What Research About Healthcare Can Teach You

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Medical Billing and the Role Played by the Clearinghouse

In the concept of medical claims processing, it’s no longer a surprise that third-party companies are being hired for their services, primarily focused on forwarding claims information from healthcare providers to insurance payers. Named as the clearinghouse, these companies work by checking the claim for any presence or existence of errors, in the process verifying if the same is in fact compatible with the software used by the payer.

Part of the clearinghouse’s job is to check and ensure that the codes, both procedural and diagnosis to be submitted are legitimate and valid, while at the same time making sure that every single procedure code is correct for the diagnosis code it is submitted with. The purpose of this meticulous responsibility is to be sure enough that processing errors are prevented.

Because you are the healthcare provider who needs the services of a medical claims clearinghouse, it is your right to be able to choose one that you believe can help you all the way. But remember this: majority if not all clearinghouse companies out there will charge you for every claim submitted, which by the way is exclusive of the other fees such as the cost of sending the paper claim to a payer. There are two ways for claims to be sent; first is when the clearinghouse will submit them to the payers directly, and second is when they’ll send it via another clearinghouse’s site before actually reaching the payer. The reason why claims may need to go through other clearinghouses is because your billing software might not be 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. The enrollment period is expected to last from three to four weeks and will be centered on testing the compatibility of the provider’s 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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Nevertheless, if you find that the clearinghouse you are enrolled with is contented on consistently sending your claims to other clearinghouses and doing nothing to change it, it probably is a good idea to look for another clearinghouse. 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. Yes, it may be true that hiring a larger company will cost you more, but in the end, it’ll be worth it considering that you’d be expecting to receive payment off those claims on schedule every single time.