What is a medical billing clearinghouse?

Medical clearinghouses are electronic warehouses that allow healthcare practices to transmit electronic healthcare claims to insurance carriers. Additionally, clearinghouses offer a way to send and manage electronic claims. Clearinghouses are intermediaries who forward claims information from healthcare provider to insurance payers for processing and payment.

Why are medical billing clearinghouse services essential to medical practices?

Clearinghouses play a critical role and have a direct impact on revenue cycle efficiency. The best clearinghouses offer high value features that provide RCM intelligence that makes their services extremely compelling from a financial perspective and also important from an office efficiency perspective. The average error rate for paper claims is 28% but using the right clearinghouse can reduce that to 2-3%.

Do all clearinghouses provide the same service?

Not all clearinghouses are the same. A fully featured clearinghouse will improve the entire billing and collections process from claim submission to workflow management. Many clearinghouses require users to upload files to individual payers.

How is AssuranceMD’s medical billing clearinghouse superior?

AssuranceMD’s medical billing clearinghouse and EDI capability allows you to manage the entire healthcare claims process in one location including eligibility, electronic claims, clinical claim scrubbing, diagnosis  & HCPCS validation, denial management, reporting,  ERA downloads, and electronic EOBs.

Eligibility is a critical first step in the claims process to provide real time patient insurance benefits. Electronic and clinical claim scrubbing function reviews claims for LCD, NCD policies and  over 14,000 payer edits and rules  to identify errors and fix them in minutes rather than days or weeks.

Scrubbing results in cleaner claims and significantly improves claim success, resulting in fewer denials and quicker payment for your medical practice. Our solution provides the ability to arrange the diagnosis and sequences the codes by RVU. Claims can be corrected and resubmitted in real time resulting in dramatically reduced time for revenue to be received. Filing electronic claims can speed up reimbursement times to under fourteen days and some commercial claims in 3-5 days.

Our medical clearinghouse solution allows you to upload the entire payer mix and it parses out to respective insurance companies. This efficiently submits all of your electronic claims in one batch instead of uploading or submitting them separately. This efficient feature provides the ability to fix errors in real time and eliminates the extra work of accessing the practice management application to make corrections.

With AssuranceMD’s clearinghouse, you can submit secondary claims electronically, as well as print individual EOBs to send with paper billing. Our EDI solution has the capability of changing the format which may be required by some payers. It also has the ability to present information in an easy to ready format. Appeals and timely filing medical claims letters are available to print with all claim information to help submit complete appeals information.

What is the best clearinghouse for medical billing?

The best clearinghouse for medical billing solution is one that allows you to manage the entire revenue cycle in one place, provides real-time claim statuses and provides an easy to use workflow. If your practice is struggling with aging accounts receivables and growing denials, you should consider switching your medical clearinghouse.

Is it easy to change clearinghouses?

The process of changing clearinghouses is relatively easy. For commercial carriers, you can submit claims within 24 hours of set up, as most commercial plans do not require enrollment for electronic claims submission. Governmental payers such as Medicare and the Blues will require enrollment which could take up to 4 weeks.

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