# Per-Provider vs Per-Claim Pricing (2026)

A 2026 cost study of per-provider versus per-claim medical billing software pricing for billing companies, modeled at 5, 20, and 50 practices.

URL: https://medibilling.app/docs/per-practice-vs-per-provider-pricing-study
Last reviewed: 2026-07-27

# Per-Provider vs Per-Claim Pricing (2026)

## Short answer

Per-provider pricing charges a billing company once for every rendering provider in its book, no matter how many claims that provider generates. Per-claim pricing charges once per claim that goes out, no matter how many providers or practices produced it. The axis you pay on decides how your software cost moves when you add clients.

At 5 practices with 3 providers each, the gap between the two models is already wide. At 20 and 50 practices it dominates the budget. Per-provider pricing turns every new hire at a client practice into a new line item whether or not that provider bills anything. Per-claim pricing does not move until a claim transmits.

Medi charges per claim, ERA included, with no monthly fee, no per-practice fee, and no per-provider fee. The rate starts at $1.00 per claim and steps down to $0.90 and then $0.80 as monthly volume crosses the published tiers; the full schedule is at [/pricing](/pricing). AdvancedMD, Tebra, and RXNT use per-provider pricing. This study models what a billing company pays each vendor at three book sizes under one consistent set of assumptions. Competitor dollar figures are published rates only; vendors that gate their pricing are discussed structurally but excluded from the dollar tables.

Sources: [Medi pricing](/pricing) · [AdvancedMD software pricing](https://www.advancedmd.com/software-pricing/) · [Tebra pricing](https://www.tebra.com/pricing)

---

## Methodology and Model Assumptions

All three scale points use the same operating assumptions, drawn from Medi competitive research published June 2026. They model mid-to-high-band volume at 100 claims per provider per month. Read the volume bands below before reading the tables, because claims per provider is the variable that decides every number in them.

**Claim volume bands.** Three bands cover most billing-company books:

- Low band, 25 to 75 claims per practice per month. Solo and part-time practices, behavioral health, and practices with a heavy private-pay, capitated, or direct-bill mix. This is an operating observation about small independent practices rather than a published benchmark; treat it as directional.
- Mid band, 75 to 200 claims per practice per month. Full-time therapists and small specialty groups. A full-time behavioral health provider carrying a typical caseload of 20 to 25 sessions per week works out to roughly 85 to 110 sessions per month (20 x 52 / 12 = 87; 25 x 52 / 12 = 108), and only the insurance-billed share becomes a claim. Caseload norms in this range are documented by therapy-network operators such as [Headway](https://headway.co/) and in practice-management guidance for behavioral health.
- High band, 250 to 400 claims per provider per month. Full-time physician groups. [MGMA](https://www.mgma.com/) benchmarks put a full-time physician at roughly 3,600 to 4,800 patient encounters per year, or 300 to 400 per month. That is an encounter ceiling, not a claim count: private pay, capitation, and direct-bill payers all remove volume before a claim reaches the billing company.

**The seat-price crossover rule.** At the $1.00 first-tier claim rate, a per-provider seat is cheaper only when that provider submits more claims per month than the seat costs in dollars. A $399 standard seat needs more than 399 claims a month; a $799 seat needs more than 799; a $99 Billing Starter seat needs more than 99, which is above the fewer-than-100 cap the tier requires. MGMA's 300-to-400 ceiling means a busy full-time physician can approach or cross the standard-seat threshold. Part-time, solo, and behavioral health providers essentially never do.

The rule is stated against $1.00 because that is the conservative bound. Medi's schedule is graduated, so a book past 1,000 claims a month is paying $0.90 or $0.80 on its marginal claims, and a seat then has to cover even more claims before it wins. At high volume the crossover moves up, not down.

