Building a Better Claim Review Company

Nokomis Health | Founder Rich Henriksen


How did you get started in the claims field? What was your career path prior to Nokomis?
I graduated from Luther College in Decorah, Iowa with a biology degree and then received my master’s degree in hospital administration from The University of Iowa. Scott Anderson, the CEO of North Memorial Medical Center in Robbinsdale, Minnesota, was an alumnus of my graduate program and each year he took on an administrative fellow from my program. He selected me to come to his hospital, so I moved to Minneapolis and ended up staying at North Memorial for 7 years. I was originally deployed to the Finance department, where I automated the hospital’s budget process. I stayed in Finance for my entire tenure at North, ultimately becoming the director of managed care. It was at this time that I really learned about coding, reimbursement, contracting, contract modeling, and data analysis. Pat Boran, the CFO, was a super boss and mentor. I learned a great deal from him.

I loved working at the hospital but realized that I needed to go elsewhere to continue my career growth. I went to Medica, where I led the contracting and provider relations team. My time at Medica allowed me to see the “other” side of the business, and it has proven incredibly helpful for me to have worked on both the provider and plan sides of the business.

After 15 years of consulting, in which I worked with more than 70 companies, I decided to establish Nokomis. I had a strong vision for what a successful company in this industry would look like and felt that the market needed a new approach to claim review. I am very proud of my firm and the individuals here that make us successful.

What motivated you to start your own company?
For providers, getting a clean bill out the door can be very difficult. For payors, paying the claim accurately, applying correct benefits and member responsibility amounts can be equally difficult. The world of billing, coding, and reimbursement is very complex. I have had the great fortune of spending my entire career in this space, so I know these things very well. I wanted to use my knowledge and skills to help others. I knew that there is a better way to conduct claim reviews, so I established Nokomis.

Why do you think there is a need for change in this industry?
The healthcare industry behaves like no other economic system in our country. The user of services (the patient) almost never knows what the price will be when they receive services, despite the proliferation of transparency initiatives in the U.S. And although consumer-driven healthcare plans (CDHPs) have become more common, most of the time the patient is not spending their own money – they are spending their insurer’s or their employer’s money. And when the payor – whether it is the health plan or the patient – receives a bill, they are often unable to verify that the bill is correct and complete. It is a broken system.

I believe that our role is to promote incremental changes to allow for true value comparisons for the consumer and to work within the existing system to improve the accuracy of claim payments so that providers are paid accurately.

Describe your vision for Nokomis. What are your goals for the firm?

I would like for Nokomis to be the national leader in claim review services. I realize that we compete with several top-notch firms, but I think that we stand out because of our state-of-the-art review engine ClaimWiseTM as well as our knowledgeable team who are masters at adding the art to the science of claim review. This powerful combination of cutting-edge technology and human intelligence results in a better end product – greater sustained savings, fewer appeals and grievances, and a high level of customer service, which enables our customers to seamlessly integrate our services.

Why do you think that you can do things better?

The biggest things that set us apart is the combination of technology and people. We have leveraged technology to create a best in class claim review engine, ClaimWiseTM. ClaimWiseTM is a powerful application housed in an Oracle database. We are able to create complex rules, which incorporate claims history. The engine allows us to customize rules for our clients and empowers us to process thousands of claims every day. Complementing ClaimWiseTM is our expert coders, analysts, and support staff. They are all highly experienced, at the top of their fields, and deeply understand the world of claims, coding, and billing.

We also provide a high level of customer support and service. We realize that companies are stretched thin and people are busier than ever, so adding claim review services is often seen as extra work. There is no one-size-fits-all formula so we do whatever we can to customize our services in a way that best fits the needs of our clients.

What inspired the need to develop ClaimWiseTM?

I have worked with many claims systems so I know what works well and where the pitfalls can be with claims data. We decided to build ClaimWiseTM from the ground up so that we could innovate and incorporate the best thinking regarding how to store and analyze claims data. Our highly experienced developers built a very powerful system, which allows for great flexibility in loading and analyzing claims data and reporting the results of our reviews. ClaimWiseTM is an agile engine, which is highly scalable and user-friendly, so we are able to add and edit rules at any time. We invested in developing the best in class claim review engine and so far it has proved to be serving that purpose.

Where do you see the biggest opportunities for a company like Nokomis?

I think the health industry will continue to need good, accurate claim review services. Getting claims right from submission through adjudication will continue to be increasingly complex and difficult. In an era of heightened competitiveness, where plan sponsors and members are willing to switch companies for a few dollars’ savings, incorporating Nokomis’s services may be the distinguishing factor that allows health plans to not only maintain their existing clients but also to grow and thrive.