Dealing with rejection: Pharmacist-designed app makes it easier to fix returned insurance claims

A couple of years ago Toronto-area pharmacist and entrepreneur Shelley Morgan asked pharmacy technicians how much time they spent on the phone with insurance companies. “One said about 10 hours a month and another one, at a busier pharmacy, said about 50 hours a month,” recalled Morgan, who works part-time as a staff pharmacist at Palermo Pharmacy in Oakville, just west of Toronto. “That’s a lot of time that can be spent on other things, like serving patients. With flu shots, med checks and the push to get minor ailments prescribing in Ontario, pharmacists’ time is stretched so thinly already.” Knowing that claim rejections are the top reason why pharmacists and pharmacy technicians call insurers, Morgan started to think about a solution. She had previously watched a video about building apps as part of research she was doing with her son, who has a keen interest in technology. “The video said that everybody has an app in them and I started thinking about the biggest frustrations for pharmacists and how an app could resolve them,” said Morgan. Read: Innovator: Pharmacist comes home to create his ultimate pharmacy That line of thinking led to Rx Billing Genie, an app-based digital billing binder that Morgan co-created in November 2019 with pharmacy assistant Nicola Sancho-Persad. Designed for Ontario pharmacies, Rx Billing Genie is a searchable app that enables quick look-ups of insurance rejection codes or keywords. The app then uses these search parameters to provide an explanation for the rejection, as well as the appropriate intervention code that pharmacists can use to resubmit a claim. In cases where there isn’t an applicable intervention, the app will advise pharmacists to return the claim to the patient. “We distilled hundreds of pages of pharmacy manuals from insurance companies into the app,” said Morgan. “It really saves you time by giving you the answers you need without having to call the insurance company, and it’s available to you 24/7. It’s also so much easier and faster to use than a paper binder.” After an initial pilot involving about 200 users, Morgan and Sancho-Persad decided to add more sections, including eligible vaccinations and glucometers. “We also have a comments section within the app so people can leave comments–this is part of our goal to build community in the app,” said Morgan. “Pharmacy groups can also leave comments for themselves, to be viewed and used just within their pharmacy group.” This month Rx Billing Genie is launching its product as a partnership with the Canadian Pharmacists Association. The app will be available through subscription, at $49.99 per pharmacy team. Read: Innovators: Empowering pharmacists one APP at a time

Dealing with rejection: Pharmacist-designed app makes it easier to fix returned insurance claims

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