Palomar Health Optimizes Claims Management with FinThrive

Palomar asked for my opinion, I said, "I have nothing bad to say about nThrive. The tool works, it gets claims out the door, and its querying capabilities are strong."

To me, is an advantage over other claims scrubbers.

Awesome. And we'll come back to the the advantages of FinThrive and the the, improvements in your process.

Just to dig in or zoom in, do you know what challenges, or how would you summarize the challenges you have with your previous vendor? So cost was a factor. Were there any other challenges from functionality to integration to service, you know, that you can think of?

Yeah. I'd say integration with the EMR. That was a big one for us, and FinTech have offered several advantages there.

The integration with between claims manager and contract management, which is also a FinThrive solution, that's a big, big, win for us too because that was a completely separate third party system from our EMR and also from, the Emdeon claims scrubber. Pull data, around the claims themselves is a big advantage, to have. So those, like I said, would be the top three ones that that we utilize, and are thankful for.

And then thinking about those disadvantages of the prior vendor, I guess, what impact did that have? So what would, like, the like, how did that really affect the bottom line or your productivity or, you know, everything that that you did these disadvantages.

Another third party company to get all of our claim files, scrub them, get all our remittances, scrub them, whereas FinThrive does that all at once. So there's thousands of dollars that we no longer had to spend once we moved to FinThrive to help drive those analytics and help us support decisions better for the for the organization.

That's awesome. And then now turning to the improvements with FinThrive, and we know we talked about some of that. Sometimes these questions are bit interrelated, so they're just kinda hitting the point of different angles. And so, and it and so what are some of the improvements you've seen with FinThrive?

You know, you mentioned some of them so far. Are there any other improvements you can think of?

So now we shifted from your prior vendor and the difficulties there now to FinThrive. So now that you've had FinThrive over these years, what are some of the big improvements that come to mind?

Yeah. So, I mean, the the analytics, being able to being able to financially put together a a better picture of where we are in terms of our unbilled, in terms of what we're able to bill out the door each day, week, month, truly identifying a true clean claim.

That's something that we've been able to do much more effectively.

In FinThrive's claim scrubber tool.

Let's see what else. Bridge routine logic. We've been able to automate a lot more actions that required manual clicks and manual reviews in the past, by working with FinTech to generate that bridge routine logic on import.

And, and then yeah. I mean, I I keep going back to the analytics, but being able to give us visibility, over all of our claim data and payer remittance information, that visibility is huge for the organization. It gives us it makes us feel much more confident when we make decisions based off of the data that we're looking at with FinThrive. The tool is very intuitive, so that that's a big part of our day at least.

And then being able to find and locate specific claims and remittances quickly, that's another big win. We don't have there's so many field options available when you're searching for things. You can you can you can find whatever you need within a matter of within a matter of minutes based off of those search functions that are available. So that's a that's a big tool we use often.

And then the bridge routine logic, like, again, that's something that we use pretty consistently.

Not only are we are we continuing to add or move it, but just being able to pull an audit of all of the bridge routines that are out there, what's what's automatically happening happening on our claims, what's not automatically happening.

That's an important thing that we think about every day, from a workflow perspective.

And then, we're actually getting ready to move to the embedded the integrated, edits in Cerner. So the it'll those will be, those will be the claims moving to when the claims generate in Cerner, they're gonna go to the FinThrive cloud, and we're gonna scrub the claims directly in, Cerner. But we're still gonna be using, FinThrive for, a secondary scrub, which we're excited to to partner with them on that. So, that's another big hopefully and more than likely, it's gonna be a big win once we move to that at the beginning of next year. So lots of things to like is basically what I'm saying about the tool.

On the topic of EHR, which, you know, yours is Oracle Cerner. Right?

So how does FinThrive play nice with Oracle Cerner and talk to Oracle Cerner and right now and hopefully complement Oracle Cerner?

So right now, it sounds like there's a non embedded integration, and soon it'll be an embedded integration. So, how is it shaking out today, and what's the hope of the embedded integration in the future?

Several hours quicker, we're gonna be able to get those claims cleaned up.

It's a great concept in the sense that we are going to be fixing things upstream, rather than downstream. Right? So this is really gonna give us the opportunity before that claim leaves Cerner to have FinThrive populate those edits and say, hey. You need to fix these things in your EMR now and not just on your claim.

Because current state today, we make a lot of updates to the insurance claim. Once it's left Cerner, and then when you look at the original claim in Cerner, there's some big variances between the two. But this embedded functionality is really going to get the these two separate claims, that look significantly different, much more in sync on on one global claim essentially, with maybe a few slight changes depending on what FinFry's claim manager tool is gonna is gonna automate and update on there. So, it is gonna it's gonna force us as an organization to look back in the EMR and say, okay.

