A medical billing clearinghouse acts as the middleman between the medical service provider such as the doctor, dentist or the chiropractor and the insurance company who are the payers. This has been made possible by the presence of the medical billing software that will be used by the professionals to generate a claim file which is then sent to the clearinghouses. Once the claim file which is in an electronic form is forwarded to the medical billing clearinghouses, they will then check for the errors that are in the files and if there are no errors, they will then forward them to the insurance companies. The clearinghouses ensure that the electronic claims pass the inspection tests. The file submitted to the insurance company will then be accepted or rejected. The claims that are accepted will have the medical service providers paid by the insurance company while the rejected files will be sent back for additional information. The medical billing clearinghouses have a lot of advantages that they bring. Some of these benefits are discussed in the text below.
One benefit associated with the medical billing clearinghouse is that they will bring convenience to both the payer and the provider of the medical services. The information that is required to be in the claim file is much and requires concentration so that one can fill all the required info. At times, the information that is in the files that are generated by the medical billing software may not be enough or may be irrelevant. The function of the medical billing clearinghouses is to ensure that the information is the electronic files for the claims is correct and they will be able to correct the errors so that they will make the job easier for the insurance company to process the claims.
The next importance of the medical billing clearinghouse is that they act the integration between the payers’ software and the medical service provider’s software. The medical service providers and the insurance companies all use programs that are varied. With the different software the files that are the claims will be different and cannot be handled by a different program. The medical billing clearinghouses will act as the integration between the two software and they are able to communicate through the Electronic Data Integration (EDI) such as the Apex EDI.
People will also experience convenience through the medical billing clearinghouses. There are a lot of people who will need their medical bills to be taken care of by the insurance companies. The health problems that the patients have may be expensive to cater for as individuals. Medical billing corruption has been reduced by the presence the medical billing clearinghouse which has also reduced the presence of the surprise medical bills to the patients.