Electronic Medical Billing – Do you need to use a clearinghouse or bill directly to insurance companies

Medical electronic billing – through clearing house or go direct

Most people think that the only choice is whether you invoice on paper or submit your expenses electronically. Deciding to submit your claims electronically opens the door to many other decisions to be made.

First, is your software suitable for electronic archiving? If you are not sure, check with your software vendor. Most likely, if your software is capable of handling the NPI number, it is capable of electronic archiving.

Once you’ve determined that your software is suitable, you’ll need to decide whether to use a clearing house. A clearinghouse takes all of your electronic claims and routes them to the appropriate insurance companies. All electronic claims would be merged into one file and then uploaded to the clearing house. You will then receive reports from the clearing house on the status of all claims you have uploaded.

This method has its advantages because you don’t have to separate the claims, you just have to merge them and submit them in one file. The clearing house usually charges a fee per claim of approximately $0.39 per claim. If you file a lot of claims, it can get quite expensive.

Most clearinghouses will also drop and mail for you any claims that cannot be submitted electronically on paper. Some offices like this method because they can just bundle ALL the claims and send them to the clearing house and be done. There is no printing, putting in envelopes and mailing. Usually, the drop-to-paper charge is slightly higher than the per-claim fee for electronics.

Another method of medical electronic billing is to submit them directly to the insurance company yourself. In addition to your practice management system, you will need special software to do this, but you are essentially acting as your own clearing house. The necessary software can be costly, but you eliminate the fee per claim. If you’re filing a large number of claims, the cost could be worth it. As a billing service for over 50 carriers in the US, this option works well for us.

We set up right away with our largest carriers, Medicare, Excellus, Medicaid and a few others. Then the rest of the claims go through a company that acts as a clearing house. Submitting directly to the insurance company can save up to 3 days of processing time.

See also  Used book classifications for collectors

So once you’ve decided that you want to file your claims electronically, you’ll need to determine which method is best for your office. Be sure to explore all of your options. Good luck!