Well, can we do better?

We're not having to fix this here. We only need to reach out a little bit further to maybe these clinical departments, maybe to registration.

When things are honky dory, but there are improvements that, you know, maybe that they suggest proactively and and changes of, hey. Here's how we recommend things, you know, can be done based on what our best customers do, etcetera, etcetera.

Yeah. What are your thoughts on our customer service and how, and how yeah. Let's leave it at that.

Yeah. So, I mean, customer service support has been great.

There's there hasn't been too many instances where tickets have taken too long to turn around.

And anytime we have asked for escalation, especially, I'm I'm sure as you're aware, the whole Change Healthcare ransomware attack that happened, and the claims FinTech, I think, had used Change for some of the the claim transmissions to specific payers, we were able to work really closely with our account manager, Mark. I forget his last name.

But we and we were talking to him pretty much on a weekly basis to try and figure out, okay, we know that the only route to get these claims to the payer were through change.

What can we do now to still make sure we get paid and get reimbursed? And so the fact that, outside of a ticket, we were able to get the customer service team on a call weekly to help to kinda wide guide us and walk us through, how to get our our AR build out the door even if it was on paper.

That's we got all of the feedback we needed there, and we felt like everybody was extremely responsive.

Melissa Ull, our account executive, I know she's probably not considered customer service, more account management.

She's been amazing.

Clean claim rate, your rejection rate, AR days, revenue, and and sort of general productivity. So I'll go through one by one. And, you know, if you can share a ballpark, either percentage improvements or numbers, that's great. If not, don't worry about it. Just directional up, down, or whatnot. Qualitative sentiment is up, down, or what whatnot.

Qualitative sentiment is okay. So first question, how has your clean claim rate improved?

So I believe when we originally came in several years ago, we were at eighty two percent, and we are about eighty six percent. We were in the eighty eight, eighty nine percent in the past, but we have had some some payer challenges that we've dealt with. I think it's something that was completely out of FinThrive's control, so we're back down to about the eighty seven percent mark right now.

How many percentage points maybe it it improved over time at any given point or something like that?

I wanna say we were at six percent before moving to inthrive and FinThrive. So we've we've seen a a a few percent increase decrease in the overall rejection rate.

Gotcha. Okay. And it's did you say it was at three percent now?

It was around yeah. Three three three and a half percent is where we're at right now.

How about the improvement in your AR days?

Yeah. So AR days, I'm looking right now where we're at, and we're kind of high because we recently partnered with a new revenue cycle management, firm that's kinda managing our operations.

And we are let's see. If I take the average of the last couple of months, we are around ninety two point eight days, which is quite high, if I'm transparent.

But I remember, are we so we've, we've expanded several service lines. We've opened a new facility since we were with, Emdeon, and switched to nThrive. So there's been a lot of changes, to the organization that have caused a growth in AR days, but, it's not doesn't have anything to do with, FinThrive. It actually has a lot more to do with how Oracle Cerner system operates on the back end, and let's switch in management from us having all Palomar Health employees, manning the the billing and follow-up department to now being its Guidehouse. Guidehouse is the company that Palomar has chosen.

Firm up what's going into those two tools to to really help us identify better opportunities. So, I wouldn't say there's been a huge huge revenue or or AR, opportunity identified by using claims management, but definitely the other FinThrive solutions have kinda helped wrap around that.

How has your productivity improved? In other words, the amount of stuff that you're able to get done in less time. You know, are you saving time? Are you able to, you know, maybe have less employees and, or something like that? So hours save, less headcount, or getting more stuff done easier, all that buzzword stuff.

Yeah. Yeah. Yeah. So I would say the bridge routine logic has helped, I I don't wanna say eliminate any FTEs, but has definitely eliminated a lot of clicks, which at the end of the day equals expense.

So for example, if we have a if we have a health plan that, the the health plan says, okay. We'll cover the emergency room services, but then the, medical group says, okay. Yeah. The health plan will cover the the emergency room services, but we'll cover any infusion or any radiology procedures that might have happened while they were in the ER.

We had to split those claims two way. And before in Emdeon, you just had to manually split that, separate it, say this is gonna go to the medical group, this is gonna go to, the health plan. And now with our bridge routines, we are able to we are able to completely automate that splitting and, assignment to which payer is responsible for which service. And that's just one example of something that would probably take ten, fifteen minutes to do, one claim on, and we have hundreds of these claims that FinThrive now automatically splits and sends off to the right payers. So the bridge routines are a huge piece of the cost savings that we've experienced with, with FinThrive claims management, definitely.

