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Important Things to Know Regarding the Medical Claims Clearinghouse

There are several types of claims clearinghouses because there are also many medical claims that you can find like the DME claims, pharmacy claims, dental claims and several others. You may also find such medical professional claims. The easiest way to explain what such claims clearinghouse can do and the services which they provide is to paint a picture of the problem which they solve and such is known to be the piece of the puzzle.

Can you just imagine the million licensed healthcare professionals that utilize different claims software and they are sending medical claims to more than 4000 insurance carriers a day? Across the 50 different states, with each state having their respective insurance regulations and every carrier using their own internal software infrastructure.

For several years, medical claims processing has been done on paper. But, the manpower required for the thousands of insurance carriers to deal with all of such paperwork and phone calls which every claim error would produce represent a huge cost to the healthcare which the beneficiaries would pay through insurance premiums.

Well, the healthcare claims now are being processed or transmitted electronically. But, you don’t have the US Postal Service to deal with the transmitting process. Those electronic claims clearinghouses were made by the Medicare as well as the large payers to step in electronically where such postal service was not able to and pre-screen for the claim errors and also act as the air traffic controllers and speak of the electronic claim submission.

The clearinghouses are known to be the aggregators or the senders and receivers of so many electronic claims information and most of them are done through the software. As every claim would trigger various actions, the large clearinghouses these days are processing trillions of transactions annually. Medical claims clearinghouses are electronic stations or they are centers that allow the healthcare practices to transmit the electronic claims to the insurance carriers in a secured way that would protect the health information of the patient or protected health information. Aside from that, the clearinghouses are offering medical billers and billing managers a method to consolidate all electronic claims and also manage them from a single place, from a dashboard control panel that is similar to online checking.

Be aware that there are several benefits that you will be able to get from the medical claims clearinghouses. However, it is very important that you look for one that offers premium services so that you can just focus on the things that need your time. Because of such, you should also take the time to compare the many options that you can find prior to making a decision.

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