Five Benefits Your Claim Clearinghouse Should Provide

June 19, 2017 By: Quadax

Looking for ways to increase efficiency and improve cash flow for your hospital or practice? Be sure you’re taking advantage of all the benefits of a claim clearinghouse.

Far from being a simple middleman in the reimbursement process, a good clearinghouse partner will assist in driving down your days in A/R and improve your operational performance.  

Consider these five key benefits your claim clearinghouse should provide:
1.    Interpreting ANSI and payer-specific claim requirements
Since ANSI 5010 was adopted in 2012, providers have needed to convert their claims into countless variations of the format to satisfy payer-specific requirements. When you employ a claim clearinghouse, this work is done for you. You submit your claims to the clearinghouse, and they translate the data according to the payers’ nuanced specifications. Not only will this improve your claim acceptance rate, but you’ll no longer be burdened with deciphering each payer’s ANSI companion guides yourself.
2.  A robust edit engine to produce cleaner claims for faster reimbursement
If you’re looking for a claim clearinghouse, you’re probably aiming to improve your first-pass clean claim rate—the percentage of claims that are accurately processed and reimbursed the first time they are submitted to the payer. To help you meet this goal, your clearinghouse should offer a powerful edit engine with the ability to customize edits by client, and a commitment to keeping edits current, documented, and supportable. A strong edit system will streamline your claims management process, reducing the need for manual intervention.
3.    Dedicated implementation, service, and support teams 
With any business relationship, you want superior customer service. The relationship you establish with a claim clearinghouse is no exception. A good clearinghouse will have specialized, knowledgeable support teams, including an implementation team to get new clients up and running quickly and efficiently; service representatives to provide on-site support; IT personnel to resolve your technical issues; and a transmissions support team to monitor your claim transmissions. This kind of service may be hard to find, but it’s an invaluable quality to look for in a clearinghouse
4.    State-of-the art claims management software with the ability to interface with your EHR
It’s important to find a clearinghouse that offers state-of-the-art claims management software so you can correct claims and configure edits with ease. One software service model that sets a clearinghouse apart from the rest is the ability to interface directly with your electronic health record (EHR). This allows you to leverage the clearinghouse’s powerful edit system while correcting claims with errors in your own EHR. With this kind of interface integration, you can expect a significant boost to the efficiency of your workflow.
5.    Managing the claims transmissions process
Whether you are a small practice or a large hospital system, your clearinghouse should be able to handle your daily claim transmissions. This includes coordinating the timing of transmissions with payers, monitoring transmissions, resolving issues, and providing you with documented results. Your clearinghouse should provide the technology and horsepower to make your claim transmissions process as seamless and hands-off as possible.
A claim clearinghouse that offers all five of these benefits will deliver the ultimate benefit you need: increased cash flow with decreased expense. If your current vendor is lacking, we'd love to talk!
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