**Book assumptions (held constant across scale points):**

| Parameter | Value | Basis |
|---|---|---|
| Providers per practice | 3 | Conservative mid-market average |
| Claims per practice per month | 300 | 100 per provider across 3 providers; mid-to-high band |
| Lines per claim | 2.5 | Blended across specialties |
| ERA return rate | 82% | CAQH Index (88% plan-side electronic, adjusted for enrollment gaps) |
| Eligibility checks per practice per month | 20 | Estimate, included in Medi transaction total |

Under these assumptions, a practice generates 300 claims per month and 20 eligibility checks per month. ERA retrieval and posting are included in the per-claim fee at no additional charge.

Many real billing-company books run below these volumes. A book weighted toward solo, part-time, and behavioral health practices sits in the low band, where a practice files 25 to 75 claims a month rather than 300. Per-claim pricing widens its advantage as volume per practice falls, because the seat fee does not shrink when the practice is small and the claim fee does. The models below are therefore the harder case for per-claim pricing, not the friendliest one.

**How the Medi claim rate is applied here.** Medi's schedule is graduated and the tiers count the billing company's whole monthly claim volume, not each practice separately. Every claim is priced by the bracket it falls in: the first 1,000 claims in a month are $1.00 each, claims 1,001 through 5,000 are $0.90 each, and every claim above 5,000 is $0.80. So a 2,000-claim month is 1,000 at $1.00 plus 1,000 at $0.90, or $1,900. The schedule of record is at [/pricing](/pricing).

That means there is no single per-practice figure that holds across book sizes. A practice filing 300 claims costs $300 in a book still inside the first bracket and $240 in a book already past 5,000 claims. The tables below price each book as a whole and add eligibility at $0.25 per check on top.

There is no platform fee under any of it. Medi has no monthly fee, no per-practice fee, and no per-provider fee.

**Competitor pricing used in this study:**

All competitor costs are seat fees only; AdvancedMD, Tebra, and RXNT include ERA retrieval and claim submission in their per-provider tiers. Fees are labeled [published] where taken from the vendor's pricing page, or [third-party/estimate] where drawn from reseller analysis or aggregators. Get a current vendor quote before using any figure here for budget planning.

| Vendor | Rate used | Label | Source |
|---|---|---|---|
| AdvancedMD | $429 per provider per month (Medical Specialties entry) | [published] | advancedmd.com/software-pricing |
| Tebra | $399 per provider per month (Practice Essentials, non-physician standard) | [published] | [tebra.com/pricing/overview](https://www.tebra.com/pricing/overview) |
| RXNT | $207 per provider per month (PM bundle) | [published/estimate] | RXNT published tiers; some rounding |

The Tebra rate used here is the standard Practice Essentials non-physician rate, not the $99 to $199 Billing Starter rate. Billing Starter applies only to practices submitting fewer than 100 claims per month, and transitions to standard rates after three consecutive months above that. Every practice in this study submits 300 claims per month, which is above the cap, so the standard rate is the right reference for these models. Low-band practices, under 100 claims a month, do qualify for Billing Starter and can hold it; the seat-price rule above is what decides that comparison, and at $99 the threshold of 99 claims sits above the cap itself. Tebra does not publish what a re-rated billing-only practice pays above the cap, which leaves the standard bundles as the only published reference there. The physician standard rate is $599, so a physician-weighted book prices higher than the tables below show.

CollaborateMD is excluded from the dollar tables: it gates its per-provider fee, and the only available figures are reseller-documented estimates, which do not meet this study's sourcing bar. It appears in the structural discussion below; get a direct quote for real numbers. Office Ally is also excluded from the primary tables: it is a clearinghouse tool without a billing-company operating surface, not a like-for-like alternative for the workflows modeled here.

