Medical Billing Clearinghouse

Electronic claims submission is a key feature of medical billing software. It is important to know the features, support, and cost associated with the medical billing clearinghouse integrated with your software package.


The following are questions to ask your software vendor concerning your medical billing clearinghouse:

How do I know which carriers I can send claims to?



You can get a list of insurance payers from the clearinghouse website. This list will tell you which carriers you can submit claims to. Larger clearinghouses have a broader list of payers but may not service small regional carriers in your area.

Let’s say your practice has a high percentage of patients on a local HMO plan. Is that HMO on the payer list and, if not, will the clearinghouse be willing to add it?



Does the clearinghouse edit my claims?



Some medical billing clearinghouses check claims using edits in conjunction with the National Correct Coding Initiative. These edits check claims for errors in CPT and diagnosis codes, modifiers, policy numbers, etc. This is a helpful feature if your coding is varied and complex.



Can I download electronic remittance files for my carriers?



If you are billing for a high volume practice, electronic remittance posting is an important time saving feature.

If you haven’t used this feature, here’s how it works. An electronic remittance file is an EOB in an electronic file format. You can download an ERA file and post it in your medical billing software. This saves you from having to manually post payments from EOBs.



If I decide to use a different clearinghouse from the one used by my software vendor, will I still be able to post my EOBs electronically?


It depends on whether the EOB file format is compatible with your medical billing software.



Can I check insurance eligibility through my medical billing clearinghouse?


Most insurance companies offer insurance eligibility on their websites. Many clearinghouses also offer this feature which is helpful because it enables you to check insurance eligibility from one online location. The list of carriers that you check eligibility for varies by clearinghouse.

Sending your claims electronically is critical to the medical billing process. Be sure to ask your software vendor these important questions about their medical billing clearinghouse.

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