Friday, 30 December 2016

The Benefits of Clearinghouses for Processing Claims

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When the healthcare industry began transmitting claims electronically, Medicare and large insurance payers envisioned clearinghouses as a way to manage the flow of information. Clearinghouses are software-based hubs that allow healthcare practices to transmit protected health information in a secure, efficient manner. Healthcare facilities can consolidate electronic claims and manage them from a single location through an online dashboard. After clearinghouses scrub claims, they transmit electronic claim information securely to the insurance carrier for reimbursement.

Clearinghouses pre-screen billing claims for errors and simplify the immense amount of information sent between and among patients, payors, healthcare providers, and insurance companies. One trade organization aptly describes clearinghouses as the air traffic controllers of electronic claim submissions.

ClinicTracker’s billing system lets you submit claims directly to a payor, cutting out the middleman and avoiding clearinghouse subscription fees. However, ClinicTracker also partners with industry leader TriZetto Provider Solutions (formerly Gateway EDI) and other clearinghouses for clients who prefer using a centralized system for claims processing.

Our seamless system handles the entire claims process – including claim status and your receivables. Integrating with our clearinghouse partners via ClinicTracker allows you to monitor all transactions, create reports, manage cash flow, and track the claims process in an intuitive, customizable format. 

While free clearinghouses remain an option, they offer no support interaction. That means payors will not talk to ClinicTracker directly, which delays the process. Nor do free clearinghouses offer integrated insurance eligibility requests or rolled up denial/rejection reporting.

With our partner clearinghouses, on the other hand, electronic data support makes it faster and easier to resolve claims rejections and denials. Clearinghouses also eliminate the need for separate workflows to submit claims for each payor; the system can send all claims in one batch, making claims easier to track. Clearinghouses also can return 835 ERAs, which detail claims’ payments. All these functions mean less frustration for the client as well as the clinic.

Our partnership with TriZetto Provider Solutions allows practices to implement an integrated clearinghouse solution designed to help practices successfully reduce manual processes, decrease errors in claims submissions and move from reactively managing rejections and denials to proactively catching problems before claims are submitted.

“The end result is accurate and increased revenue collection, accelerated cash flow and decreased days in A/R,”” says Kristin Weir, TriZetto’s senior manager of product management. “We are focused on developing solutions that help practices thrive financially and efficiently so they can spend more time on their primary goal: caring for patients.”

About ClinicTracker

ClinicTracker is a robust, future-proof mental health and substance abuse EHR. Dr. Michael Gordon, a renowned clinical psychologist, and Joshua Gordon, an award-winning software engineer, founded the company in 2000. ClinicTracker EHR’s powerful software empowers your agency to succeed. ClinicTracker will automate all of your clinic routines, boost staff productivity, increase billing efficiency, and provide the tools you need to manage your clinic effectively. While mental health and substance abuse agencies are the most common group of users, foster care agencies, social services, equine assisted therapy programs, university clinics, academic counseling systems, family counseling services, and eating disorder clinics also take advantage of our powerful software.

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