How I Became An Expert on Processing

How Clearinghouses Help in Medical Claims Processing In the traditional practice of medical billing and claims, it is common to see companies being tapped to act as middlemen and work by forwarding the claims information from the healthcare provider to the insurance payers. Called the clearinghouses, these companies are tasked to assess and check the medical claim for any errors, no matter small or minor it can be, and then verify if the same is compatible with the payer’s software. Likewise, it is the clearinghouse’s responsibility to be certain that the procedural and diagnosis codes to be forwarded are valid and that every aspect of the procedure code is indeed compatible with the diagnosis code submitted together with it. The objective of this quite scrupulous process is to avoid future processing errors. If you happen to be the healthcare provider who wants to hire a medical claims clearinghouse, it is your right to choose the one that you think ideally fits your needs. But you do have to remind yourself that most clearinghouse companies will be charging you for each claim successfully submitted plus the additional costs involved in the process, such as sending a paper claim to the payer. There are instances when the clearinghouse will just submit the claims directly to the payers, while most of the time they’re going to send the same using another clearinghouse’s site. The most notable reason why some claims will have to be submitted through another clearinghouse is because there are times when your own billing software is not compatible with the processing software of the payer. With the possibility of an incompatible software and the challenges they could pose, it is understandable that majority of clearinghouses will require healthcare providers to submit to an initial enrollment period before sending claims for the very first time. This period meanwhile could last for about three to four weeks and in which the clearinghouse will be testing the compatibility of your software to that of the payer’s.
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Anyway, be reminded that this process, although tedious, actually benefits you in the long run since it is designed to make sure you no longer will be suffering from delays in your medical claims later on.
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On the other hand, it is wiser on your part to find another clearinghouse should you find out that the one you are enrolled with always sends the claims to other clearinghouses. There’s no problem with a clearinghouse that will subject you to a transition period, but it no longer makes sense if you’re put on the same setup forever. The thing is if you’re looking for a larger company, it will definitely cost you more, but you’ll find it practical later on because your payments will arrive on time.

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