Electronic billing software uses software edits to ensure speedier payments. You must remember at least one time when you submitted a claim, waited over a month to get the check from the insurance carrier, but instead got a letter stating that you were missing information and you have to resubmit the claim. This will not happen with electronic submission. This is because the software will check for missing data, invalid codes, and mismatched diagnostic-procedure codes. You will get a report back after your transmission telling you which claims were accepted and which ones had errors. In addition, you will be told what those errors were so you can go back and correct them and resubmit the claim. This should take you no more than two to five minutes - much less than the one month you were subject to in the past. Some states are beginning to require electronic billing, and refusing paper claims
How does it work? During each day you will create claims as you usually do. However, instead of printing to paper you will tag the records for electronic submission. At the end of the day you will "compile" all of your claims into a file. Next, you will dial into the electronic billing service using a local number and transmit the file. The next day there will be a report with how many claims you sent and how many were "error free" and where sent to the appropriate insurance carriers. Any claims with mistakes (wrong ICD code, invalid dates, missing information) will be displayed with the errors. If you sent these claims by paper you may not find out they were rejected until after four or more weeks. Using electronic billing you'll know the next day, correct the problem and resubmit them; you'll get paid for a higher percentage of claims in less time.
How much does this service cost? The software module which is seamlessly attached to the main program is $600. The one-time registration is $150. This module will take your data and create a file that is ready to send over the telephone line. The module will dial into a processing center that will take your claim and disperse it to the proper insurance company. Each claim will cost 40 cents. There is no monthly or yearly minimum. Some companies will charge you $750 to $1000 a year just for using their software; not us!
Why use a Clearinghouse. Well, Medicare is always making changes to the submission format. If these changes are not met the claim will be rejected. Programmers at the processing center are always working in order to keep their format up to date with the insurance companies' specifications. The Clearinghouse takes care of all this and keeps up to date with Medicare, Blue Cross, and all other insurance companies' changes behind the scenes. As a user, you never have to worry if your system is up to date.
You must enroll with the Clearinghouse. For a doctor there is a one time fee of $150. If you are a billing service, your first doctor is $150 and each additional doctor is $50. This is a processing fee in order to obtain agreements and submission numbers with the insurance companies you use. The Clearinghouse does more then just provide a means for claims transmission; they offer assistance and support with the transmission and processing of your claims. They also provide you with concise daily, month-to-date and yearly financial reports.
The shorter processing time and higher percentage of error-free claims will increase office efficiency and revenue. Your claims will be processed faster and more claims will be accepted.