Epic EHR users need RCM software that seamlessly integrates with Epic's clinical workflows while delivering superior collection rates and automation. This guide compares seven top RCM platforms, ENTER, Waystar, R1 RCM, Optum, Oracle Health, Availity, and Change Healthcare across integration capabilities, pricing, automation features, and ideal use cases to help Epic users maximize revenue cycle performance.

Why Epic Users Need Specialized RCM Software

Epic Systems serves 41.3% of U.S. hospitals and 43.92% of ambulatory practices, making it the dominant EHR platform in healthcare. While Epic includes native revenue cycle tools (Resolute Billing, Cadence Scheduling), many organizations choose third-party RCM software for:

Key Reasons to Supplement Epic's Native RCM

• Higher collection rates: Specialized RCM platforms achieve 90-99.6% of contract value vs. 75-85% with Epic-only workflows
• Advanced automation: AI-powered claim scrubbing, denial management, and payment posting reduce manual work by 40-60%
• Lower total cost: Third-party RCM can cost 30-50% less than Epic's full Resolute implementation
• Faster implementation: Modern platforms deploy in 40-90 days vs. 6-12 months for Epic RCM modules
• Specialty-specific features: Tailored workflows for radiology, cardiology, oncology, and other specialties

The global RCM market is projected to reach $105.35 billion by 2030, with Epic integration capabilities becoming a critical selection criterion.

Evaluation Criteria for Epic-Compatible RCM Software

When comparing RCM platforms for Epic environments, assess these key factors:

1. Integration Method

• FHIR APIs: Modern, cost-effective, real-time (requires Epic 2018+)
• HL7 Interfaces: Comprehensive data access but expensive licensing ($50K-$200K annually)
• Custom REST APIs: Flexible, real-time, avoid HL7 fees

2. Epic IT Burden

• Low: Pre-built App Orchard integrations requiring minimal Epic configuration
• Medium: Custom integrations needing Epic endpoint setup
• High: Complex HL7 interfaces requiring Chronicles queries and Bridges configuration

3. Automation Capabilities

• AI-powered claim generation and scrubbing
• Automated payment posting (ERA and EOB)
• Predictive denial management
• Real-time eligibility verification

4. Pricing Model

• Per-provider monthly fees
• Percentage of collections
• Transaction-based pricing
• Flat monthly subscription

5. Implementation Timeline

• Fast: 30-60 days
• Standard: 60-90 days
• Extended: 90-180 days

Top 7 RCM Software for Epic Users: Quick Comparison

1. ENTER: AI-First RCM Platform

Overview

ENTER is an AI-powered revenue cycle management platform that delivers end-to-end automation from claim creation to payment posting. The platform integrates with Epic via custom REST APIs, eliminating expensive HL7 licensing fees while providing real-time data synchronization.

Epic Integration Approach

• Method: Custom REST APIs built specifically for Epic's data structures
• Epic IT Burden: Low—ENTER handles integration development and maintenance
• Timeline: 40 days from contract to full automation
• Cost: No HL7 licensing fees; integration included in platform pricing
• Epic Version Support: All versions (2015+)

Key Features for Epic Users

• claimAI: Builds perfect claims automatically using Epic encounter data, real-time eligibility, and proprietary scrubbers
• paymentAI: Posts payments in seconds from ERAs and EOBs with automatic contract reconciliation
• denialAI: 0% leakage with programmatic payer follow-up and AI-assisted investigation
• contractAI: Manages fee-for-service, value-based care, and workers comp contracts
• EHR Connect: Pulls all billing data and documents once Epic encounter is locked

Performance Metrics

• Collection Rate: 99.6% of contract value (vs. 68% industry average)
• Payment Posting Speed: Seconds (vs. 5 days industry average)
• Denial Rate: <5% with 100% follow-up
• Implementation: 40 days to full automation

Pricing

• Custom pricing based on practice size and volume
• No per-provider fees—scales with collections
• Integration costs included (no separate HL7 fees)

Best For

• Organizations seeking maximum automation with minimal Epic IT involvement
• Practices frustrated with slow payment posting and high denial rates
• Health systems wanting to eliminate HL7 licensing costs
• Epic users ready to fully automate revenue cycle (not hybrid models)

