6 Best Tennr Alternatives in 2026

1. Flexbone AI, Best for the Full Back-Office AI Stack

Flexbone is an AI ops platform purpose-built for outpatient back-office work. Where Tennr is strongest at referral and document intake, Flexbone runs the full back-office stack: prior authorization, eligibility verification, denials and appeals, and inbound and outbound voice. The delivery model is forward-deployed, so every workflow ships against the customer's specific EHR build, payer mix, and operational SOPs rather than off a generic catalog.

Best For

Specialty groups, ASCs, SNFs, MSOs, and BPOs that need more than referral automation. Strongest fit when the buyer wants one vendor across PA, eligibility, denials, and the phone, and when the EHR mix includes Tebra, athenahealth, eClinicalWorks, NextGen, ModMed, PointClickCare, Dentrix, or HST.

Key Features

• Prior authorization automation that submits to payer portals, fax, and phone. Agents handle medical, procedural, and DME PA, with built-in policy retrieval and exception routing.
• Eligibility verification (EVOB) unifies 270/271 EDI, payer portals, IVR, and manual inputs into one record. Returns patient responsibility with contracted-rate math, not just plan-level benefits.
• Denials and appeals ingests denial letters, extracts denial codes, classifies them against payer policy, and pushes corrected claims and appeals back to clearinghouses.
• Voice agents for inbound intake and outbound payer calls. Voice Room analyzes 100 percent of recorded calls instead of the 1 to 5 percent sample most QA teams reach.
• EHR coverage: 16+ documented integrations including ASC and SNF systems many AI vendors skip. Forward-deployed engineers ship per-EHR builds rather than asking customers to wire APIs themselves.

Strengths

• Single vendor across PA, eligibility, denials, and voice means one BAA, one data model, and one escalation queue rather than four.
• Forward-deployed engineering shortens the deployment for non-Epic shops. A typical first workflow goes live in 2 to 6 weeks.
• Zero-retention security architecture: PHI flows through the pipeline and is not retained for model training. This passes compliance review faster than long-retention competitors.
• EHR depth on the outpatient stack: Tebra, athenahealth, eClinicalWorks, NextGen, ModMed, PointClickCare, Dentrix, HST, SIS, and more.

Limitations

• Flexbone does not sell into health plans. If your buyer is a payer UM team, Cohere Health is a better starting point.
• Public health-system reference counts are smaller than Notable's or Tennr's largest accounts. Buyers needing dozens of named IDN logos before signing should ask for the customer list during qualification.
• Flexbone is not an ambient clinical scribe. Documentation AI requires a separate tool.

Pricing

Custom, scoped to workflows and volume. Customers commonly report mid-to-high six-figure annual savings on staff hours and recovered denials. Contact the team for a written quote.

Honest Take

Flexbone is on this list because it covers four workflows that buyers shopping Tennr typically stitch from two or three other vendors. If your only pain is faxed referrals and document ingestion, Tennr is the more specialized tool and the right starting point. If your pain includes the staff hours that follow intake (eligibility checks, PA submissions, denial appeals, payer hold time on the phone), Flexbone is the single-vendor consolidation play. The honest test is whether your CFO is signing for one back-office vendor or four; if it is one, this is the section to read closely.

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2. Notable Health, Best for Large Medical Groups Standardizing Intake

Notable Health is one of the established AI platforms in ambulatory healthcare. It started in patient intake and has expanded into scheduling, registration, and select revenue-cycle workflows. The buyer tends to be a large medical group or health system that wants a unified intake-to-registration platform across many sites and is willing to invest in a longer enterprise rollout.

Best For

Multi-specialty medical groups, IDNs, and large ambulatory networks that need to standardize patient intake and registration across dozens of sites. Strongest when the buyer already runs Epic ambulatory or athenahealth and has internal IT capacity to support the integration.

Key Features

• Intake and registration workflows with branded digital forms, ID and insurance card capture, and patient self-service.
• Scheduling automation including waitlist management, slot optimization, and reminder cascades.
• Revenue-cycle modules covering eligibility, estimation, and patient financial communications.
• Voice agents for inbound calls in select specialties.
• Reporting and analytics across the patient access funnel.

Strengths

• Mature platform with named multi-site deployments at large medical groups.
• End-to-end coverage from first patient touch through registration on a single platform.
• Deep Epic ambulatory and athenahealth experience.

Limitations

• Targets larger medical groups; smaller specialty practices and ASCs often find the enterprise-SI motion heavy.
• Less visible in eClinicalWorks, NextGen, ModMed, Tebra, PointClickCare, and Dentrix shops.
• Coverage of payer-side workflows (PA submission to portals, denial appeals) is thinner than Flexbone or the dedicated RCM agent vendors.

