See below for an editor’s note
Walgreens Health announced Wednesday it is contracting with electronic data interchange clearinghouse Claim.MD to better the claims submission process, reduce denials and improve cash flow.
Pecos, New Mexico-based Claim.MD helps providers, software vendors and insurance carriers manage electronic medical transactions. The company was founded in the early 1980’s and has an insurance network that includes Medicare, Medicaid and commercial payers. Walgreens Health, a business division of the retailer, aims to provide equitable, personalized, whole-person healthcare to local communities across America in a manner that is convenient for consumers – in-store, at home, in the doctor’s office and via mobile app.
“Essentially, Claim.MD connects providers with insurance companies and other payers, offering clearinghouse tools and services that help healthcare providers improve their bottom line,” said Nihal Titan, vice president of Claim.MD. “They create a single point of communication between all the various claims processing systems to simplify the process for physicians to get paid.”
Claim.MD is converting patient claims information from Walgreens Health to electronic ANSI X12 standards. This allows staff members to review and correct claims errors and monitor remittance data through an online portal. If Walgreens needs to follow up with a payer, Claim.MD provides a complete claim history that can be printed.
“When claims are rejected, Claim.MD manages the return process, speeding payment, and eliminating the confusion of re-billing,” Titan said.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
To further simplify operations, Claim.MD’s software integrates with Walgreen Health’s existing electronic health record and revenue cycle management solutions, Titan added.
Other clearinghouse companies include Change Healthcare, Ability, Availity and Waystar. Walgreens Health did not respond to a question about which companies it evaluated before selecting Clear.MD but what impressed Brett Kleebauer, director of revenue cycle management at Walgreens Health, about the latter was its efficiency.
“Inefficiency within the revenue cycle has become a chronic condition across healthcare, but Walgreens Health is committed to proactively improving our claims operations,” he said in a news release. “We turned to Claim.MD to ensure our reimbursement processes were as streamlined as possible and their team delivered with an impactful, cost-efficient solution. The platform helps us to always submit clean claims which lowers our denials rate, while reducing days in A/R to improve our cash flow.”
So far, working with Claim.MD has paid off, Kleebauer added.
“One area of our business that is so important to us is constantly improving the relationships with our payer clients,” he said. “Because the Claim.MD platform provides more timely and accurate billing, it allows us to streamline those interactions. We’ve also been able to grow our business through new client implementations, as the platform allows us to test the claims data from individual payers while easily communicating those findings.”
Photo: sorbetto, Getty Images
Editor’s Note – Walgreens Boot Alliance representatives Margaret Sheehan and Donna Jolly refuted most of the details as reported in the story above involving their relationship with Claim.MD. This despite the fact that this story was based on a news release that quoted a Walgreens Health executive. In a call with the reporter who wrote this story, they said that Walgreens Health is only using Claim.MD for one payer in New Jersey for zero-dollar claims – they declined to identify the payer. They stressed that everything in the story about improving cash flow and reimbursement processes is incorrect. Additionally, Claim.MD’s platform is not being integrated into Walgreens Health’s EHR, as was indicated in the press release. This press release has now been scrubbed from the Claim.MD site but here is a copy that was emailed to us. Walgreens Health did not make the executive quoted in the press release — Brett Kleebauer, director of revenue cycle management at Walgreens Health — available on the call. Nihal Titan, vice president of Claim.MD, who had initially responded to questions in an email facilitated by the company’s public relations representative, was on the call. He did not refute Walgreens Health’s characterization much beyond confirming Claim.MD’s business as an electronic data interchange clearinghouse that helps reduce claims denials and improve cash flow. Per Claim.MD’s press release, the company has been around since the 1980s.
