How Clearinghouses Help in Medical Claims Processing

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. 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 objective of this quite scrupulous process is to avoid future processing errors.

Because you are the healthcare provider who needs the services of a medical claims processing software 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 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. Because of the risks and difficulties involved in having an incompatible software, it is very common for clearinghouses to require an enrollment period right before sending claims for the 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.

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. To know more about medical claims, visit h ttp:// .

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. 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, get a free demo here!