competes head-to-head with EPS across claims, eligibility, and remittance workflows at much greater scale.
• Trizetto (Cognizant): Established healthcare claims processing and payer administration platform within Cognizant; offers clearinghouse and RCM solutions comparable to EPS's eClaims/eDirect.
• Experian Health: Healthcare division of Experian providing eligibility verification, claims management, and patient access solutions — overlapping with EPS's IQ Eligibility and broader RCM suite.

Emerging players

• Infinx: Healthcare RCM and prior authorization automation vendor combining AI-enabled workflows with clearinghouse-like capabilities; emerging competitor addressing some of the same provider pain points as EPS.
• Claim.MD: Modern web-based clearinghouse offering claims submission, eligibility, and remittance at competitive pricing — directly competes with EPS in the small-to-mid-practice segment with a newer technology stack.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about eProvider Solutions