Health insurance has always been a highly debated topic. With more people using a larger variety of health insurance options, we ultimately have more insurance claims to file. Unfortunately, this means medical associations and individual practitioners often find themselves bogged down with more and more paperwork and medical billing can become overwhelming.  

Medical claims processing can be a stressful ordeal, so let us help you figure out what you need to know. Schedule a free live demo of Apex EDI today.  

How Medical Claims Processing Works 

We live in a world where technology is expanding at unbelievable rates. With this massive growth, the way we do things is constantly changing. What was commonplace even a few years ago may be obsolete now. The medical field is no different. While we all know that medical procedures have changed drastically over the past decade, many people don’t consider how much the work behind the scenes has changed. Whether you have been in the field for years or are just starting, we’ll show you what you need to know. 

The Old Way 

Let’s start by looking at the traditional process of medical claims processing.  

It’s a Tuesday morning and you’re still working on claims from last week. You have a pile of files on your desk. They are medical claims that need to be filed with several insurance companies. They are sorted into distinct piles based on where they should be submitted. It’s a lot to keep track of. You diligently fill out the forms. After a few hours, you can feel that familiar tension building between your eyebrows. 

Now that you’ve started to make a dent in your first pile, it’s time to start correcting the older,  rejected claims. The first few go quickly. Silly mistakes, typos, and an incorrectly spelt name. You  can’t believe you missed these the first time, but at least they’re easy to fix. Until, you get stuck  on one. You can’t see anything wrong with the form and you’re not sure why they denied it. 

You glance at your phone, then decide to set the file aside so you can deal with it later. You have  too much to do to spend a half-hour on the phone with an insurance company right now. By the  end of the day, you’re even more behind than you were this morning. Then you see that file  next to you. You forgot about it. So, you call the insurance company. 20 minutes later, you still aren’t sure what went wrong, so you put down the phone. If this  sounds familiar, rest assured that there is an easier way.

The New Way 

Now imagine it’s Friday and you aren’t behind at all. You started using a clearinghouse for your  medical claims processing. The process seemed so different at first, but you’ve gotten used to it  and now it feels like second nature.  

You simply log into the clearinghouse and upload your files. After a few minutes, you notice that  several were flagged, so you quickly go in and correct the problems. Then, the forms are sent to  the insurance companies, so you don’t have to think about it much. In fact, you’re already  getting reimbursed for claims filed a week ago! 

 You can get through more claims quickly and you know that it’s secure and HIPPA compliant.  You finally feel at ease.  

The Benefits of Using a Medical Claims Clearinghouse 

The new method for medical claims processing simplified life for those of us who do regular billing. Whether you’re an individual with a private practice or the head of a medical claims processing department that bills for many healthcare professionals, a clearinghouse can help you. But a more enjoyable workday isn’t the only benefit of a clearinghouse. In fact, we have a list of ways this service can help you! 

1. Reduced Errors

With the aid of a claims clearinghouse, you can drastically reduce the number of errors in your claims. In fact, the average error rate for claims submitted electronically through a clearinghouse is 25% lower than those submitted by paper. 

2. Make Changes Quickly

When the clearinghouse does catch an error, you can correct it quickly. Before it is submitted to the insurance company. This means that you are fixing the problem in a matter of minutes, rather than weeks and don’t have to deal with excruciating phone calls with the insurance company. 

3. Fewer Denied Claims 

Since the clearinghouse catches so many little mistakes, you can trust that you’ll have fewer claims denied. It’s nice to have someone looking out for you! 

4. Batch Filing 

Since clearinghouses process claims for a number of insurance companies, you won’t have to sort them on your own like you did when you submitted claims to each company separately. Instead, you can simply upload all of your claims at once. 

5. Headache Relief

For those moments when you do face a roadblock in your claims processing, you can be assured that you’ll have someone (other than the insurance company) to call for help. The customer services that goes along with a clearinghouse means you won’t have to figure out everything on your own.

6. An Accurate Picture of Finances 
Because the clearinghouse streamlines the process of medical claims processing, everything  moves faster. Instead of waiting weeks or even months for an insurance company to reimburse  you, you may only have a wait a few days. With less to keep track of, you’ll know where you  stand financially on a more immediate basis.

 

7. Increased Safety 
You know that the clearinghouse uses HIPPA compliant procedure and protects patient data, so  you don’t have to worry about potential violations.

8. Save Money 
Time, the old adage goes. When you combine all these benefits and your staff and patients are  happier, the productivity and profitability of your practice or billing department increases. 

Next Steps 

Now that you’re ready to work with a clearing house for your medical claims processing needs, what’s next? We offer a free live demo of our software, so you’ll be able to see how the program works yourself. Schedule your demo today.