Pros & Cons

Pros:

• Industry-leading collection rate (99.6% of contract value)
• Fastest implementation timeline (40 days)
• No HL7 licensing fees
• Real-time payment posting and denial management
• Transparent, cloud-based reporting dashboard

Cons:

• Newer market entrant (less brand recognition)
• Custom pricing requires sales consultation
• Best suited for full automation (limited manual override options)

2. Waystar: Revenue Cycle Technology Platform

Overview

Waystar (formerly Navicure and ZirMed) provides a comprehensive revenue cycle technology platform with Epic-certified integration via App Orchard. The platform emphasizes denial management, prior authorization automation, and patient financial engagement.

Epic Integration Approach

• Method: HL7 interfaces + FHIR APIs (App Orchard certified)
• Epic IT Burden: Medium—requires Epic Bridges configuration
• Timeline: 60-90 days for full deployment
• Cost: HL7 licensing fees apply ($50K-$150K annually)
• Epic Version Support: 2015+

Key Features for Epic Users

• Predictive denial management with AI-powered root cause analysis
• Prior authorization workflow automation
• Patient cost estimation and payment plans
• Claims and remittance processing
• Real-time eligibility verification

Performance Metrics

• Collection Rate: 92-95% of contract value
• Denial Prevention: 15-25% reduction in preventable denials
• Prior Auth Approval Rate: 90%+ first-pass approval
• Implementation: 60-90 days

Pricing

• Per-transaction fees (typically $0.75-$2.50 per claim)
• Monthly subscription options for larger organizations
• Separate fees for patient engagement modules

Best For

• Mid-sized to large Epic practices (20+ providers)
• Organizations with high prior authorization volume
• Health systems needing patient financial engagement tools
• Practices prioritizing denial prevention over full automation

Pros & Cons

Pros:

• Epic-certified App Orchard integration
• Strong denial analytics and prevention
• Comprehensive patient engagement features
• Proven track record with Epic users

Cons:

• HL7 licensing fees add significant cost
• Per-transaction pricing can be expensive for high-volume practices
• Requires Epic IT involvement for HL7 setup
• Less comprehensive automation than AI-first platforms

3. R1 RCM: Enterprise Revenue Cycle Outsourcing

Overview

R1 RCM is a full-service revenue cycle management company with $2.46 billion in annual revenue, serving large hospitals and health systems. R1 provides end-to-end RCM outsourcing with dedicated Epic integration teams.

Epic Integration Approach

• Method: HL7 interfaces (full-service model includes integration management)
• Epic IT Burden: Medium—R1 manages most integration tasks but requires Epic access
• Timeline: 180+ days for enterprise implementations
• Cost: HL7 licensing included in service fees
• Epic Version Support: All versions

Key Features for Epic Users

• End-to-end RCM outsourcing (patient access, coding, billing, collections)
• Dedicated Epic integration and optimization team
• Revenue integrity and compliance monitoring
• Patient financial services and call center
• Advanced analytics and benchmarking

Performance Metrics

• Collection Rate: 90-94% of contract value
• Cost Reduction: Up to 15% reduction in cost to collect
• Revenue Improvement: 1-3% revenue lift
• Implementation: 6-12 months for full deployment

Pricing

• $420-$1,300 per provider per month
• Volume discounts for large health systems
• Long-term contracts (typically 3-5 years)

Best For

• Large hospitals and health systems (100+ providers)
• Organizations wanting to fully outsource RCM operations
• Epic users with complex revenue cycle needs
• Enterprises with dedicated RCM budgets

Pros & Cons

Pros:

• Comprehensive outsourcing reduces internal staffing needs
• Proven success with large Epic implementations
• Dedicated account management and support
• Strong payer relationships and revenue recovery

Cons:

• Expensive ($420-$1,300/provider/month)
• Long implementation timelines (6-12 months)
• Customer service concerns reported by smaller clients
• Multi-year contracts limit flexibility

4. Optum: AI-First Enterprise RCM

Overview

Optum, a UnitedHealth Group company, launched its AI-first RCM platform in May 2025, targeting large health systems with deep payer integration and predictive analytics.

