2 min read

Clearinghouse 101 – a re-introduction to automated claims processing

By Prime Care Tech Marketing on Fri, Mar 25, 2016 @ 07:00 PM

pCL-Blog-Clearinghouse-Basics.jpgNow would be a good time to get back to the basics, the essentials, of what a clearinghouse is and offers. “Clearinghouse 101” – an introduction to the some of the critical features and benefits of a claims clearinghouse. Whether you are using one today or not, take a peak. You may find some of the following tips and points useful.

One portal does it all

A clearinghouse becomes the one-stop shop, the aggregator, for all claims processing actions - all in one portal with a single sign-on to submit, respond to, monitor, and manage all claims submitted to Medicare, Medicaid, Managed Care, private insurances, and other 3rd party payers. Within the portal, billers can make changes or corrections to the claims and have access to DDE, HETS, and claims-in-process.

A claims translator

The clearinghouse takes the claims created within billing software and should run them through a scrubber to make sure that they are compliant with each payer’s requirements. If the clearinghouse find errors, it notifies the billers which claims need what information. Once the clearinghouse verifies that the claims are complete and comply with the payer billing requirements, it converts them into a format readable by the payer and forwards the claims. As a link between the provider and its payers, in essence, a clearinghouse is a claims translator.

Not a billing service

Periodically, someone will ask us if we, a clearinghouse, are a billing service. The straightforward answer is, “No.” A clearinghouse works with a provider's billing service/billers to complete the revenue cycle and to get cash back in your hand.

A convenient tool to monitor, manage, and follow-through

Submitting the claims is one thing, monitoring and follow-through are another. The clearinghouse portal enables you to see into what is happening with the claims once the payer has accepted them. Through the portal, billers can view the entire lifecycle of the claim and take action as needed to keep the claims flow steady.

Create secondary claims automatically

Please refer to this blog to learn more about how a clearinghouse should help to process secondary claims automatically and timely.

Claims data storage

Our clearinghouse, for example, securely stores the data up to 10 years, retrievable for the provider at any time.


Experience and expertise are the foundation of a responsive and reliable support system. A clearinghouse can identify what is acceptable and answer claims submissions and processing questions.


A clearinghouse should have a core set of useful reports to help billers, their managers, and the executive team to track and trend the claims cycle. The reports offerings should help providers to track their billers and claims.  

The bottom line

From a benefits point of view, what does a clearinghouse offer?

  • Simplicity - An effective clearinghouse makes the submission and management of claims simple, easy to learn, and monitor – a single location for claims management.
  • Efficiency - From clearinghouse.org, we find that “the average error rate for paper claims is 28%. But using the right clearinghouse can reduce that to 2-3%.”
  • Control – A clearinghouse delivers a provider-specific portal which serves as an all-in-one centralized location to monitor, manage, and extract necessary information.
  • Speed – A clearinghouse facilitates quicker claims turnaround with higher claims success.
  • Peace of mind – With a clearinghouse, billers have the confidence that they can track all claims easily throughout the entire claims-based revenue cycle.

It all makes cents.

Topics: clearinghouse HETS Medicare claims DDE CLIP claims clearinghouse revenue cycle paper claims Managed Medicare Medicaid claims claims scrubber software portal intermediary claims cycle
2 min read

Do Yourself a Favor - Simplify the Reimbursement Process

By Prime Care Tech Marketing on Mon, Dec 21, 2015 @ 04:29 PM

With a Claims Management Solution - The gift that keeps on paying

Reimbursement Clearinghouse ClaimsAdmittedly, the reimbursement process is complicated. Not only must billers identify who is to pay the bill, they have to know how to bill the payer and get paid as quickly as possible. This is especially the case when billing third party payers, such as Medicare, Medicaid, Managed Care, and private insurances. Each has its own requirements as far as coding, bill timing, and claims processing quirks are concerned which seem to change frequently. If billers are having to prepare, process, track, and follow up with claims manually using spreadsheets, phone calls, emails, letters, logs, and on and on, it is no wonder that billers are stressed and overwhelmed, that dollars are left on the table and claims are lost or misplaced. Reimbursement, or revenue cycle management, does not have to be complicated, however. In fact, it can be relatively simple with an automated claims management solution through a claims clearinghouse. But, buyers beware. Let’s take a closer look.

Keeping it simple – clearinghouse musts

Let’s assume that the strengths of automating claims management are a given. Specific clearinghouse features can considerably contribute to claims management simplicity. To help simplify and accelerate converting revenue to cash, a clearinghouse, like primeCLAIMS, should be able to do the following:

  • In the event a claim is rejected, the clearinghouse should be able to isolate specific claims, not reject the entire batch of claims.
  • The solution should give billers the ability to edit, scrub, monitor, and manage claims throughout the process.
  • The clearinghouse must be able to stay on top of the almost daily changes to submission requirements, even the most obscure.

Visibility and control – an AR manager’s dream

Visibility and control with an enterprise-class claims solution also contributes to process simplification. With one log-in:

  • Billers can connect directly to all Medicare payers via CMS-approved NSVs (Network Services Providers)
  • Billers should have access to tools needed to manage claims, DDE, ADR status tracking, eligibility, secondary billing, and claims denied.
  • AR managers can view each facility’s claims status and provide assistance where necessary.

Such simple tools to help speed cash flow with fewer rejections and cleaner claims. They also reduce costs by:

  • Eliminating unnecessary paperwork
  • Reducing transaction fees
  • Reducing labor through elimination of such labor-intensive inefficiencies as:
  • Log-ins to multiple systems to view all locations, determine eligibility, edit, and track all claims
  • Manually compiling and submitting secondary payer claims

Simplicity in claims processing and managing also delivers peace of mind with:

  • HIPAA checks
  • Up to 10 years of data stored online

The bottom line

Using a clearinghouse to process, submit, and monitor claims yields numerous cost savings and improved cash flow. It’s much simpler and it just make cents.

Claims Process

Topics: automated claims management revenue cycle management claims processing coding rejected claims unnecessary paperwork reimbursement process claims clearinghouse reduce labor-intensive inefficiencies reduced transaction fees


Posts by Tag

See all