Pricing

Custom enterprise pricing. Typically multi-year contracts with implementation services. Demo and statement of work required.

Honest Take

Notable wins when the buyer is a multi-specialty IDN or a large medical group with internal IT capacity and a multi-year roadmap. It loses when the buyer is a single specialty practice, a small ASC, an SNF, or a dental DSO that needs a workflow live in six weeks. If you read three sentences into Notable's customer page and recognize the named accounts as bigger than you, that is a signal to evaluate Flexbone, Tennr, or Adonis instead. None of that means Notable is the wrong tool; it just means it is sized for a specific buyer.

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3. Cohere Health, Best for Health Plans Automating Utilization Management

Cohere Health is the most-cited name in payer-side prior authorization. The platform is used by health plans to ingest provider PA requests, apply clinical-evidence policies, and either auto-approve, route to clinical review, or return for more information. The buyer is typically a payer or a payer-affiliated entity rather than a provider group.

Best For

Health plans, payer-affiliated UM organizations, and risk-bearing provider entities (delegated UM, full-risk ACOs) that need to industrialize PA review.

Key Features

• Clinical-evidence-driven PA decisioning with payer-configurable policy modules.
• Auto-approval and exception routing for cases that require nurse or physician review.
• Specialty coverage including musculoskeletal, cardiology, oncology, sleep, and others depending on the payer rollout.
• Integration with payer claims systems and provider-facing portals.
• Reporting on turnaround time, approval rates, and policy adherence.

Strengths

• Production deployments at named health plans, including Humana and Geisinger Health Plan, give the platform real operational exposure.
• Strong clinical-evidence library and physician-led policy design.
• Reduces provider abrasion when a payer rolls Cohere in to replace older UM vendors.

Limitations

• Cohere is on the wrong side of the PA transaction for most provider buyers. If your team submits PAs to payers, Cohere is what the payer uses to review your request; it is not the tool that automates your submission.
• Provider groups looking for help filling out and tracking PA on the practice side should evaluate Flexbone, SamaCare, or Tennr instead.

Pricing

Enterprise contracts with health plans. Not sold to provider groups in the same SKU. Pricing is custom and not publicly published.

Honest Take

Cohere shows up in provider conversations because the name sounds like a PA tool. It is a PA tool, but it sits on the payer side of the fax line, not the practice side. The fastest way to disqualify Cohere from a provider RFP is to ask the sales team for a provider customer running PA submissions on the platform. If the answer is "we do not sell that way," you have your answer. Provider buyers should focus on Flexbone, Tennr, SamaCare (for drugs), or Adonis (for the broader RCM layer).

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4. SamaCare, Best for Drug-PA in Specialty Practices

SamaCare is a focused medical-benefit prior authorization platform. The platform centralizes drug-PA workflow across infusions, biologics, and specialty pharmacy use cases. The business model is pharma-subsidized, which is why SamaCare can offer the platform free to practices. Earlier public funding includes a $17M round, though that figure should be treated as potentially stale (pre-2025 source).

Best For

Specialty practices that submit a high volume of medical-benefit drug-PA: oncology infusion, rheumatology biologics, neurology, GI, ophthalmology, and dermatology. Strongest where the buyer is the practice's drug-access or specialty pharmacy coordinator.

Key Features

• PA submission and tracking across payer portals for medical-benefit drugs.
• Policy templates by drug, indication, and payer.
• Drug-PA-specific reporting on approval rates, turnaround time, and denial reasons.
• Free practice tier subsidized by pharma manufacturer partnerships, including a distribution partnership with AmerisourceBergen announced in 2023 (potentially stale).

Strengths

• Free to the practice for in-scope drug-PA workflows. The price tag is hard to argue with on the use case it covers.
• Deep specialization in drug-PA: policy templates, manufacturer co-pay programs, and payer-specific quirks are pre-built.
• Adoption inside specialty practices on the drug-PA workflow is high because the staff who do this work full-time recognize the platform.

Limitations

• Drug-PA only. Procedural PA, DME PA, eligibility, denials, and voice are out of scope.
• Pharma-subsidized model means the platform is steered toward use cases that map to manufacturer partnerships. Practices with a payer mix that does not align may see less coverage.
• Standalone web app rather than embedded in the EHR. Practice staff move between systems.

Pricing

Free to the practice for in-scope medical-benefit drug-PA. Pharma-funded.

