Smart Ideas: Software Revisited

December 28, 2016

How Clearinghouses Help in Medical Claims Processing In the process of medical claims, there are those companies described as intermediaries or middlemen, with the function of forwarding the claims information from the healthcare providers to the insurance payers. Referred to as clearinghouses, these companies are responsible for checking the medical claim to see if there any errors and then make the verification if the same is compatible with the software used by the insurance payer. Furthermore, it also is the clearinghouse’s responsibility to make sure that all the diagnosis and procedural codes are valid and that every procedure code is ideal for the diagnosis code to which it is submitted with. The purpose of this meticulous responsibility is to be sure enough that processing errors are prevented. Since you’re the healthcare provider planning to hire a medical claims clearinghouse, it is your right to choose one that you think will help you the most. 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. Traditionally, clearinghouses may submit the claims directly to the payers, but there are instances when they will have to send the same via other clearinghouse sites before they get to the payers. The primary reason why claims may have to go through another clearinghouse is because your billing software might not be compatible with the payer’s processing software. 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. It is no biggie if the clearinghouse does it a couple of times, but if there’s no adjustment, it is your right to look for another option. It may be true that you will have to spend more on hiring a bigger company, but in the end you’ll realize it’s all worth it since you’d be getting payments off the claims right on time.