---

## The Cost Comparison at Three Book Sizes

### Book size 1 (mid-to-high band): 5 practices, 15 providers, 1,500 claims per month

| Vendor | Pricing axis | Monthly cost | Annual cost | Notes |
|---|---|---|---|---|
| **Medi** | Per claim | **~$1,475** (1,500 claims: 1,000 at $1.00 + 500 at $0.90 = $1,450, plus $25 eligibility) | **~$17,700** | No monthly, per-practice, or per-provider fee; ERA included in the claim price |
| AdvancedMD ($429/provider) | Per provider | ~$6,435 | ~$77,220 | Seat-only; 15 providers × $429 |
| Tebra (~$399/provider) | Per provider | ~$5,985 | ~$71,820 | Published; [tebra.com/pricing/overview](https://www.tebra.com/pricing/overview) |
| RXNT (~$207/provider) | Per provider | ~$3,105 | ~$37,260 | PM bundle reference |

At 5 practices, the Medi all-in is roughly a quarter of the Tebra standard non-physician reference in this model and less than one-quarter of AdvancedMD's entry tier.

The structural point is what each side is paying for. The per-provider platforms charge $3,105 to $6,435 for those 15 seats before a single claim moves. Medi charges nothing until a claim moves, and $1,450 of the $1,475 above is 1,500 claims that went to a payer.

### Book size 2 (mid-to-high band): 20 practices, 60 providers, 6,000 claims per month

| Vendor | Pricing axis | Monthly cost | Annual cost | Notes |
|---|---|---|---|---|
| **Medi** | Per claim | **~$5,500** (6,000 claims: 1,000 at $1.00 + 4,000 at $0.90 + 1,000 at $0.80 = $5,400, plus $100 eligibility) | **~$66,000** | No fee for the 20 practices or the 60 providers; ERA included in the claim price |
| AdvancedMD ($429/provider) | Per provider | ~$25,740 | ~$308,880 | Seat-only; 60 providers × $429 |
| Tebra (~$399/provider) | Per provider | ~$23,940 | ~$287,280 | Published; [tebra.com/pricing/overview](https://www.tebra.com/pricing/overview) |
| RXNT (~$207/provider) | Per provider | ~$12,420 | ~$149,040 | PM bundle reference |

At 20 practices AdvancedMD's 60-provider seat cost is more than four times Medi's all-in, and Tebra at the published standard non-physician rate is over four times it as well. Per-provider platforms are counting 60 providers at $399 to $429 each. Medi is counting 6,000 claims.

Medi's number grew from ~$1,475 to ~$5,500 while claim volume grew fourfold, and that gap is the graduated schedule doing its work. The 6,000th claim in the month bills at $0.80 rather than $1.00, so cost rises more slowly than volume. A book that adds light-volume practices sees a smaller increase than this model assumes; one that adds high-volume specialty practices sees more.

### Book size 3 (mid-to-high band): 50 practices, 150 providers, 15,000 claims per month

| Vendor | Pricing axis | Monthly cost | Annual cost | Notes |
|---|---|---|---|---|
| **Medi** | Per claim | **~$12,850** (15,000 claims: 1,000 at $1.00 + 4,000 at $0.90 + 10,000 at $0.80 = $12,600, plus $250 eligibility) | **~$154,200** | Published schedule, no quote required; ERA included in the claim price |
| AdvancedMD ($429/provider) | Per provider | ~$64,350 | ~$772,200 | Seat-only; 150 providers × $429 |
| Tebra (~$399/provider) | Per provider | ~$59,850 | ~$718,200 | Published; [tebra.com/pricing/overview](https://www.tebra.com/pricing/overview) |
| RXNT (~$207/provider) | Per provider | ~$31,050 | ~$372,600 | PM bundle reference |

At 50 practices and 15,000 monthly claims, the Medi all-in is about a fifth of Tebra's seat cost and a fifth of AdvancedMD's. Most of that volume sits in the $0.80 bracket, which is why the Medi share falls at this book size rather than holding at the quarter it was at 5 practices. The $12,850 is the published number, not a quote to negotiate.

This is the scale point where the two curves are worth reading carefully. The per-provider platforms bill 150 seats every month regardless of what those providers submit. Medi bills the 15,000 claims. If your 150 providers bill more than this model assumes, Medi costs more than shown; if a client practice slows down, Medi costs less that month and the seat fees do not move.