Epic Integration Approach

• Method: HL7 interfaces + proprietary payer connections
• Epic IT Burden: High—requires extensive Epic configuration
• Timeline: 90-180 days for enterprise deployments
• Cost: HL7 licensing fees apply
• Epic Version Support: 2018+ (FHIR-enabled versions preferred)

Key Features for Epic Users

• AI-driven claims optimization and denial prediction
• Direct payer connectivity (especially UnitedHealthcare)
• Revenue integrity and compliance monitoring
• Population health integration
• Advanced analytics and benchmarking

Performance Metrics

• Collection Rate: 91-95% of contract value
• Denial Prevention: 20-30% reduction with predictive AI
• UHC Claims: 98%+ acceptance rate for UnitedHealthcare
• Implementation: 90-180 days

Pricing

• Custom enterprise pricing (typically $500K+ annual contracts)
• Volume-based discounts for large health systems
• Implementation costs: $100K-$500K

Best For

• Large Epic health systems (100+ providers)
• Organizations with significant UnitedHealthcare volume
• Enterprises requiring deep analytics and population health integration
• Health systems prioritizing AI-powered automation

Pros & Cons

Pros:

• Strongest payer relationships (especially UHC)
• Advanced AI and predictive analytics
• Comprehensive population health capabilities
• Proven enterprise scalability

Cons:

• Prohibitively expensive for small to mid-sized practices
• Long implementation timelines
• Requires dedicated IT and RCM staff
• Less flexible for independent practices

5. Oracle Health (Cerner): Unified EHR + RCM

Overview

Oracle Health (formerly Cerner) offers an integrated EHR and RCM platform with 21.8% hospital market share. While not an Epic integration partner, Oracle Health is included as an alternative for organizations considering EHR consolidation.

Epic Integration Approach

• Method: N/A—Oracle Health is a competing EHR platform
• Migration Path: Epic-to-Cerner EHR migration required
• Timeline: 12-24 months for full EHR + RCM migration
• Cost: $1M+ for large implementations

Key Features for Epic Users Considering Migration

• Native EHR-RCM integration (no third-party interfaces)
• Enterprise revenue cycle management
• Contract management and compliance
• Patient accounting and billing
• Cloud-based infrastructure with AI roadmap

Performance Metrics

• Collection Rate: 88-93% of contract value
• Integration Overhead: Zero (native platform)
• Implementation: 12-24 months for EHR + RCM

Pricing

• Custom enterprise pricing ($1M+ implementations)
• Bundled EHR + RCM pricing available
• Ongoing maintenance: 15-20% annually

Best For

• Organizations unhappy with Epic and considering EHR switch
• Large health systems wanting unified clinical-financial platform
• Enterprises with dedicated IT departments

Pros & Cons

Pros:

• Seamless EHR-RCM integration eliminates data silos
• Proven scalability for large health systems
• Strong compliance and security features
• Comprehensive training and support

Cons:

• Requires Epic-to-Cerner migration (not integration)
• Extremely high cost and long timelines
• Less flexible than best-of-breed RCM platforms
• Lower collection rates than specialized RCM vendors

6. Availity: Epic-Certified Clearinghouse

Overview

Availity is a healthcare clearinghouse with Epic-certified integration via App Orchard, providing claims processing, eligibility verification, and payer enrollment services.

Epic Integration Approach

• Method: HL7 + FHIR APIs (App Orchard certified)
• Epic IT Burden: Low—pre-built integration reduces configuration
• Timeline: 30-60 days for clearinghouse setup
• Cost: HL7 licensing fees may apply depending on data volume
• Epic Version Support: 2015+

Key Features for Epic Users

• Real-time eligibility verification
• Claims submission and tracking
• Denial management and appeals
• Patient payment portal
• Payer enrollment services

Performance Metrics

• Claim Acceptance Rate: 95%+ first-pass acceptance
• Eligibility Response Time: <3 seconds
• Payer Network: 2,000+ payers connected
• Implementation: 30-60 days

