Defining the Role of a Medical Billing Clearing House

The importance of a clearing house in the medical world cannot be overemphasized. Also called Third Party Administrators (TPAs), clearing houses make healthcare payment seamless by serving as a link between the hospital, patient, and insurance provider.

The role of the clearing house is to interact with the billing system of a hospital, clinic or physician’s office to evaluate medical claims. It sets up necessary documents for patients with claims before forwarding them to the insurer. Typically, a clearing house has strong ties with various insurance providers.

Clearing houses aren’t restricted to just collecting documents and ensuring proper documentation for the claim/claims of patients, they are also saddled with the responsibility of analyzing reports from insurance providers, recording insurance reports, and filing claims both manually and electronically.

It is quite a task for hospitals and providers to be in touch with the various insurance providers. This will also distract them from the primary responsibility of healthcare and health management.

Simplification of this claim accumulation and collection process is the role of a clearing house and this makes it possible for hospitals and providers of healthcare to liaise with one entity instead of having to interact with various providers of health insurance services. A clearing house may either be a public or private entity.
Some of the benefits of using a clearing house include, data accuracy, secure transfer of relevant data, paperless management of claims, fast, clean, and efficient submission of claims, reduction of billing errors.

Summarily, the functions of a clearing house are:

● Submission of claims
● Payer remittance and posting
● Denial management
● Patient billing
● Delivery of real time reports and analysis

POPULAR CLEARING HOUSES TO CONSIDER

i.
Availity: Based in Florida and a recent recipient of the Governor’s Business Ambassador Award, this clearing house provides a secure multi-payer portal for hospitals and providers of healthcare.

ii.
Trizetto Provider Solutions: They facilitate electronic transactions in Guam, Puerto Rico, and all states in the United States of America. They do not only offer a streamlined solution for workers’ claims for compensation, they are also specialists in the conversion of paper payments to remittance files.

iii.
Navicure/Zirmed: This is an award-winning clearing house. They offer a software solution which is cloud-based and useful for streamlining the process of healthcare or medical billing.

iv.
Emdeon: This is a renowned clearing house that offers payment cycle management. They are also specialists in revenue management and they also serve as a link between patients, providers of insurance services, and clinics/hospitals.

FACTORS TO CONSIDER WHEN SELECTING A CLEARING HOUSE

i.
Budget: This is probably the most important factor to consider. Clearing houses offer different packages at different costs. Therefore, you should find out what the cost and financial implication of partnering with them is. Ultimately, your budget and. financial capability will determine if you should opt for a web-based solution or a cloud-based product.

ii.
Compatibility with your medical billing system: The solution offered by your preferred clearing house must sync seamlessly with the medical billing software used in a facility. Software compatibility is very important and cannot be compromised.

iii.
Ease of use of the clearinghouse interface: Good UI/UX is also of high importance because it helps minimize the efforts needed to train people and improves the efficiency of running billing processes.

iv.
Customer Support: A good clearinghouse should have real time customer support such as chat and messaging options so that billers can be accessed with ease. Apart from that the clearinghouse should be available all the time to provide response to queries, complaints, and inquiries.

View all Articles by: Kary C. - OMG, LLC. COO