Are you frustrated with billing bottlenecks, your current vendor’s lack of flexibility and limited understanding of your needs? Tired of waiting in a queue? Dreaming about what it would be like to experience personalized client service? It might be time for a change.
Does that realization take you from frustration to fear? It’s true: the thought of implementing a new claims clearinghouse can be overwhelming. How could a new vendor understand our billing cycle’s unique complexities? How could we manage to upload all of our claim files to a new system without slowing down our billing cycle? Even if they manage to set it up, how could a new vendor maintain a high level of on-going personal service? These are just a few of the anxieties that often arise before healthcare providers successfully transition to a new vendor.
Whether you are a new provider deciding on a vendor for the first time, or switching vendors after years of service, implementing a new claims clearinghouse is a significant undertaking that requires an investment of time, money and resources, not to mention a tremendous amount of internal and external collaboration. The best way to conquer your claims clearinghouse change anxiety is to control your implementation and make your expectations known upfront.
When considering a vendor’s implementation strategy, make sure it includes these three vital steps: facilitate, automate, and educate.
- FACILITATE the transition with parallel testing.
Parallel testing allows your organization to transition to a new vendor system seamlessly without disrupting your billing cycle. Loading duplicates of your outgoing claims into a parallel testing environment, your new vendor can ensure the proper data is present and in the correct format/location. It will also verify that the necessary payer edits are in place and identify any discrepancies between your previous system’s process and the new one. Furthermore, a good vendor maintains a robust network of payer connections to preserve your current streams of revenue and allow for development of new ones.
- AUTOMATE the electronic submission of COB claims.
One of the most complicated processes in claims management is the COB (secondary/tertiary) claims process. It is not surprising that COB can be difficult to implement. To fully maximize your organization’s efficiency, your new claims clearinghouse needs to minimize the amount of time your staff spends dealing with COB claims. To do that, you need a vendor that can implement three critical facets of COB claim management: 1) automatic or manual creation of electronic COB claims, 2) training for your personnel on management of those claims, and 3) submission of automated electronic COB claims immediately after going live.
- EDUCATE personnel to understand and create custom edit logic.
Given the complexity of the medical billing cycle, it’s expected that a vendor will create, track, and manage customized edits for the unique needs of your practice or facility. However, the reality is that most practices require more than just what is deemed standard. You should expect a vendor to not only provide you with tools that allow you to write your own customized logic, but also train your personnel to do so.