Pricing

• Transaction-based ($0.50-$2.00 per claim)
• Monthly subscription options for high-volume users
• Additional fees for patient payment processing

Best For

• Epic practices needing clearinghouse services
• Organizations wanting real-time eligibility verification
• Practices with straightforward billing needs (not complex denials)
• Health systems with Epic IT support for HL7 setup

Pros & Cons

Pros:

• Epic-certified App Orchard integration
• Fast implementation (30-60 days)
• Transparent transaction-based pricing
• Extensive payer network

Cons:

• Limited automation compared to full RCM platforms
• HL7 fees for high-volume data exchange
• Requires supplemental tools for complete RCM
• Less comprehensive denial management

7. Change Healthcare: Network Connectivity Leader

Overview

Change Healthcare provides revenue cycle technology and network connectivity services, including claims processing, remittance management, and payment solutions for Epic users.

Epic Integration Approach

• Method: HL7 interfaces + FHIR APIs
• Epic IT Burden: Medium—requires Epic Bridges configuration
• Timeline: 60-90 days for full deployment
• Cost: HL7 licensing fees apply
• Epic Version Support: 2015+

Key Features for Epic Users

• Claims submission and tracking
• Remittance processing and payment posting
• Denial and appeals management
• Patient payment solutions
• Revenue cycle analytics

Performance Metrics

• Claim Acceptance Rate: 93-96% first-pass acceptance
• Payment Posting: 2-3 days for automated posting
• Network Reach: Largest payer network in U.S.
• Implementation: 60-90 days

Pricing

• Per-transaction fees (typically $0.75-$2.00 per claim)
• Monthly subscription for larger organizations
• Additional fees for analytics and patient engagement

Best For

• Epic practices needing broad payer connectivity
• Organizations with high claim volumes
• Health systems wanting network-based solutions
• Practices prioritizing claims processing speed

Pros & Cons

Pros:

• Largest payer network in healthcare
• Proven reliability and uptime
• Comprehensive claims processing
• Strong remittance and payment capabilities

Cons:

• HL7 licensing fees add cost
• Less automation than AI-first platforms
• Requires Epic IT involvement
• Per-transaction pricing can be expensive

How to Choose the Best RCM Software for Your Epic Environment

Step 1: Assess Your Current Performance

Calculate these baseline metrics:

• Current collection rate (% of contract value collected)
• Average A/R days
• Initial claim denial rate
• Payment posting time (days from remittance to posting)
• Cost to collect (RCM cost ÷ total collections)

Identify top pain points:

• High denial rates (>10%)
• Slow payment posting (>3 days)
• Manual data entry consumes staff time
• HL7 licensing costs
• Epic IT resource constraints

Step 2: Define Your Integration Requirements

Epic version and modules:

• Epic version (2015, 2018, 2020, etc.)
• Modules implemented (Resolute, Cadence, Beaker, etc.)
• Current integration infrastructure (HL7 Bridges, FHIR endpoints)

Data requirements:

• Real-time vs. batch data synchronization
• Specific data elements needed (demographics, charges, clinical notes)
• Bi-directional data flow (RCM → Epic for payment posting)

Epic IT capacity:

• Availability for integration projects (current backlog)
• HL7 licensing budget
• Preference for low-touch vs. collaborative integrations

Step 3: Evaluate Total Cost of Ownership

3-Year TCO Calculation:

Example: Practice with $10M annual charges, improving the collection rate from 85% to 95%:

• Revenue improvement: $1M annually
• Platform cost: $200K annually
• Net benefit: $800K annually (400% ROI)

Step 4: Request Demos and Validate Claims

Demo checklist:

✅ Live demonstration with your Epic data (not generic demos)

✅ Integration walkthrough (how data flows from Epic to RCM platform)

✅ Exception handling (how the platform handles errors, missing data)

✅ Reporting and analytics capabilities

✅ User interface for billing staff

Validation questions:

• Request customer references using the same Epic version
• Ask for performance guarantees (collection rate, denial rate)
• Review contract terms (length, termination clauses, price escalation)
• Understand implementation timeline and resource requirements

Step 5: Pilot Before Full Deployment

Pilot approach:

• Start with a single department or specialty
• Run parallel with existing RCM for 30-60 days
• Measure key metrics (collection rate, denial rate, staff time)
• Gather user feedback from billing staff

Success criteria:

• Collection rate improvement of 5-10%
• Denial rate reduction of 20-30%
• Staff time savings of 30-50%
• Positive user experience ratings

Epic-RCM Integration Best Practices

1. Engage Epic IT Early

Schedule initial meetings 3-6 months before planned go-live to understand Epic's integration approval process, timelines, and resource availability.

