Making a New Year’s Resolution for Your Claims Clearinghouse

December 19, 2017 By: Quadax

With the New Year fast approaching, resolutions for improvement are on everyone’s minds.

If cleaner claims for faster reimbursement are at the top of your healthcare organization’s wish list, 2018 may be the perfect time to consider making a claims clearinghouse change. If your claims first pass rate is less than 99.6%, then your claims processing may be hindered by an under-performing editing engine. Just 1% improvement can represent thousands of claims, saving hundreds of follow-up hours. As you create your revenue cycle resolutions for the New Year, examine your claims to cash flow. Is the performance of your claims clearinghouse contributing to best path?

A key performance indicator (KPI) used by the industry to measure a clearinghouse’s performance is claims first pass rate—percentage of claims accepted for adjudication on initial submission. Understanding what goes into achieving a leading claims first pass rate can help a healthcare organization define its claims clearinghouse expectations as it pursues the best path for reimbursement.

Here’s what you can expect from a high-performance clearinghouse.

Automate and Streamline

Automating your business rules can streamline your claims processing. Automatically account for each payers’ unique requirements and policies. Count on your claims clearinghouse to work with you to get it right at the start, making sure your claims reach payer adjudication the first time.

Follow the Rules

Knowing what a payer requires can put your claims on the best path for payment. Payer requirements and policies are regulated by standard insurance plans, contracted engagements or government plans (Medicare LCD & NCD rules).  Does your claims processing engine access the most current industry rules and payer requirements? Is your clearinghouse vendor dedicated to maintaining an edits library? Does the library include automated BlueCard routing, Medically Unlikely Edits (MUEs), and Correct Coding Initiative (CCI) edits?  

Self-Help Editing Options

Starting with the strength of your clearinghouse solution’s industry and payer edits library, do you then have the option to add additional rules and edits to fit your business? When you need client-specific claim processing, the best clearinghouse solutions provide an easy, convenient editing wizard that puts you in control. It’s your business; they’re your edits. Self-help editing options can help you accelerate change. Why wait for your vendor to perform the custom corrective edits you know you need now.

Client Support

Client engagement teams give you the support you need when you need it. Do you have someone you can call when you need answers? Is your clearinghouse vendor a claims management partner?

Cleaner claims for faster reimbursement starts before the claim drops. So this New Year’s Eve, while you’re waiting for the ball to drop, consider making a resolution to review your claims clearinghouse’s performance. Turn your claims clearinghouse into a top-performer, learn more about how you can take control

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