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Medical Billing and the Role Played by the Clearinghouse In the process of medical claims, there are those companies described as intermediaries or middlemen, with the function of forwarding the claims information from the healthcare providers to the insurance payers. Called the clearinghouses, these companies are tasked to assess and check the medical claim for any errors, no matter small or minor it can be, and then verify if the same is compatible with the payer’s software. Furthermore, it also is the clearinghouse’s responsibility to make sure that all the diagnosis and procedural codes are valid and that every procedure code is ideal for the diagnosis code to which it is submitted with. The purpose of this meticulous responsibility is to be sure enough that processing errors are prevented. If you happen to be the healthcare provider who wants to hire a medical claims clearinghouse, it is your right to choose the one that you think ideally fits your needs. But you do have to remind yourself that most clearinghouse companies will be charging you for each claim successfully submitted plus the additional costs involved in the process, such as sending a paper claim to the payer. Traditionally, clearinghouses may submit the claims directly to the payers, but there are instances when they will have to send the same via other clearinghouse sites before they get to the payers. The most notable reason why some claims will have to be submitted through another clearinghouse is because there are times when your own billing software is not compatible with the processing software of the payer. With the possibility of an incompatible software and the challenges they could pose, it is understandable that majority of clearinghouses will require healthcare providers to submit to an initial enrollment period before sending claims for the very first time. In this period, which usually lasts from three to four weeks, will all be about testing the compatibility of your software to that of the payer.
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Anyway, be reminded that this process, although tedious, actually benefits you in the long run since it is designed to make sure you no longer will be suffering from delays in your medical claims later on.
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But in the event that you observe that the clearinghouse you’re enrolled with does not make the effort not to send the claims to other clearinghouses every single time, it probably is best for you to look and shop for someone else out there. It is no biggie if the clearinghouse does it a couple of times, but if there’s no adjustment, it is your right to look for another option. The thing is if you’re looking for a larger company, it will definitely cost you more, but you’ll find it practical later on because your payments will arrive on time.