Honest Take

"Free" is a strong wedge, and SamaCare deserves credit for building a platform that practices actually use. The catch is scope. If your PA workload is 80 percent drugs and 20 percent everything else, SamaCare plus a manual fallback on the rest works. If your PA workload is split across procedures, imaging, DME, and drugs, you will end up running two systems and tracking two queues. Most growing groups eventually consolidate; Flexbone is the consolidation play when that moment arrives.

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5. Adonis, Best for Agentic RCM Across Claims and Denials

Adonis is an AI orchestration platform for revenue cycle. Founded as an RCM analytics platform, Adonis layered agentic AI on top for claims, eligibility, and denials. The company closed a $40M Series C in 2026 (PR Newswire, 2026) and reported 4x year-over-year revenue growth (Yahoo Finance, 2026). The buyer is usually a CFO, VP of RCM, or director of revenue cycle at a growth-stage medical group, MSO, or specialty network.

Best For

Mid-market and growth-stage outpatient groups standing up RCM AI for the first time, and CFOs who want one platform to track AR, claims, eligibility, and denials with agents working the backlog.

Key Features

• Claims agents that submit, track, and rework claims across clearinghouses.
• Eligibility agents that run 270/271 checks and confirm patient responsibility.
• Denial agents that classify denials, draft appeals, and route to humans where needed.
• Underlying RCM analytics layer with AR aging, payer-mix dashboards, and bad-debt forecasting.
• EHR coverage on Epic, athenahealth, Tebra, NextGen, eClinicalWorks, and others.

Strengths

• Strong analytics foundation under the agents. CFOs see the financial impact in the same UI that runs the workflow.
• Recent $40M Series C funds engineering capacity and roadmap velocity.
• EHR integration breadth is solid across the outpatient stack.

Limitations

• Voice and intake are out of scope. Buyers needing inbound or outbound call automation pair Adonis with another tool.
• Prior authorization is lighter than eligibility and denials in the marketing surface area.
• "AI orchestration" positioning can hide where the deterministic work ends and the human queue begins. Ask for the exception-handling SLAs.

Pricing

Custom. Some modules priced as percent-of-recovery; others as flat platform fees. See the side-by-side.

Honest Take

Adonis is a credible choice for groups whose center of gravity is the CFO's office. The analytics surface is honest about where money is leaking, and the agents address the largest leaks first. The trade-off is that voice and PA submission are not the focus. If your front desk pain (calls, scheduling, intake) outweighs your back-office AR pain, you will outgrow Adonis as a single vendor. If AR is the dominant pain, Adonis or Thoughtful AI both deliver.

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6. Thoughtful AI, Best for ROI-Guaranteed RCM Agent Personas

Thoughtful AI sells RCM automation as named "AI employees" rather than as a generic platform. EVA handles eligibility, CAM handles claims and authorizations, and PHIL handles payment posting. The pitch leans hard on an ROI guarantee structure that ties price to outcomes. The company is frequently named in 2026 agentic-RCM roundups alongside Adonis and the larger health-system platforms.

Best For

Multi-location practices and growing groups that prefer a packaged AI employee per workflow over a flexible platform. Strongest when the buyer wants written ROI commitments tied to a specific workflow.

Key Features

• EVA, CAM, and PHIL: pre-built agents for eligibility, claims and authorizations, and payment posting.
• ROI-guarantee contract structures that tie pricing to measurable outcomes.
• EHR coverage including Epic, athenahealth, eClinicalWorks, NextGen, and others.
• Dashboard reporting on agent productivity per workflow.

Strengths

• The "named agent" framing makes ROI conversations concrete. CFOs respond well to "EVA does X, CAM does Y."
• ROI-guarantee language reduces buyer risk, particularly for first-time AI adopters.
• Pre-built agents shorten the discovery phase compared with custom-built workflows.

Limitations

• Productized agents are less flexible when your workflow differs from the catalog. Buyers with non-standard payer mixes or unusual fee schedules sometimes hit the edges.
• Voice and intake are not the focus.
• ROI guarantees are valuable but come with definitional fine print. Read the contract carefully for what counts toward the guarantee and what is excluded.

Pricing

Custom with ROI-tied structures. Side-by-side with Flexbone.

Honest Take

The named-employee framing is the cleanest pitch in this category. The risk is that "EVA does eligibility" is a shorthand, not a contract. The contract is what the SOW says EVA does on your payer mix, on your EHR, on your specific edge cases. Buyers should treat the demo as marketing and the SOW as the product. The other note: ROI guarantees only guarantee what is written in them. Ask Thoughtful for the exact list of metrics that trigger the guarantee and the exact list of carve-outs. Then compare that to what Flexbone's forward-deployed contract commits to on the same workflow.