Palomar Health Optimizes Claims Management with FinThrive

Introduction to FinThrive's Claims Management

So, you've been there for about two to two and a half years. Do you know how long your team has been using FinThrive's Claims Manager or claims management solution for?

Gosh. I mean, I want to say since 2016 or 2017. So, we're probably coming up on our ten-year anniversary with claims management, actually.

Wow. Oh, wow. I hope we do something nice for such anniversaries.

I'll have to tip off the customer service folks and hook you guys up with something. But honestly, they already do enough for us.

There's nothing additional needed there.

We’ll come back to your thoughts on customer service later, but do you know why your team initially chose FinThrive's Claims Manager over other vendors?

Yeah. The main reason was financial. We’ve been licensed and using Cerner Millennium since 2003 or 2004.

Several years after going live with Cerner—and this was before my time—FinThrive (formerly known as nThrive or MedAssets) introduced their claims scrubbing tool. They partnered with Cerner and began offering it to Cerner clients. Palomar had been using Emdeon or Change Healthcare for years, but around 2014 or 2015, we realized we had access to a free claims scrubber service through FinThrive that we weren’t utilizing.

At that point, management decided that instead of continuing to pay Emdeon high fees for claims processing, we should switch to FinThrive. Since it was already included in our Cerner contract, it made financial sense to explore its flexibility and how it could help solve our business challenges.

When I joined, I vouched for FinThrive because I had used it on the technical IT side at Loma Linda University Medical Center, Murrieta, when they first opened. I had a great experience with it. So, when 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.

Challenges with the Previous Vendor

To dig deeper, how would you summarize the challenges you faced with your previous vendor? Cost was a factor, but were there other issues related to functionality, integration, or service?

Yeah. Integration with the EMR was a big issue, and FinThrive offered several advantages there.

One major win for us was the integration between Claims Manager and Contract Management, another FinThrive solution. Previously, our contract management system was a completely separate third-party tool, unconnected to our EMR and Emdeon's claims scrubber.

Another challenge was the limited ability to query data in our previous claims scrubber. FinThrive allows us to create analytics and pull data directly from our claims, which has been a huge advantage.

Impact of Previous Vendor’s Limitations

Thinking about those disadvantages, what impact did they have? How did they affect your bottom line, productivity, and daily operations?

There was a significant financial impact on staffing.

Since Emdeon didn’t integrate well with Cerner, our staff had to work in two separate systems just to piece together a claim’s history. That inefficiency cost the organization a lot of money.

Additionally, we had to invest in third-party analytics tools to process our claims and remittance data—something Emdeon couldn’t do. This meant hiring another vendor to extract, scrub, and analyze our claim files and remittances. Once we moved to FinThrive, we eliminated these extra expenses, saving thousands of dollars.

Improvements with FinThrive

That’s great. Now, turning to improvements with FinThrive—what are some of the biggest positive changes you've seen?

The biggest improvement has been analytics. We now have a clear financial picture of our unbilled claims and the volume we process daily, weekly, and monthly.

Another key benefit is the ability to identify a true "clean claim" more effectively.

We’ve also automated many manual tasks through Bridge Routine Logic, reducing the need for manual clicks and reviews. By working with FinThrive’s tech team, we’ve streamlined many processes that were previously time-consuming.

Visibility over our claim data and payer remittance information has also improved. This transparency gives us confidence when making data-driven decisions.

Favorite Features & Functionality

What are some of your favorite FinThrive features? What aspects of the tool have had the biggest impact on your team’s productivity?

Definitely the query creator—it allows us to quickly generate, copy, and customize reports. The tool is very intuitive.

Another major benefit is how easy it is to locate specific claims and remittances. The search functionality is powerful, with numerous field options that make finding the exact data we need a matter of minutes.

And, of course, Bridge Routine Logic—we use it consistently. It allows us to pull audits of existing bridge routines, monitor automatic claim processes, and identify gaps that need attention.
 
Looking ahead, we’re excited about the embedded integration with Cerner, where claims will be scrubbed directly in Cerner’s cloud before moving to FinThrive for a secondary scrub. This should be a major efficiency boost.

Integration with Oracle Cerner
 
How does FinThrive integrate with Oracle Cerner today, and what do you hope to gain from the embedded integration in the future?
 
Right now, there’s good data flow between the two systems, but we still have manual workflows in FinThrive.
 
The embedded integration will allow us to fix claims upstream before they leave Cerner, rather than correcting them later. This means claims will be cleaner from the start, reducing discrepancies between what’s in Cerner and what’s in FinThrive.
 
Ultimately, this integration will push us to improve workflows across departments, including clinical and registration teams, so that fewer errors make it to claims processing.

Customer Service Experience

How has your experience been with FinThrive’s customer service?

Customer service has been great. Tickets are resolved quickly, and when escalation is needed—such as during the Change Healthcare ransomware attack—our account manager worked closely with us to navigate claim transmission challenges.

Melissa Yuel, our account executive, has also been instrumental in escalating tickets and managing projects. We feel like a priority to FinThrive’s team, and the support we receive is timely and effective.

Financial Outcomes & Metrics

Now, let’s talk numbers. How has your clean claim rate improved?

When we first started, our clean claim rate was 82%. Over time, we improved to 88-89%, though payer-related challenges have brought us down slightly to 87%. Our long-term goal is to exceed 90%.

What about your rejection rate?

We initially had a 6% rejection rate, but after optimizing our bridge routines and contract management, we've reduced that to 3-3.5%.

How have your AR days changed?

Currently, our AR days are 92.8, but that’s influenced by operational changes, including a transition to Guidehouse for revenue cycle management. The increase isn’t related to FinThrive, but rather organizational shifts.

Has revenue improved?

Most revenue gains have come from contract management rather than claims management. However, FinThrive plays a supporting role by ensuring cleaner claims feed into our contract analysis, helping us identify financial opportunities.

Productivity Enhancements & Claims Processing Automation

How has productivity improved?

Bridge Routine Logic has significantly reduced manual work. While we haven’t eliminated staff, we have eliminated thousands of manual clicks, which translates to cost savings.

For example, we used to manually split claims when different payers covered different services within the same visit. Now, FinThrive automatically splits these claims—something that used to take 10-15 minutes per claim is now handled instantly. Multiply that by hundreds of claims, and the efficiency gains are substantial.

Final Thoughts

Overall, FinThrive has streamlined our claims management process, improved financial visibility, and enhanced efficiency through automation. We look forward to further improvements with the upcoming embedded integration with Cerner.