Pilot results in up to 30% reductions in paper claims, phone calls, denials, and pended claims. WellPoint to expand participation across all markets.

JACKSONVILLE, FL – Health information network Availity today announced that after completing a highly successful pilot program, WellPoint will expand its sponsorship of RealMed – Availity’s revenue cycle management solution – across all of its markets. WellPoint will work with RealMed to continuously improve workflow rules and editing within its claims processes, to improve its first-pass clean claims and auto-adjudication rates for physicians, further improving the physician revenue cycle and speed of payment.
“The results of a recent six month pilot were really eye opening for us,” said Veeneta Lakhani, vice president of provider experience and analytics at WellPoint, Inc. “We learned that when we work with RealMed to fine tune our claim rules and edits, physicians receive immediate notifications of missing information or errors before they send a claim to us. The result is fewer phone calls to our call center, fewer paper claims and fewer denied and pended claims – all of which require human intervention and slow the process of paying our physician partners. For us, that amounts to huge administrative cost savings, and for our physicians, an easier path to getting paid.”
The pilot compared a group of physician practices using RealMed against a control group of non-RealMed users. Overall, the group using RealMed performed substantially better than the control group on reducing paper claims, pended claims, denied claims and phone calls.
“Even though we have only been on RealMed for a short while we have noticed positive changes in key billing areas, specifically the ease of use when correcting a claim, the status and feedback for claims we send, and an overall improvement in our workflow process,” said Steven Sinclair, CPA, CMPE, associate administrator for Graves-Gilbert Clinic, Bowling Green, Kentucky. “Also, the Client Account Manager support has been professional and knowledgeable, which is vital for this change to RealMed.”
“The RealMed solution eliminates inefficiencies and waste for both health plans and physicians,” said Russ Thomas, Availity CEO. “By working closely with health plan customers like WellPoint, we are able to identify process edits and rule changes that can mean the difference between an auto-adjudicated claim and one that goes through multiple manual touch points and delays. WellPoint immediately recognized the value to the company and the physician community. We are delighted to work with WellPoint in expanding RealMed to all of their markets.”