Had a great experience with it. So I kinda told Palomar when they asked me, what's your opinion? I'm like, well, I have nothing bad to say about nThrive. I used the tool. It got our claims built out the door, and it has this really strong querying ability and functionality. So, to me, it's an advantage to use this tool in the market over all the other scrubbers.

Awesome. And we'll come back to the advantages of FinThrive and the improvements in your process.

Just to dig in or zoom in, do you know what challenges—or how would you summarize the challenges—you had with your previous vendor? So cost was a factor. Were there any other challenges, from functionality to integration to service, that you can think of

Yeah. I'd say integration with the EMR. That was a big one for us, and FinThrive offered several advantages there.

The integration between claims manager and contract management, which is also a FinThrive solution, is a big win for us too because that was a completely separate third-party system from our EMR and also from the Emdeon claims scrubber. Pulling data around the claims themselves is a big advantage to have. So those, like I said, would be the top three ones that we utilize and are thankful for.

And then thinking about those disadvantages of the prior vendor, I guess, what impact did that have? How did that really affect the bottom line, your productivity, or everything that you did?

Another third-party company had to get all of our claim files, scrub them, and get all our remittances scrubbed, whereas FinThrive does that all at once. So there are thousands of dollars that we no longer had to spend once we moved to FinThrive to help drive those analytics and support decisions better for the organization.

That's awesome. And now turning to the improvements with FinThrive, we know we talked about some of that. Sometimes these questions are a bit interrelated, so they're just kinda hitting the point from different angles. So, what are some of the improvements you've seen with FinThrive?

You know, you mentioned some of them so far. Are there any other improvements you can think of?

So now we’ve shifted from your prior vendor and the difficulties there to FinThrive. Now that you've had FinThrive over these years, what are some of the big improvements that come to mind?

Yeah. So, I mean, the analytics—being able to financially put together a better picture of where we are in terms of our unbilled, in terms of what we're able to bill out the door each day, week, and month, and truly identifying a true clean claim—that's something that we've been able to do much more effectively.

In FinThrive's claim scrubber tool.

Let's see what else. Bridge routine logic. We've been able to automate a lot more actions that required manual clicks and manual reviews in the past by working with FinThrive to generate that bridge routine logic on import.

And then, yeah, I mean, I keep going back to the analytics, but being able to give us visibility over all of our claim data and payer remittance information—that visibility is huge for the organization. It makes us feel much more confident when we make decisions based on the data that we're looking at with FinThrive. The tool is very intuitive, so that's a big part of our day at least.

And then being able to find and locate specific claims and remittances quickly—that's another big win. There are so many field options available when you're searching for things. You can find whatever you need within a matter of minutes based on those search functions that are available. So that's a big tool we use often.

And then the bridge routine logic, again, that's something that we use pretty consistently.

Not only are we continuing to add or move it, but just being able to pull an audit of all of the bridge routines that are out there—what's automatically happening on our claims, what's not automatically happening—that's an important thing that we think about every day from a workflow perspective.

And then, we're actually getting ready to move to the embedded, integrated edits in Cerner. So those will be the claims moving to when the claims generate in Cerner, they're gonna go to the FinThrive cloud, and we're gonna scrub the claims directly in Cerner. But we're still gonna be using FinThrive for a secondary scrub, which we're excited to partner with them on. So that's another big, hopefully—and more than likely—it’s gonna be a big win once we move to that at the beginning of next year. So lots of things to like is basically what I'm saying about the tool.

On the topic of EHR, yours is Oracle Cerner, right?

So how does FinThrive play nice with Oracle Cerner and talk to Oracle Cerner right now and hopefully complement Oracle Cerner?

So right now, it sounds like there's a non-embedded integration, and soon it'll be an embedded integration. So, how is it shaking out today, and what's the hope of the embedded integration in the future?

Several hours quicker, we're gonna be able to get those claims cleaned up.

It's a great concept in the sense that we are going to be fixing things upstream rather than downstream, right? So this is really gonna give us the opportunity, before that claim leaves Cerner, to have FinThrive populate those edits and say, hey, you need to fix these things in your EMR now and not just on your claim.

Because current state today, we make a lot of updates to the insurance claim once it's left Cerner, and then when you look at the original claim in Cerner, there are some big variances between the two. But this embedded functionality is really going to get these two separate claims, that look significantly different, much more in sync on one global claim essentially, with maybe a few slight changes depending on what FinThrive's claim manager tool is going to automate and update on there. So, it is gonna force us as an organization to look back in the EMR and say, okay, can we do better?

