Medical claims and clearinghouses: the two go hand in hand. If your clearinghouse isn’t up to par, your medical claims (and ultimately your practice) suffer. So how do you select the best clearinghouse for your claims? It’s not a simple answer, and there are tons of things to consider. So let’s take a deeper dive and look at what you need to compare when choosing the best clearinghouse for those important medical claims.
Review customer service/support options
Your patients expect customer support from your staff, and you should expect the same customer service from your clearinghouse. Should an issue arise — hint: one will, no matter which service you choose — the longer you have to wait for your clearinghouse to rectify the issue, the longer you have to wait for financial payment. Look for a clearinghouse that allows you to file an inquiry anytime and can respond to you in 24 hours. You can test potential clearinghouses out on this matter by submitting questions to them in the discovery process and seeing how long it takes them to respond.
Speed wins in claims status
In the same vein as the above, if there is a problem with a claim, you want to know about it immediately. A clearinghouse that can pinpoint claim status all the way down to the individual claims will be able to tell you which claims were filed successfully and which ones were not. This allows you to make the necessary changes and receive payment as quickly as possible.
Is the service easy and usable?
When you start work in a new program you expect there will be a learning curve for yourself and your staff. However, you don’t want that learning curve to become a lifestyle. A clearinghouse system with features that are easy to use makes the onboarding process easier for everyone and allows you to do future training with new employees in-house.
Accreditation is important
Healthcare providers are used to compliance and regulation, so it should come as no surprise that clearinghouses have accreditation as well. When shopping for a clearinghouse, look for one that has been accredited by the Electronic Healthcare Network Accreditation Commission (EHNAC). Depending on where your practice is based, this may or may not matter, but some payers — and states — require the use of an EHNAC-accredited clearinghouse for all business transactions.
Does the clearinghouse work where you work?
Each clearinghouse has a payer list, which you should be able to find on the company’s website. Research this list and make sure the insurance providers you work with most frequently are on this list. If they are not, you’re setting yourself up for a hurdle before you start.
In some cases, the insurance providers you work with may not be on the list because the clearinghouse is regional, not national. Opting for a national clearinghouse eliminates these issues and ensures your clearinghouse is always ready as the needs of your practice change.
A contract that matches your needs
You look to your clearinghouse to help your practice earn in the money it’s owed, so it behooves you to look into how your clearinghouse gets the money it’s owed from you. Look beyond simple matters of price — though that is certainly important — and toward other factors like the contract itself. Is the contract easy to walk away from if you’re unhappy with the service, or are you sequestering yourself to a life without options? And once you’ve looked at the contract, let’s talk fees. A monthly fee of $75-$95 is common; make sure the fee is for unlimited medical claims. If you find a clearinghouse that charges more, ask them to explain why their service is more and review their answer with a critical eye.
Never stop learning
The selection of a clearinghouse has many moving parts and so should your research. The questions we’ve posed above can be predominately answered by the clearinghouse’s website or customer support team but don’t be afraid to dig a little deeper. Contact existing customers of the clearinghouse to learn more about their experiences and visit helpful third-party sites like clearinghouses.org to find an industry view of your options. Leave no stone unturned, because selecting a clearinghouse is a big decision for your practice and you want to make sure the choice you’ve made turns out to be a great one.
Clinical Director October has been a Registered Nurse for over 15 years. She is board certified in Mental Health and Psychiatric Nursing. She holds a Bachelor of Arts from the University of North Carolina at Greensboro. She also graduated with bachelor and master degrees in Nursing from Western Governors University.