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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, Texas-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.

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



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