Clearing House Definition - Benfits and Services

It plays an important role in medical billing process

What exactly does a clearinghouse do? Well, for one thing, they check claims for accuracy. But, the biggest thing they do is re-format the data you send to them to a format that a given carrier can read.

How Clearinghouse Works

The billing software creates the electronic file (the electronic claim), which is then sent to your clearinghouse account thorugh software. The clearinghouse then scrubs the claim checking it for errors and then once the claim is accepted, the clearinghouse securely transmits the electronic file to the specified payer with which it has already established a secure connection that meets the strict standards laid down by a HIPAA.

At this stage, the claim is either accepted or rejected, but either way, a status message is sent back to the clearing house which updates the claim's status in your account. It then alert's you that you have an accepted or rejected claim. If rejected, you have a chance to make the needed corrections and then re-submit the claim. Ultimately assuming there are no other corrections needed and the patient's insurance is valid, you'll receive a reimbursement check along with an explanation of benefits (EOB), all very simple. Not

The same sort of activity takes place every night within the federal banking system as our checks and banking activities are sent electronically from local banks to central ACH repositories (Automated Clearing Houses) and then on to banks of origin across the country, and then back to local banks -- all done electronically, and somewhat instantly.

Thus today, you have dozens of regional medical clearinghouses throughout the country all serving the same role; that of scrubbing claims and then transmitting the claim information securely to insurance carriers electronically.

The best clearinghouses offer added features that provide a whole new level of claim intelligence for revenue cycle management that makes their services extremely compelling from a financial perspective, and as well, highly desirable from an office-staff efficiency point of view.

Clearing House Premium services includes:

- Eligibility Verification
- Electronic Remittance
- Claim Status Reports (Know the status of a claim at all times)
- Rejection Analysis
- Online Access
- Printed Claims - Have non-par claims automatically dropped to paper but
still be able to track them electronically.
- Patient Statement Services
- Support

Main Clearing House Benefits

Here are the main benefits of using a electronic claims clearinghouse

Using an electronic clearinghouse to send claims:

Allows you to catch and fix errors in minutes rather than days or weeks
Results in significantly higher claim success --fewer rejected claims.

Allows you to catch and fix errors in minutes rather than days or weeks.

Results in significantly higher claim success --fewer rejected claims.

Rapid claims processing: Submitting claims electronically can reduce your reimbursement times to under ten days.

Eliminates the need to prepare claims and manually re-key transaction data over and over for each payer.

Submit all your electronic claims in batch all at once, rather than submitting separately to each individual payer.

It provides a single location to manage all your electronic claims
Avoid long hours of being on-hold with Medicare and Blue Cross inquiring about claim errors.
Vastly improve vender relationships with insurance carriers.

If you subscribe to a good clearinghouse, you'll be speaking with a knowledgeable support person within just a few rings.

Shorter payment cycles lead to more accurate revenue forecasts.

Reduce or eliminate need for paper forms, envelopes and stamps.

Plain and simple, using a clearing-house will greatly simplify your claims processing.

Charge Entry Process can be found here
Steps ingvolved in Medical Billing and Coding Process