Claims submittal is one of the most important workflows of a medical practices. Without proper claims submittals, a medical practice’s revenue cycle is severely impacted. Whether you’ve already found a clearinghouse but are thinking about switching or are finding a clearinghouse for the first time, here are some key considerations when choosing a clearinghouse:
One of the most important factors is whether the clearinghouse’s payer list contains the insurances that you bill. A clearinghouse that operates nationally will most likely include all large insurance payers but may not include your regional payers. Weigh these pros and cons carefully.
Talk to any potential vendors about the claims software that your medical practice is using. It is crucial that the two software platforms are compatible. Another important factor is the usability of the clearinghouse’s software. Ask for a demo to make sure the software is easy to use and that you’ll feel comfortable training new employees on the software.
Waiting for a response from customer support can delay your claims submittal which then delays revenue. If possible, select a clearinghouse that has 24/7 support and guarantees a response time of 24 hours.
If you’d like your clearinghouse to scrub your claims for CPT and diagnosis code errors, modifiers, policy numbers, patient information, etc express this desire up front and eliminate any clearinghouses from your list that do not offer these services.
While this list is most likely not inclusive of all the features you may be looking for from a clearinghouse, it does include some of the most critical.