What is ClearingHouses ?

In Medical billing Clearinghouses are a major part of a billing service's ability to conduct business. Your professionalism and reputation depend on aligning yourself with a reputable clearinghouse.


What exactly does a clearinghouse do? Well, for one thing, they check claims for accuracy. But, the biggest thing they do is re-format the data you send to them to a format that a given carrier can read.


Clearinghouses charge fees in many ways. Some charge an initial start up fee to the billing service ranging from $125 to $300. Others are free to sign-up with initially. Some charge a provider enrollment fee for every healthcare provider you enroll, while others don't. Most of them charge a per claim fee of some sort, depending upon the carrier.


In the last couple of years, clearinghouses have adjusted their fees to the advantage of billing services. Many only charge for Medicare, Medicaid and Blue Cross/Blue Shield claims, while major commercial carrier claims are free in some cases.


If the company you are considering purchasing from is not able to offer you free NEIC claims, you may be able to find a better alternative by obtaining your own claims clearinghouse connection.


If a company tells you they are their own clearinghouse, BEWARE!!! That means you are tied into them, and can't use any other clearinghouse. What happens to you if they go out of business? You'll have to buy new software so you can make your own connection with a different clearinghouse.


These days, you can find a company that offers you many choices in clearinghouses. You may need two or more for medical claims and another for dental claims. The point is, be sure your options are many, not few.

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clearing house review Gateway EDI

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