We're not having to fix this here. We only need to reach out a little bit further to maybe these clinical departments, maybe to registration.

When things are honky-dory, but there are improvements that, you know, maybe they suggest proactively and changes of, hey, here's how we recommend things can be done based on what our best customers do, etcetera, etcetera.

Yeah. What are your thoughts on our customer service and how—yeah, let's leave it at that.

Yeah. So, I mean, customer service support has been great.

There haven't been too many instances where tickets have taken too long to turn around.

And anytime we have asked for escalation, especially—I’m sure as you're aware—the whole Change Healthcare ransomware attack that happened, and the claims FinThrive, I think, had used Change for some of the claim transmissions to specific payers, we were able to work really closely with our account manager, Mark—I forget his last name.

But we were talking to him pretty much on a weekly basis to try and figure out, okay, we know that the only route to get these claims to the payer was through Change.

What can we do now to still make sure we get paid and get reimbursed? And so the fact that, outside of a ticket, we were able to get the customer service team on a call weekly to help guide us and walk us through how to get our AR built out the door, even if it was on paper.

We got all of the feedback we needed there, and we felt like everybody was extremely responsive.

Melissa Ull, our account executive—I know she's probably not considered customer service, more account management—she's been amazing.

Clean claim rate, your rejection rate, AR days, revenue, and general productivity. So I'll go through one by one, and if you can share a ballpark—either percentage improvements or numbers—that's great. If not, don't worry about it. Just directional up, down, or whatnot. Qualitative sentiment is okay. So first question, how has your clean claim rate improved?

So I believe when we originally came in several years ago, we were at 82%, and we are about 86% now. We were in the 88–89% range in the past, but we have had some payer challenges that we've dealt with. I think it's something that was completely out of FinThrive's control, so we're back down to about the 87% mark right now.

How many percentage points maybe it improved over time at any given point or something like that?

I wanna say we were at 6% before moving to FinThrive. So we've seen a few percentage points increase in the overall rejection rate.

Gotcha. Okay. And did you say it was at 3% now?

It was around, yeah, 3–3.5% is where we're at right now.

How about the improvement in your AR days?

Yeah. So AR days—I'm looking right now where we're at, and we're kind of high because we recently partnered with a new revenue cycle management firm that's managing our operations.

If I take the average of the last couple of months, we are around 92.8 days, which is quite high, if I'm transparent.

But I remember, we've expanded several service lines. We've opened a new facility since we were with Emdeon and switched to FinThrive. So there have been a lot of changes to the organization that have caused a growth in AR days, but it doesn't have anything to do with FinThrive. It actually has a lot more to do with how Oracle Cerner's system operates on the back end, and the switch in management from us having all Palomar Health employees manning the billing and follow-up department to now being Guidehouse. Guidehouse is the company that Palomar has chosen.

Firming up what's going into those two tools to really help us identify better opportunities. So, I wouldn't say there's been a huge revenue or AR opportunity identified by using claims management, but definitely the other FinThrive solutions have helped wrap around that.

How has your productivity improved? In other words, the amount of stuff that you're able to get done in less time. Are you saving time? Are you able to maybe have fewer employees or something like that? So hours saved, less headcount, or getting more stuff done easier—all that buzzword stuff.

Yeah. Yeah. Yeah. So I would say the bridge routine logic has helped. I don't wanna say it eliminated any FTEs, but it has definitely eliminated a lot of clicks, which at the end of the day equals expense.

For example, if we have a health plan that says, "Okay, we'll cover the emergency room services," but then the medical group says, "Okay, yeah, the health plan will cover the emergency room services, but we'll cover any infusion or any radiology procedures that might have happened while they were in the ER."

We had to split those claims two ways. And before, in Emdeon, you just had to manually split that, separate it, and say, "This is gonna go to the medical group, this is gonna go to the health plan." And now, with our bridge routines, we are able to completely automate that splitting and assignment to which payer is responsible for which service. And that's just one example of something that would probably take 10–15 minutes to do for one claim, and we have hundreds of these claims that FinThrive now automatically splits and sends off to the right payers. So the bridge routines are a huge piece of the cost savings that we've experienced with FinThrive claims management, definitely.

And then, thinking about the bridge routine logic, it’s not just about splitting claims. It’s also about automating other processes that used to require manual intervention. For example, we’ve been able to set up rules that automatically apply certain adjustments or flags based on payer requirements. This has saved us a significant amount of time and reduced the risk of human error.

