USA – Walgreens Health has contracted an 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 1980s 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.
To further simplify operations, Claim.MD’s software integrates with Walgreen Health’s existing electronic health record and revenue cycle management solutions.
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.
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.
Impressed by Claim.MD’s software
Brett Kleebauer, director of revenue cycle management at Walgreens Health, expressed his delight about the efficiency of Claim.MD software and said: “Inefficiency within the revenue cycle has become a chronic condition across healthcare, but Walgreens Health is committed to proactively improving our claims operations.”
“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 to always submit clean claims which lowers 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.
In separate development, Walgreens Boots Alliance has completed its majority stake acquisition in at-home care technology platform CareCentrix.
The US$330 million investment gives Walgreens a 55% ownership of CareCentrix. Walgreens has the option to acquire the remaining equity in the future.
The investment, first announced in October, expands Walgreen’s reach in the health sector, especially in the areas of primary care, specialty pharmacy, post-acute, and home care.
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