Claims Clearinghouses

Written by Kimberly Clark
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Claims clearinghouses were developed to assist professionals in preparing and submitting claims to insurance companies. Their services are most commonly used in the healthcare industry. This is mainly because the healthcare insurance companies require precisely formatted and very detailed claims, which they commonly referred to as "clean" claims.

The services of claims clearinghouses are retained by both small healthcare providers, as well as by those that are rather large. The smaller ones may not have the resources to upgrade their current claims submission process to comply with the federally enacted standards. However, by outsourcing this portion of their workload to a clearinghouse, they are able to continue preparing their claims as usual, relying on the clearinghouse to translate the data into an acceptable format.

Larger providers have to deal with various insurance payers and even though the government has issued mandates for standardizing the preparation and submission of claims, many of the commercial payers have been slow to comply with the ruling. But the regulations must be followed, if filing a claim with a government payer such as Medicare. So instead of compiling and tracking claims in several different formats, the larger provider may opt instead to just submit the claim in one format, leaving it up to the clearinghouse to convert the data according to which insurance company it will ultimately be sent to.

Using Billing Software

One way to handle these transactions is to work with a software program that is fully integrated and able to smooth the submission process. However, you will want your software provider to work with a nationally recognized clearinghouse. This way, the staff can be freed up while still providing efficient tracking of all billing issues.

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