FEATURE sTOrY will have stellar customer support that is easy to contact. Dashboard reporting tools are helpful when managing rejections by both the clearinghouse and the payor, and some clearinghouses offer real-time claim correction from within their Web portal. Answers to the Top Three Questions About Transitioning to a New Clearinghouse The following Q&a is a resource for you as you search for and transition to a new clearinghouse. 1. WHAT ARE THE KEY FACTORS IN SELECTING A NEW CLEARINGHOUSE? It is vital to be comfortable with the vendor’s industry experience and previous track records of success. Being agile enough to conduct prompt and proactive client services is paramount to the success of any billing company and providers during the transition and – most importantly – with the final system. look for experienced, hands-on, and personalized support staff who act promptly on client requests and issues. Conducting client reference calls and asking specific questions about service levels is key. a vendor’s track record of success or struggles is a good indicator of that vendor’s future performance within your organization. as clearinghouse technology has evolved into Web-based solutions, billing companies and providers should have simple and easy-to-use tools that are customized to their workflow and billing practices. search for vendors that deliver a customized workflow management solution that can be tailored to fit your business needs. ensure that all vendors being evaluated can process all HIPaa transactions, including patient eligibility, claims status, and paper-based services, such as patient statements and paper claims. multiyear archival of all transactions processed through your clearinghouse should be available at minimal costs, if any. 2. WHAT SHOULD I DO TO PREPARE FOR A TRANSITION TO A NEW CLEARINGHOUSE? ask the vendor to explain its payor enrollment and registration policy. a quality clearinghouse will conduct this work on behalf of its new client – and it ensures accuracy with the payor requirements and frees up the client to continue doing their work. also, being able to archive all claims and remittances in a new clearinghouse, prior to the “go live” date, allows for a more seamless transition. a quality clearinghouse vendor will detail all aspects of the implementation project plan, conduct all paperwork on the client’s behalf, and make useful recommendations before, during, and after the transition. BEST PRACTICES FOR A SUCCESSFUL TRANSITION • understand the full pricing structure with all the bells and whistles, including the monthly support fee. Compare the pricing structure to the value of the product and services being offered to make an informed decision. • maximize the full benefits of the system to improve your overall performance. If further automation and staff efficiency improvements are possible, consider a workflow change to accommodate it across the board. • Keep in mind that newer technology drives performance and is often simple to use. • ensure that the vendor has a test claims environment established for each client. • look for a vendor with a 12- to 18-month minimum archive for all payor claims and remittances. • expect more than the status quo from your clearinghouse vendor. explore all of your options and implement integration strategies to improve your top and bottom line. • make sure the pricing structure works best for you and that all agreement language is easy to understand and allows for a 90-day termination clause. • Find a vendor with a single point of contact for any client service issues or requests. ask about the credentials and experience of the vendor support team, and weigh their client service support structure. evaluate your current clearinghouse environment and determine if areas can be improved upon, and, if so, weigh this heavily in your clearinghouse vendor selection process and decision making. • Negotiate custom programming work, prior to contract execution. understand the ongoing costs associated with new product development or custom programming work needed on your behalf, along with monthly service fees. THe jOurNal OF THe HealTHCare BIllINg aND maNagemeNT assOCIaTION 15
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