---

## Why the axis matters: claim volume vs provider count

A vendor's pricing axis reflects who it built the product for.

Per-provider pricing originated in the EHR market, where a per-clinician seat license is the natural unit: each clinician uses the software independently to chart, prescribe, and schedule. When billing modules were bolted onto those systems, the seat structure came with them. A billing company on an EHR-adjacent platform inherits that structure even though it does not manage individual clinician workflows the way an in-house clinic does.

Per-claim pricing treats the billing company as the customer and its output as the unit. A billing company gets paid on what it collects, which starts with claims going out clean and on time. Pricing the software the same way puts the cost on the same clock as the revenue: the charge lands when the claim transmits, not when a provider is added to a roster.

The tables above show the consequence. When a billing company adds a 4-provider family medicine group, per-provider platforms add four seats on day one. Medi adds nothing until that group's first claim transmits, and then adds the bracket rate for each claim, between $1.00 and $0.80 depending on where the book's monthly volume already sits. When the practice adds a fifth provider mid-year, per-provider platforms add a fifth seat whether or not that provider is credentialed and billing yet. Medi's bill moves only if the claim count moves.

The asymmetry is sharpest for books weighted toward multispecialty groups or mid-sized practices, where provider count runs well ahead of what any single provider bills. It also matters during onboarding and credentialing, when a client's providers are on the roster but not yet producing claims. Under a seat model that period is full price.

This study assumes 300 claims per practice per month across 3 providers, or 100 claims per provider, which is the mid-to-high band. Books whose providers bill below that, which includes most low-band books of solo, part-time, and behavioral health practices, see per-claim pricing widen its advantage. Books that bill well above it should model their own volume against the seat-price rule, remembering that their marginal claims price at $0.90 or $0.80 rather than $1.00.

---

## Caveats and Where Per-Provider Can Close the Gap

The study uses representative assumptions. Several real-world conditions change the picture.

**High claim volume per provider compresses the gap.** Medi's cost is driven by claim volume alone, so a book whose providers bill far above the 100-claims-per-provider assumption climbs toward the point where a fixed seat becomes competitive. The threshold is the seat-price rule: a seat wins only above the claim count that equals its dollar price. A 3-provider practice submitting 2,000 claims per month costs $1,900 as a standalone book (1,000 at $1.00 plus 1,000 at $0.90), ERA included, against $1,197 for three $399 standard seats, because 667 claims per provider is well past the 399 threshold. That is above MGMA's 300-to-400 encounters-per-month ceiling for a full-time physician, so it is uncommon at the individual-practice level. It is still the scenario to model if your book includes high-volume multispecialty groups.

**There is no fixed floor either way.** Medi has no monthly minimum, no per-practice fee, and no per-provider fee, so a month with no claims costs nothing. The whole variable is claim count. Model it against your own volume in the [pricing calculator](/tools/pricing-calculator).

**Competitor figures are ranges, not quotes.** The AdvancedMD figure here ($429/provider) is the published Medical Specialties entry price; AdvancedMD's actual range runs to $1,070 per provider per month. Tebra publishes a $99 to $199 Billing Starter rate at [tebra.com/pricing/overview](https://www.tebra.com/pricing/overview), but it applies only to practices submitting fewer than 100 claims per month and re-rates after three consecutive months above that, so it does not price the 300-claim practices modeled here. It does price a low-band book, and by the seat-price rule a $99 seat still needs more than 99 claims a month to beat per-claim, which the cap forbids. The $399 reference used in this study is the published Practice Essentials non-physician standard rate; the physician standard rate is $599 and Practice Automation runs $449 to $799. Some billing companies negotiate volume discounts through partner programs (AdvancedMD's AdvancedBiller program, for instance), but those discounts are not published and cannot be modeled. Get a current quote with your specific provider count, practice count, and payer mix before drawing conclusions.