Another area where we’ve seen improvements is in reporting. The analytics tools within FinThrive have allowed us to create custom dashboards that give us real-time insights into our claims and revenue cycle performance. This has been a game-changer for us because we can now identify trends and address issues much faster than we could before.

And then, of course, there’s the integration with Oracle Cerner. Even before the embedded integration, the current setup has been a big improvement over what we had with our previous vendor. The data flows more smoothly, and we’ve had fewer issues with claims getting stuck or lost in the process. Once the embedded integration is fully implemented, we expect things to get even better.

So overall, I’d say the combination of automation, analytics, and integration has made a huge difference for us. It’s not just about saving time or money—it’s about being able to operate more efficiently and make better decisions based on accurate, up-to-date information.

And then, when we think about the embedded integration, it’s really going to help us address some of the pain points we’ve had with our current process. For example, right now, we sometimes have to go back and forth between systems to make updates or corrections. With the embedded integration, we’ll be able to catch and fix issues directly in Oracle Cerner before the claims even leave the system. That’s going to save us a lot of time and reduce the number of rejections or denials we have to deal with later.

It’s also going to help us standardize our workflows across the organization. Right now, there’s some variability in how different teams handle claims, but with the embedded integration, we’ll have a more consistent process that everyone can follow. That’s going to make it easier to train new staff and ensure that we’re all working towards the same goals.

And then, from a compliance perspective, having everything integrated and automated is going to help us stay on top of regulatory requirements. We’ll be able to track and document everything more effectively, which is especially important when we’re dealing with audits or payer disputes.

So, overall, I’d say the embedded integration is going to be a big win for us. It’s going to make our processes more efficient, more consistent, and more compliant, which is exactly what we need to keep moving forward.

And then, thinking about the future, we’re really excited about the potential for even more automation and integration. FinThrive has been a great partner in helping us identify opportunities to streamline our workflows and improve our overall efficiency. We’ve already seen significant improvements in areas like claims processing, analytics, and reporting, but we know there’s still more we can do.

For example, we’re looking at ways to leverage FinThrive’s tools to improve our denial management process. Right now, we’re still doing a lot of manual work to track and resolve denials, but we think there’s an opportunity to automate more of that process and reduce the time it takes to get claims paid. We’re also exploring ways to use FinThrive’s analytics to identify patterns in our denials and address the root causes more proactively.

Another area we’re focusing on is patient financial engagement. As healthcare continues to shift towards more patient-centered care, we want to make sure we’re providing a seamless and transparent experience for our patients. FinThrive has some great tools for managing patient payments and communications, and we’re excited to see how we can use those to improve our patient satisfaction and financial performance.

So, overall, we feel like we’re in a really good place with FinThrive. They’ve been a great partner in helping us navigate the challenges of the healthcare industry, and we’re confident that they’ll continue to support us as we work towards our goals.

And when it comes to customer service, I really can’t say enough good things about the support we’ve received from FinThrive. Whether it’s resolving tickets, providing training, or helping us navigate complex situations like the Change Healthcare ransomware attack, the team has always been responsive and helpful.

For example, during the ransomware attack, we were in constant communication with our account manager and the customer service team. They worked closely with us to find alternative solutions and ensure that our claims were still being processed and paid. That level of support made a huge difference for us during a very challenging time.

Even outside of those critical situations, the day-to-day support has been excellent. Whenever we have a question or need assistance, the team is quick to respond and always provides clear, actionable guidance. It’s clear that they’re invested in our success, and that’s something we really value in a partner.

Looking ahead, we’re excited to continue working with FinThrive to build on the progress we’ve made so far. There’s always room for improvement, and we know that with their support, we’ll be able to tackle whatever challenges come our way.

And I think that’s really the key takeaway for us. It’s not just about the technology or the tools—it’s about the partnership. FinThrive has been more than just a vendor for us; they’ve been a true partner in helping us achieve our goals and navigate the complexities of the healthcare industry.

We’ve faced a lot of challenges over the years, from payer changes to system transitions to external disruptions like the ransomware attack. But through it all, FinThrive has been there to support us and help us find solutions. That kind of partnership is invaluable, and it’s one of the main reasons we’ve been able to achieve the level of success we have today.

So, to sum it all up, we’re very happy with the progress we’ve made with FinThrive, and we’re excited about what the future holds. We know there’s still work to be done, but with FinThrive by our side, we’re confident that we’ll be able to continue improving and delivering the best possible outcomes for our organization and our patients.