What is Medical Billing Clearinghouse Service?

A medical billing clearinghouse is a go-between for healthcare providers and insurance companies. A clearinghouse assesses medical claims, checks for errors, and processes them correctly. Once the clearinghouse has established that a claim is clean, it can be submitted for payment.

process of billing

The Medical Clearinghouse Process

Clearinghouse services perform a process known as claims scrubbing. This means that they check insurance claims for errors and make sure that they conform to payer software.

The clearinghouse process also ensures that each claim’s diagnostic and procedural codes are valid and appropriate. This helps to prevent processing errors.

How Clearinghouse Services Solve your Problems

It may not seem immediately apparent as to why healthcare providers and insurance companies use healthcare clearinghouse services. However, when broken down, the advantages are plain to see.

Every day, healthcare providers file millions of medical insurance claims. Different providers use different software solutions to send their claims to thousands of different insurance companies electronically. Each insurer has its payer-specific regulations. All this makes the system complicated. Here’s how clearinghouse services solve your problems:

Solving Claim errors
  • They offer expert services: You can count on the fact that each employee at a medical billing clearinghouse service has been fully trained. Typically, they have lots of experience with medical billing processing and routing.
  • They have HIPPA compliance: Medical billing clearinghouses must comply with HIPPA standards. This means that they have to protect the security of patient health information.
  • Quality control is a priority: One of the essential aspects of claim scrubbing is to make sure the data is accurate. All claims pass through a quality control check before sending to the clearinghouse account.
  • They are an invaluable resource: Your medical billing clearinghouse service is your primary resource for any problems or questions with a claim. You can rely on their expertise rather than having to depend on an internal billing department.
  • They streamline your workflow: Clearinghouse services enable you to funnel multiple workflows into one inclusive service. Electronic processing means that insurance companies will reimburse you within days rather than the weeks or months it takes for manually processed claims.

features of Clearinghouse Services

Medical billing clearinghouse services have the following features:

Electronic Claims:

Because claims are filed electronically, the processing is faster than manual claims. This also reduces the time taken if disputes arise.

Electronic Remittance Advice (ERA):

 This process automatically updates any adjustments and payments. It includes information about a provider’s claims payment and explains why they have denied a claim.

Insurance Eligibility:

One of the main features of a clearinghouse service is that it checks each patient for insurance eligibility. So, you can vet patients before you schedule an appointment.

Claims Submission:

You can submit claims quickly and efficiently. If an insurance company rejects a claim, it will be corrected and resubmitted immediately.

Patient Statements:

Clearinghouse services put patient statements on autopilot. This means that they can print and mail the statements professionally and check the accuracy of addresses.

Claim Rejections:

Billing clearinghouse services reduce the risk of claim rejection. They also use the data from previously rejected claims to reconcile known errors in the future.

Claims Attachments:

 E-attachments are additional documents that must be submitted with a claim but are separate from the claim itself. A clearinghouse service can easily attach these electronic documents to a claim.

Real-Time Customer Support:

High-quality clearinghouse services provide support from experienced medical billers in real-time. They can quickly alert you of errors that would lead to rejection.

I really appreciate the ability to rely upon PrognoCIS to handle the billing. It allows me to concentrate on providing patient care.

Gwynn, thank you for your personal assistance and willingness to coordinate, manage, and explain billing.

Karen McGraw

FNP, LITTLE POUDRE FAMILY MEDICAL

Key Takeaway

Medical clearinghouse service’s main benefits include scrubbing, fast reimbursement, support, and reduced administrative costs. Bear in mind that the quicker an insurance company gets a bill, the sooner they will reimburse you.

The faster a patient is billed for a service not covered by insurance, the sooner you will be able to collect and utilize that money.

If you haven’t already, consider using a medical billing clearinghouse service for your practice. Prognocis can provide you with a range of services to facilitate your medical billing process, including easy integration to your EHR, RCM, credentialing and account resolution service.

Contact us today to find out how we can help you with medical billing. You can reach our team at 408-873-3030.

Our Range of Services to Facilitate your Medical Billing Process

Revenue Cycle Management

Use our RCM services to process statements and handle your claims, while you connect with patients

Account Resolution Service

Accelerate patient communication for shorter billing cycles using our account resolution service.

EHR Integration

The most appropriate solution for enhancing the workflow and overall resourcefulness of a healthcare practice.

Credentialing

Quickly enroll your practice with third-party payers and begin seeing patients

If you haven't already, consider using a medical billing clearinghouse service for your practice.

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Please fill in your details with the best contact email and phone number.

All our promotional offers are as individual and unique as the practices and clinics we support.

We look forward to exploring the potential benefits and offers prognoCIS has for you.

Please fill in your details with the best contact email and phone number.

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