Electronic billing clearinghouse: how to choose the right one for your needs
How do you go about finding the right electronic billing clearinghouse for you? It’s pretty easy to find the right one when you know what to look for.
You need to gather a bit of information before you start comparing benefits. Gathering your information before you begin will make it much faster for you to find the eBilling clearinghouse that’s right for you.
Remember, not all insurance can be filed electronically. Medical claims processing is changing with emerging technology, but not everyone is on board yet.
We suggest that you check out at least 2 or 3 different companies; the more the better. Over time, the difference in cost can be substantial. You will need to know:
o What insurance companies are the most important to send electronically? Or another way to ask is which insurance companies are the largest in your area? Generally, Medicare is big, closely followed by Blue Cross Blue Shield. Choose the ones for which you submit the most claims and which companies require electronic filing.
o How many claims do you submit in a week or month that can be submitted electronically? Once you know which insurance companies you want to submit electronically and how many claims you submit, you’re ready to start comparing options. Now you want to know:
o Is this electronic billing clearinghouse capable of e-filing with the insurance companies I want? They will have at their disposal a list of all the companies with which they are currently established for electronic transmission. Check your list to make sure your big companies are on it. If there are one or two that aren’t on it, but most are, be sure to check how often the list is updated. You may want to check with a Clearing House representative to see if that company has been recently added or is in the process of being tested, meaning it will be listed soon.
How much do you charge? Is it a fee per claim? Is there a monthly minimum? How much if they lower the claim to paper? Do you have a setup fee?
Do you offer support with your service, or is there an extra charge?
Some of the ones you check may not be equipped to send electronically to all the companies that are important to you. You will need to decide how important the company is or find out if it will be added soon.
Prices will vary between clearinghouses. But you’ll want to compare all aspects, not just price. Be careful choosing the one that’s right for you, but don’t be afraid to switch if it doesn’t work out at some point.
We started with an Electronic Billing Clearinghouse which we thought was a good one, and it turned out to be run by a couple of people out of their garage! We had to change and we had to change fast. Fortunately, we didn’t have a lot of money committed to the first one. The second one we used worked very well, until a larger company bought them. We then switched to software that allowed us to act as our own electronic billing clearinghouse. That worked fine for several years, but another purchase later and we went back to looking. We have bought another program to do it ourselves and it is working very well. This may seem like a lot of change, but considering it was over a 14-year period, it really isn’t. My point is, if something doesn’t work, find something that does!