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What is a Healthcare Clearinghouse?


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healthcare clearinghouse

The healthcare industry is one of the largest industries in the world. Electronic data interchange combined with software work to communicate with insurance companies to generate revenues. The healthcare clearinghouse is the vehicle that drives the claim information from software to insurance companies to generate revenue. Therefore, today it is vitally important that the practice manager, clearinghouse administrator, and billing entity are familiar with every aspect of the services the clearinghouse provides.

The Healthcare Clearinghouse

The healthcare clearinghouse is a contracted agent with the medical practice and insurance companies. The clearinghouse must comply with HIPAA and the health insurance companies. All entities must remain HIPAA compliant. Clearinghouses in the healthcare industry are the hub of data interchange to initiate revenue. Once the medical practice sets up an electronic healthcare record software for billing purposes, finding the correct healthcare clearinghouse is vital.

The trend today in the healthcare industry is to remain compliant and reduce paper claims and files. The healthcare clearinghouse eliminates the need for paper claims. In addition, electronic claims delivery saves money on supplies, human resources, and postage. Finally, using a healthcare clearinghouse as a middleman is the most efficient method of working the revenue cycle.

Professional healthcare consultants have experience assessing the practice’s needs to make these critical decisions. In addition, the healthcare clearinghouse provides diverse quality controls to ensure timely claims submissions. Knowing what services to look for in a clearinghouse to match the chosen software and align with other third-party vendors of services is beneficial. Contractual negotiations between the medical practice and the clearinghouse can control costs, ensure protections, and reach the goals of the revenue cycle,

What to Look for When Selecting a Healthcare Clearinghouse

The healthcare clearinghouse streamlines the claim process for medical professionals. Finding a compliant professional company that can handle your claim volume is a good starting point. What clearinghouse is recommended by insurance companies and provides essential support when needed? The following considerations are important in your healthcare clearinghouse decisions.

  • Knowledgeable and Immediate Customer Support. When searching for a healthcare clearinghouse to use for your medical practice, it is imperative to explore their training and support capabilities. Depending on the contract, administrators and billing staff will need training on all processes that could affect the practice’s revenue. In addition, knowledge allows for a transparent system of checks and balances. Finally, there must be a consistent support system for problems like uploading data failures.
  • Quality Efficient Control of Data. In choosing a healthcare clearinghouse, there must be the capacity to hook up with the billing EHR. After the clearinghouse enters the foundation data, it has the information within its databases to review claims for errors. Errors in claims, diagnosis, CPT codes, insurance information, and demographics for patients can all cause errors and rejections of the claim. This process holds the label of “scrubbing.”
  • Quick Claim Responses (Claim Status). Early morning uploads of claims occur daily through the billing entity. The claims go through the scrubbing process for any errors. Therefore, the healthcare clearinghouse needs to have the capability of reporting claim status to ensure timely filing. Claims the insurance company rejects need to register as well as clearinghouse rejections. Clean claim ratio reports are tools for billing and administration to review.
  • Usability. Can the clearinghouse process patient payments through a website or in real-time within their software? This enables the office to take copays in the office and the billing department to accept payments from patient calls. Does the clearinghouse provide report capabilities to track data? The healthcare clearinghouse can upload data files for statement generation. This process allows a third-party statement processor to receive the files from the clearinghouse and send them directly to the patients.
  • Consistency and Accountability with 835s. The healthcare clearinghouse also brings in payment remittances for the provider’s payments. The clearinghouse has a connection to the billing software, so payments can be uploaded and run through an auto-post process, streamlining the revenue cycle further. The undisputable factor is knowledge of every aspect of how the provided services work. This knowledge can save revenue when errors occur.

Quality, Efficiency, and Streamlining the Revenue Cycle

Time is of the essence for all businesses. Undoubtedly, the healthcare industry relies on providing quality healthcare for patients while remaining HIPAA compliant. However, with thousands of insurance companies, it is difficult to track each requirement with claim submission. The healthcare clearinghouse allows for the streamlined and efficient submission of claims to insurance companies in the most efficient manner.

By using the healthcare clearinghouse, billing departments and administrators can review the daily uploads of claims, correct errors, and stay on track for timely filing. In addition, the collected data in the clearinghouse can track denials, corrections, submissions, payments, charges, and patient payments. Investing in finding the right match for your practice is a win-win situation.

Find A Healthcare Clearinghouse for your Medical Practice in Florida

Bloom Consulting in Florida understands how confusing setting up EHR, the healthcare clearinghouse, and other important factors of running a medical practice is. We offer our professional consultants who are familiar with assessing the practice’s needs to determine the best tools for handling their revenue cycle. We work with practice administrators, billing agencies, and other staff to coordinate the training and support protocols after making important decisions. Contact us to set the process in motion now.