2. Prioritize Data Quality

Audit Epic data before integration—clean up duplicate patients, invalid insurance, and incomplete encounters to ensure smooth data flow.

3. Plan for Epic Upgrades

Epic releases major updates twice yearly (May and November). Test RCM integrations after each upgrade and build regression testing into workflows.

4. Establish Governance

Create a joint Epic-RCM governance committee with representatives from Epic IT, billing, compliance, and the RCM vendor to resolve issues quickly.

5. Monitor Integration Health

Track integration performance metrics weekly (data sync success rate, claim submission time, error rates) and conduct quarterly reviews.

Frequently Asked Questions

What is the best RCM software for Epic users?

The best RCM software depends on your priorities:

• Maximum automation: ENTER (99.6% collection rate, 40-day implementation)
• Denial management: Waystar (predictive AI, prior auth automation)
• Full outsourcing: R1 RCM (end-to-end service, dedicated teams)
• Enterprise scale: Optum (AI-first, deep payer integration)
• Clearinghouse needs: Availity (Epic-certified, fast implementation)

How much does RCM software cost for Epic users?

Pricing varies by platform and practice size:

• Transaction-based: $0.50-$2.50 per claim (Availity, Change Healthcare)
• Per-provider: $300-$1,300/provider/month (Tebra, R1 RCM)
• Custom enterprise: $500K-$2M+ annually (Optum, Oracle Health)
• Volume-based: Custom pricing scaling with collections (ENTER)

Add HL7 licensing fees ($50K-$200K annually) if using HL7 integration method.

Can I avoid HL7 licensing fees with Epic?

Yes, modern platforms like ENTER use custom REST APIs or FHIR to integrate with Epic without HL7 licensing fees, saving $50K-$200K annually.

How long does Epic-RCM integration take?

Integration timelines vary by platform:

• Fast: 30-60 days (Availity, ENTER)
• Standard: 60-90 days (Waystar, Change Healthcare)
• Extended: 90-180+ days (R1 RCM, Optum, Oracle Health)

Do I need Epic IT team involvement?

Yes, but the level varies:

• Minimal: Pre-built App Orchard integrations (Availity, Waystar)
• Moderate: Custom REST APIs (ENTER)
• Extensive: HL7 interfaces (R1 RCM, Optum)

Choose vendors with Epic integration expertise to minimize Epic IT burden.

Conclusion

Choosing the right RCM software for your Epic environment requires balancing integration capabilities, automation features, cost, and implementation complexity. With Epic commanding over 40% market share, selecting an RCM partner with proven Epic integration expertise is critical to revenue cycle success.

Key Takeaways:

• ENTER delivers industry-leading automation (99.6% collection rate) with custom Epic integration in 40 days
• Waystar excels at denial management and prior authorization for mid-sized Epic practices
• R1 RCM provides full-service outsourcing for large health systems willing to invest in long implementations
• Optum offers enterprise-grade AI and payer integration for large Epic users
• Availity provides fast, cost-effective clearinghouse services for straightforward billing needs

Ready to Optimize Your Epic-RCM Integration?

The right RCM platform can improve collection rates by 10-30%, reduce A/R days by 15-25%, and free up staff time for higher-value activities. Modern AI-powered platforms like ENTER deliver these results in 40 days with minimal Epic IT burden, while traditional solutions may require 6-12 months and significant ongoing costs.

Next Steps:

1. Calculate your current collection rate and cost to collect
2. Identify your top 3 revenue cycle pain points
3. Request demos from 2-3 platforms matching your practice profile
4. Validate claims with customer references using similar Epic versions
5. Pilot with a single department before full deployment

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