Are you looking for the best clearinghouse for medical billing? If YES, here are 9 best clearinghouses for medical billing.
A healthcare clearinghouse basically serves as the middleman between healthcare providers and insurance payers. A clearinghouse checks medical claims for errors, ensuring the claims can get correctly processed by the payer. Interestingly, claims are subjected to rejection or denial because of human error.
Insurance companies return rejected claims to billers because they contain one or more errors and need to be corrected. Clearinghouses use scrubbing to make sure claims are not rejected.
This is how clearinghouses work; when healthcare facilities install medical billing software, each claim becomes a file known as an ANSI-X12- 837. The software uploads the file to your medical claims clearinghouse where it is checked for errors, then transmitted electronically to the payer.
Each transmission takes place over the secure connections required by the Health Insurance Portability and Accountability Act (HIPAA). Please note that the way clearinghouses work is that the payer can either accept or reject the claim.
Once they make their decision, your clearinghouse receives a status update and adds them to the control panel on your machine.
Your claims department can make changes from there and resubmit them for payment. The payer will only send you money through an electronic funds transfer (EFT) and an explanation of benefits if the claim doesn’t require any corrections.
The process is similar to what is obtainable in banking, with financial institutions sending secure transactions electronically, checking them for errors at each step along the way. If there is a breakdown at any point, the transaction can be tracked so no information is lost and errors can be quickly corrected. Having said that, here are some of the best Clearinghouses for medical billing that you should consider.
Best Clearinghouse for Medical Billing in 2023
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Top-Notch Medical Billing Clearinghouse
Top-Notch Medical Billing Clearinghouse is no doubt one of the best clearinghouses for medical billing that you can get out there. Top-Notch Medical Billing Clearinghouse is part of AdvancedMD billing software designed to maximize your profitability.
Top-Notch Medical Billing Clearinghouse billing software also includes an A/R control center, centralized billing, built-in payment processing, and more. Here is how Top-Notch Medical Billing Clearinghouse works: When you post charges, claims are automatically scrubbed for accuracy within seconds.
You can immediately submit claims from a single portal to their networks of carriers & track them with the integrated claim adjudication log. You may have hundreds of payers, now you have a single page to submit charges to all of them.
Availity Medical Billing Clearinghouse
Availity is a free Florida-based service that offers medical practices clearinghouse and revenue cycle management products. It offers access to a secure multi-payer portal (Availity Portal) that provides users with access to multiple health plans, allows them to check eligibility, and acquires real-time authorization.
The health information network recently won the Governor’s Business Ambassador Award for its contribution to the nation’s economy.
As the nation’s largest health information network, Availity facilitates over 4 billion clinical, administrative, and financial transactions annually. Availity’s suite of dynamic products enables real-time collaboration for success in a competitive, value-based care environment.
Emdeon is the nation’s largest clearinghouse and is a leading provider of revenue and payment cycle management and clinical information exchange solutions, connecting payers, providers, and patients in the U.S. healthcare system. Emdeon’s offerings integrate and automate key business and administrative functions of its payer and provider customers throughout the patient encounter.
Through the use of Emdeon’s comprehensive suite of solutions, which are designed to easily integrate with existing technology infrastructures, customers are able to improve efficiency, reduce costs, increase cash flow and more efficiently manage the complex revenue and payment cycle and clinical information exchange processes.
Navicure recently merged with ZirMed and now operates under both Navicure and ZirMed brands. The revenue cycle management company offers a one-stop cloud-based software solution (ClaimFlow™) that streamlines medical billing processes from initial claims submissions to an analysis of patient eligibility, claims editing, remittance, denial, and appeal management.
The company has received four “Best in KLAS” awards, including one this year. Using Navicure / ZirMed Clearinghouse will help you drastically reduce error rates. Paper claims have errors that result in denial an estimated 28 percent of the time. Navicure / ZirMed clearinghouse can cut that number to between two and three percent, save manpower.
With Navicure / ZirMed, you can send claims in a batch instead of submitting them one at a time and spend less time correcting medical billing mistakes.
Office Ally is a HIPAA-compliant clearinghouse that offers web-based services to healthcare providers for free. It works with around 5,000 payers nationwide and offers 24/7 customer service, free setup, and training. Additionally, the service also allows medical practices to use their own software to create and submit insurance claims electronically.
One of the benefits of using Office Ally medical claims clearinghouse is that you will receive quick updates once you submit claims. Once you upload claims, scrubbing them for errors and submitting them to payers takes minutes. You should know the same day if claims were accepted or if they need to be corrected and resubmitted.
Trizetto Provider Solutions
With more than 340,000 providers, TriZetto Provider Solutions helps practices maximize revenue by securing accurate reimbursements, decreasing claims rejections, and improving turnaround time for patient payments. Trizetto Provider Solutions also help healthcare providers prepare for and manage through industry change.
Trizetto Clearinghouse allows you to process professional, institutional, dental, and workers’ compensation claims. Direct payer relationships allow electronic transactions in all 50 states, Puerto Rico, and Guam. It has 8,000+ payer connections including primary, secondary, ERA, eligibility, dental, and work comp.
It provides integration with more than 650 electronic health records/practice management solutions. Here are Other features under Trizetto Provider Solutions include the following:
- Streamlined solution for workers’ compensation claims
- All claim formats accepted — NSF, print image, 4010, and 5010
- Payer-specific edits catch mistakes before they become rejections
- Rejection analysis tracks common errors
- Denial’s solutions help identify denials and automate the appeal process
- Convert paper payments to postable 835 remittance files
Alveo Healthcare Technologies
Alveo Healthcare Technologies is a national full-service healthcare claims clearinghouse providing fully configurable revenue cycle management solutions, intuitive tools, reports, and processes, along with access to a team of specialists who get to know you and your needs.
The benefit of using Alveo Healthcare Technologies medical claims clearinghouse is that your organization has access to more accurate data. You can also manage electronic claims from a single location and make more precise revenue forecasts with reduced payment cycles.
EDI Insight by Waystar
EDI Insight by Waystar provides powerful, easy-to-use revenue cycle and workflow management tools that improve efficiency and minimize denials for over 450,000 providers. Our essential solutions – focused on eligibility, claims, data and analytics, audits and denials, and quality and compliance – save providers time and money so they can focus on what really matters – their patients.
When you work with Waystar, you get much more than just a clearinghouse. With EDI Insight by Waystar, you will get truly groundbreaking technology backed by full-service, in-house client support.
eMed Clearinghouse Services
eMed’s clearinghouse services provide you greater convenience by tightly integrating the electronic claims and remittance process with our Revenue Cycle Management software. You can submit electronic claims to thousands of payers and receive claim processing reports with status updates on your claims.
You can search your claims by date, patient, date of service, claimed date range or service date range, by an insurance provider, and much more. Track your claim and receive the claim status in 12 hours. With eMed Clearinghouse Services, the system will post each level of status to the claim automatically.
With the given status filters, you can view the rejected claims, fix any problems and reclaim them. Reason for rejection accompanied by a complete explanation will be posted next to each claim. You can fix the claim and reclaim the bill instantly when you make use of eMed Clearinghouse Services.