Integrated Claims Processing Benefits Practice Management Vendor and Clients

The goal for every software vendor is to increase the “stickiness” of their products, making them so valuable in customers’ day-to-day operations that renewal rates stay high.

While an 80% renewal rate may sound good, successful companies rock renewal rates of 90% or higher by constantly tweaking their products to be more useful or coming up with value-added extensions that customers are willing to pay for.

As Jane, a cloud-based practice management software company based in Canada, considered expansion into the U.S. market, leaders knew they would need to address the claims differences between Canadian and U.S. healthcare providers. The company first built rudimentary billing features that supported a handful of clearinghouses that processed claims. After evaluating the claims and support experiences of users, Jane created deeper ties with Claim.MD, launching a beta version of claims early last year before the official rollout in July. 

“There are a lot of similarities between, say, a chiropractor in Canada and a chiropractor in the U.S., but one big difference is how they can submit their claims and bill,” says John Whaley,senior product manager at Jane. “If we can build great insurance billing features that work for many different specialties, we believe that Jane will continue to grow across the U.S.”

Jane is used by more than 150,000 practitioners and 50,000 support staff in over 75 countries. The software has a 99% renewal rate, underscoring the importance of developing a tightly integrated product suite that proves useful to the market.

Claims are a natural extension of practice management software

Like many innovations in the healthcare space, Jane started with a practitioner who couldn’t find a product that would do what she needed it to do. Co-founder Alison Taylor opened a multidisciplinary clinic in North Vancouver, British Columbia, in 2011 that featured a wide range of practitioners including acupuncturists, chiropractors, counsellors, dieticians, massage therapists, midwives, osteopaths, physiotherapists, and others. 

Taylor teamed up with Trevor Johnston, a developer and owner of a design agency, to create her clinic website. Noting her frustration with practice management software on the market, Johnston offered to build Taylor a bespoke solution. The pair co-founded Jane and brought it to market in 2014.

Functionality includes patient and practitioner online booking, staff and appointment scheduling, HIPAA-compliant telehealth, charting and note-taking capabilities, and online payments, in addition to claims and billing.

While Jane gained popularity in Canada, clinicians south of the border started buying the product, which spurred the need to develop billing and claims capabilities suited to U.S. payers and practices. The company built such features as electronic remittance processing, offering a handful of clearinghouses to process claims. Among those clearinghouses, Claim.MD represented the smallest percentage of usage but boasted the best feedback from clients regarding service and support.

Even before becoming an official integration partner, Whaley and his team worked with Claim.MD to better understand the insurance and billing needs of clients, notes Nihal Titan, director of operations at Claim.MD. Titan says his company receives several calls and emails a month from practice management software companies that want to integrate claims into their products. Depending on the level of integration required and the motivation and experience of the development team, adding claims processing can take a few days to a few weeks, he notes

Positive customer feedback prompts move to single vendor integration

Prior to the Claim.MD integration, users downloaded a batch file from Jane, then logged into the clearinghouse to upload it. Whaley says that may sound simple, but the process is manual, tedious, and prone to error, which could leave a provider not knowing their revenue stream had stopped. “Now, users click two buttons and send a batch of claims to Claim.MD without leaving our system,” Whaley explains. “If there’s an issue like a rejection, we have a workflow in Jane where that is clearly communicated to customers. Essentially, it’s a matter of clicking a few buttons to keep on top of their workflows.”

Michelle Weatherby, product marketing manager, says client feedback has been overwhelmingly positive, with many saying they can submit claims during the day when they have a minute, rather than waiting for day’s end or week’s end, which saves hours of time while speeding reimbursement.

 “The majority of our new customers that take insurance are also signing up with Claim.MD. We estimate it’s four out of every five customers.” Weatherby says. “Many existing clients are also transitioning to Claim.MD. The feedback we get across the board is that it’s a super seamless transition, and the onboarding is great. Most say they wish they would have switched sooner.”

Since the beta launch in early 2023, total claim volume through Claim.MD has jumped 350%, making the vendor the top claims processor. Since the official product launch in July, the number of accounts using the vendor has more than doubled, with Claim.MD processing 225,000 claims monthly.

“With the integration, the whole process from a claim being sent to posting payment is faster — you can send batches off sooner because it takes less time and mental load to submit them from Jane,” says Cassie Hulme CTA, CCCA, CPPM, practice manager and chiropractic therapist assistant at Active Spine and Joint Center, Hendersonville, Tennessee. “That means knowing if there are any denials faster and getting errors resolved quicker. Claim.MD even catches errors before claims are sent.”

Partnership allows seamless integration

When a cloud vendor partners with another company to add features and functionality, the integration must be seamless to users, with no conflicts among vendors when questions or issues arise. Claim.MD has developed an onboarding and training process that’s unique to Jane users, with instructions that are specific to the software. The partners have developed joint marketing efforts that include webinars, newsletters, and joint conference appearances.

The company also stresses ease of use for both vendors and users. For vendors, that includes ingesting a variety of data formats that aren’t so particular as to the structure of the data. For clients, changing clearinghouses can be a hassle, with the need to contact each insurance company the practice uses with new remittance information. Claim.MD has developed an automatic tool to handle the heavy lifting, leaving just the necessary signatures to submit the change documentation.

Already, Jane plans to deepen the integration with Claim.MD, allowing users to check insurance eligibility without leaving Jane. That functionality is expected later in 2024.

When done properly, partnerships can create a rare triple win that benefits the user, the practice management system, and the vendor, Titan says. “We really appreciate practice management system vendors that are willing to partner on a more intimate level, because it removes the friction between the PMS and the clearinghouse when issues arise. 

“It lets us come together when the client is having issues, even to the degree that our support interface allows the practice management system to see the support tickets that their providers have opened with us and the issues that they’ve raised,” Titan says. “The bottom line is to solve any customer issues as quickly as possible.”