A clearinghouse in medical billing is an intermediary between healthcare providers and payers that helps to streamline the claims submission process. Here are some of the key things that a clearinghouse does during claims submission:
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Claims Scrubbing: Clearinghouses audit bills and claims for errors such as missing or incorrect patient data, erroneous insurance provider information, inaccurate billing codes, and incomplete data related to procedures or diagnostics performed. 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.
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Storing Detailed Information: Clearinghouses store detailed information on each claim, which can help to speed up the submission process.
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Consolidating Claims: Clearinghouses offer medical billers and billing managers a way to consolidate all their electronic claims and manage them from a single location, from an online dashboard control panel, similar to online checking.
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Checking 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.
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Submitting Claims Electronically: Clearinghouses allow healthcare practices to transmit electronic claims to insurance carriers in a secure way that protects patient health information. They send all the claims to all the payers electronically, which saves time and increases reimbursements.
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Providing Back-Up Copies: In the case of an emergency event, a clearinghouse can provide you with a back-up copy of any important billing data you submitted and then lost.
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Offering Customer Service: The best clearinghouses offer prompt and responsive customer service. Outsourcing the technical and administrative aspects of your claims process to a third party can be helpful in minimizing the human errors that may happen due to manual re-key transaction data at each insurance provider’s website.
Overall, a clearinghouse helps to ensure that the right procedural and valid diagnosis codes are submitted in medical claims, and it also ensures that every procedural code s...