**Office Ally is cheaper on raw price but is not a billing-company operating layer.** Office Ally's Service Center is free for participating-payer claims, with a $44.95 per-month non-par fee per unique Tax ID and Rendering NPI combination. For a heavily government-payer book with low commercial exposure, Office Ally's transaction cost is the lowest available. But it is a clearinghouse, not a work surface: it routes claims and retrieves ERAs, and it does not run denial workflows, A/R aging views, multi-practice queues, or posting decisions across a book. Companies that run Office Ally typically add manual processes or separate tools to cover those gaps.

**CollaborateMD is a genuine usage-based peer.** It is the one platform here with a partly similar structure (transaction-based fees plus a per-provider component). Its pricing is gated, which is why it carries no dollar figures in this study; get a direct quote before comparing.

---

## Frequently asked questions

### Does Medi charge per provider or per practice?

Neither. There is no per-provider fee, no per-practice fee, and no monthly fee. A 2-provider practice and a 10-provider practice generate identical bills if they submit the same number of claims. What changes the bill is claim volume plus any eligibility, claim status, COB, insurance discovery, or attachment transactions you run. COB, insurance discovery, and attachments are in controlled rollout and are enabled per billing company during onboarding.

### Does Medi offer volume pricing?

Yes, and the tiers are published rather than quoted. The rate starts at $1.00 per claim and drops to $0.90 and $0.80 once monthly volume passes the published thresholds, each claim priced by the bracket it falls in and the brackets counted across the billing company's whole monthly volume. The full schedule is at [/pricing](/pricing).

### How does Medi's cost change if a client practice adds a provider mid-engagement?

Only through claims. Adding a provider does not add a fee. If that provider lifts the practice's claim volume, the bill grows by the bracket rate for each additional claim, $1.00 inside the first 1,000 of the month and $0.90 or $0.80 beyond that. During credentialing, when the provider is on the roster but not yet billing, the cost is zero.

### Are there scenarios where per-provider pricing wins outright?

Yes, at high claim volume per provider. The rule at the $1.00 first-tier rate: a seat is cheaper only when the provider submits more claims per month than the seat costs in dollars. A 3-provider practice billing 2,000 claims per month, or 667 per provider, on a $150-per-provider seat runs $450 in seat fees against $1,900 on Medi as a standalone book. The graduated schedule narrows that gap somewhat at higher volume but does not close it, since a cheap seat still beats any per-claim rate once a provider bills enough. Billing companies with consistently high-volume practices should model their own claims-per-provider average in the [pricing calculator](/tools/pricing-calculator) rather than assuming per-claim pricing is always lower.

### Why do incumbent platforms still use per-provider pricing?

They inherited it from the EHR market, where a per-clinician license is natural because each clinician uses the system independently to schedule, chart, and prescribe. When billing modules were added, the seat structure followed. Software built for billing companies from scratch can use a different axis. Per-claim pricing puts the software cost on the same event the billing company gets paid on.

---

For onboarding fees, hidden costs, and year-over-year trends, see the [State of Billing Company Software Costs 2026](/docs/state-of-billing-company-software-costs-2026). For the broader vendor field, see the [best medical billing software for small billing businesses](/best/small-billing-business-software).

[See Medi's published fee schedule](/pricing) or [book a walkthrough to run the numbers against your own book](/demo).

---

## A note on the pricing figures here

Pricing for other vendors comes from their public pricing pages where they publish one, and from third-party aggregators, reseller materials, and customer reports where they do not. Many of these vendors do not publish pricing, so these figures are approximate, may not reflect negotiated or current rates, and can change without notice. Treat them as a starting point and confirm with each vendor directly. Where a vendor gates its pricing, this page says so rather than presenting an estimate as fact. Medi's own pricing is published in full at [/pricing](/pricing).

Sources: [Medi pricing](/pricing) · [AdvancedMD software pricing](https://www.advancedmd.com/software-pricing/) · [Tebra pricing](https://www.tebra.com/pricing) · [State of billing company software costs 2026](/docs/state-of-billing-company-software-costs-2026)