Don't Commit to a Medical Claims Clearinghouse Before Reading This

Posted by Meagan Vitek on Thu, Jun 14, 2012 @ 08:06 AM

Selecting a clearinghouse is an important decision for any practice. You need to make sure you are picking the service that is right for you, so we've put together some important things that we think you shoud consider...medical-claims-clearinghouse

Before committing to a clearinghouse, ask yourself:

  1. What is the enrollment and set up process going to require?
  2. Do they offer training for you and your staff?
  3. What type of commitment is required? Can you do month-to-month service?
  4. Is their support team knowledgeable about your specialty?
  5. What do their exisiting customers say about them? (testimonials)

In addition to our questions, we found a great list of things to ask from the Washington State Medical Association. Check a few of them out below:

  1. How will the clearinghouse affect the current physician practice management system and workflow?
  2. Does the clearinghouse offer access to payers that represent a significant portion of the physician practice? What is the relationship between the payer and clearinghouse?
  3. How are the charges to the physician practice assessed (eg, Monthly, per user, per transaction)? What is the typical term for payment (eg, net 10, 15, 30 days)? What method of payment is acceptable?
  4. What are the system requirements for the physician practice?
  5. What is the clearinghouse claims transaction process for gathering data from the physician practice and submitting the claim to the payer?
  6. Does the clearinghouse allow for real-time connection and resubmission of claims to all payers accessed through the clearinghouse?
  7. What additional services does the clearinghouse offer and, if applicable, what are the charges?
  8. What types of reports does the clearinghouse provide to the physician practice regarding claims submission and payment?

See the full list of questions here (it's on the second page!)

Also, make sure you ask about any specials, discounts, or referral programs. These are great ways to offset the cost of a clearinghouse!

We think these things are all important things to consider, but we wonder if there is anything else that you would advise a colleague to think about. Did we miss anything? If so, post a comment!

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