Get the Most Out of Your Clearinghouse WHAT TO LOOK FOR WHEN MAKING A TRANSITION By Lauren Collins and Cindy Groux, CHBME ost medical billing companies utilize a clearinghouse. However, there may come a time when your company is ready to transition to a new one. To help you prepare for this potential transition, we have compiled some questions and answers that can guide you through this process. If you are new to clearinghouses, the following paragraphs will provide a good overview of what clearinghouses are and the benefits and services they provide. Otherwise, you can skip ahead to the Q&a section on transitioning to a new clearinghouse. An Overview of Clearinghouses Clearinghouses transmit electronic claims to insurance carriers, serving as the transport mechanism of claim information between a physician or billing office and a payor. The majority of claims are entered into your practice management or billing software. The software will generate an electronic file (known as an 837 file), which contains all the claims to be sent (uploaded) to a clearinghouse. The clearinghouse performs “claim scrubbing” – perhaps one of the most valuable services offered – which checks 14 HBma BIllINg • NOVemBer.DeCemBer.2014 all claims for errors that may cause them to be rejected immediately by your clearinghouse or later by the payor . 837 File Claims can be rejected for thousands of reasons; clearinghouses perform eligibility verification to check that a patient name and ID number are correct, that the claim is sent to the proper payor, and that the patient is eligible for coverage on the dates of service. Once the claims pass inspection, the clearinghouse will parse through the batch and forward them to the payors. The claim will either be accepted or rejected by both the clearinghouse and the payor. a status message is sent back through the clearinghouse, and a “277” claims acknowledgment file will contain the status notification from the payor. The 277 file information can be later used, if needed, to prove timely filing. Clearinghouses offer additional services. a great clearinghouse M software Claim scrubbing Correct errors Payor
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