Medical Clearinghouse Reports Simplified

Have you ever been confused over the Clearinghouse Reporting system? Well, let me try and break it down in the most simplified terms:

A few years ago most medical offices were ecstatic about being able to send electronic claims (NO MORE PAPER - YEAH) but now insurance carriers are sending clearinghouses so much more information. Clearinghouses can choose to supply/support different features based on their clients needs. Identify with your Clearinghouse which reports they can supply to you.

Reports:
270 Electronic patient Eligibility Inquiry
271 Electronic patient Eligibility Response (does the patient have insurance)
275 Documentation/Medical Attachment (i.e. Texas Workers Compensation claims)
276 Claim Status Inquiry
277 Claim Status Response (is claim on file, was claim paid, why is claim pending)
278 Prior Authorization and Service Authorization
820 Remittance Advice for Managed Care Organizations
834 Medicaid Enrollment for Managed Care Organizations
835 Remittance Advice (electronic explanation of benefits or EOB)
837P Professional Health Care Claim (CMS-1500 format or HCFA 1500 format)
837I Institutional Health Care Claim (UB04 or UB92 format)
837D Dental Health Care Claim
997 Acknowledgement of Claim Status

What you may not know is that Clearinghouses also supply additional services like:
Patient Address Verification
Patient Credit Verification
Patient Credit History
Patient Ability to Pay
Claim Scrubbing
Statements (ask them how long it takes for the clearinghouse to get the statements to the post office)
Collection Letters
Logos on Statements
Appointment Reminder Postcards
Custom Inserts
Financial Documents
Online Patient Portal
Reporting Options

I have found a wonderful website which reviews many of the clearinghouses for purchase. Please visit: http://www.medicalbillingsoftwarepro.com/Medical%20Billing%20Clearinghouses.html and click on the links to read more about the services they offer.

Post a comment if you would like me to answer any follow up questions! Or if you have additional questions on Electronic Medical Billing and Claims then click here medical claims electronic billing

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