Per-claim pricing is uncommon at the core DME software layer. Most DME/HME platforms (including Brightree and NikoHealth) price on a flat monthly platform fee or a percentage-of-collections model rather than charging per submitted claim. Per-claim fees show up more often one layer down, at the clearinghouse or outsourced-billing-service level, where vendors are pricing pure transaction volume rather than a full operations platform.
Flat monthly platform fee
A flat-fee model charges a set monthly amount tied to users, locations, or modules rather than claim count. This is the default structure for full DME/HME platforms because the software is doing far more than claims submission — inventory, intake, delivery, and resupply are bundled in. Budgeting is predictable, and the fee doesn’t spike during a high-volume month or a seasonal resupply push.
Percentage-of-collections pricing
Some vendors, particularly those pairing software with outsourced billing services, price as a percentage of what’s actually collected rather than what’s billed. This aligns vendor incentives with provider cash flow, since the vendor is paid on net collections, not gross claim volume. It also means costs scale down automatically during slow periods, which per-claim or flat-fee models don’t do.
Per-claim and per-transaction fees
True per-claim pricing is most common among clearinghouses and standalone medical billing services, where fees of roughly $2 to $10 per claim (or $0.35 to $1.00 for simple transactions) are typical, according to industry billing-cost research. For a DME provider processing thousands of claims monthly, an uncapped per-claim structure can become more expensive than a flat platform fee once volume climbs — worth modeling out before committing to either structure.
Comparing the three models
Pricing model | How it’s typically structured | Best fit |
Flat monthly platform fee | Fixed cost by user/location/module, independent of claim volume | Full HME/DME platforms like NikoHealth and Brightree |
Percentage of collections | Fee scales with net collections, not gross claims billed | Providers pairing software with outsourced RCM services |
Per-claim / per-transaction | $2–$10 per claim submitted, sometimes lower for simple transactions | Clearinghouses and standalone billing services, not full platforms |
Before signing, ask any vendor to walk through their model against your actual claim volume rather than a sample scenario — the same question we recommend in our billing software evaluation guide. Automation depth also affects real cost more than the pricing label does — see how DME billing automation reduces the manual touchpoints that drive per-claim costs up in the first place.
