Some Things that You Must Know About the Medical Claims Clearinghouse

There are various kinds of claims clearinghouses which you can find as there are also different medical claims available such as the pharmacy claims, the DME claims, dental claims and many more. You will also find medical professional claims. But, the easiest way for you to explain what the insurance claims clearinghouse is and the services that they offer is to paint a picture of the problem that they solve and this is actually the piece of the puzzle.

Can you think of the million licensed healthcare professionals which use various claims software and would send medical claims to over 4000 insurance carriers every day? In the 50 states, every state has their respective insurance regulations and each carrier make use of their own internal software infrastructure.

For many years, medical claims processing has been carried out on paper. The manpower necessitated for the thousands of insurance carriers to manage all the paperwork and also the phone calls that each error is going to produce would represent a big cost to the healthcare that the beneficiaries would pay via insurance premiums.

Well, the healthcare claims now are being processed or transmitted electronically. But, you don’t have the US Postal Service to deal with the transmitting process. Those electronic claims clearinghouses were made by the Medicare as well as the large payers to step in electronically where such postal service was not able to and pre-screen for the claim errors and also act as the air traffic controllers and speak of the electronic claim submission.

The clearinghouses are known to be the aggregators or the senders and receivers of so many electronic claims information and most of them are done through the software. As every claim would trigger various actions, the large clearinghouses these days are processing trillions of transactions annually. The medical claims clearinghouses are actually electronic stations or they are hubs which allow the healthcare practices to transmit such electronic claims to the insurance carriers in a secure manner which would protect the patient health information or such protected health information. In addition, the clearinghouses are providing medical billers as well as billing managers a method to consolidate all the electronic claims as well as manage them from just one place, from the online dashboard control panel, which is the same to online checking.

Be aware that there are several benefits that you will be able to get from the medical claims clearinghouses. It is very important that you look for one that offers premium services so that you will be able to focus on those things that actually need your time. Because of such, you should also take the time to compare the many options that you can find prior to making a decision.

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