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Guide to Switching Clearinghouses

Billing claims is difficult work. As the insurance industry continues to grow more complex, it’s no wonder more providers are turning to clearinghouse services than ever before. But with so many choices available to you for processing claims, how can you make sure your clearinghouse partner is doing everything it can to improve the health of your billing process? This guide will assist you with evaluating your current service and highlight some of the key logistics of a switch if it makes sense for your business.

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Deciding to switch

Switching your clearinghouse can seem like an overwhelming process.  It’s an essential part of your daily operations. Oftentimes providers worry their connections to payers may be disrupted or lost in the transition to a new clearinghouse. The last thing your team wants to do is manually reconnect to payers inside a new clearinghouse. Losing or spending time re-configuring connections could significantly disrupt reimbursement and cash flow. This is one of the largest reasons why providers are hesitant to try another clearinghouse, even if it has more impactful features.

We know switching clearinghouses is hard. You should partner with a clearinghouse that has a policy of reconnecting you with payers as part of the set up and implementation process. This keeps cash flowing and your team freed up for other tasks.

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Evaluating Your Current Vendor – What to ask yourself

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What level of insights do you need?

Too often, problems with your claims will go unaddressed because your clearinghouse isn't providing insights into your specific revenue cycle issues. Doing the same thing month after month won’t result in a different outcome. You need a clearinghouse service that not only offers insights, but one that directs you to take action using these insights to solve problems.

Are you happy with your clearinghouse’s level of customer support and service?

When you rely on a clearinghouse to process your claims, you’re also relying on their support team to quickly address any problems. When a vendor isn’t efficiently resolving support requests, the resulting slowdown could negatively impact your revenue cycle and reimbursement rate. Choose a clearinghouse that offers direction when you’re faced with choosing between contacting a payer or your practice management system vendor for solving an issue.

Your clearinghouse partner's support should align with the way you do business. If you’re considering switching clearinghouses, make certain the clearinghouse works with you to determine the best, most flexible support options for your team.  A clearinghouse should have enrollment and implementation teams dedicated to your exact needs. These teams should give you total transparency throughout your enrollment process so you are confident you'll meet that go-live date that's so critical to your revenue and livelihood. 

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What other services do you need from a clearinghouse?

Not every provider uses their clearinghouse the same way. While some may only need a simple connection to payer platforms, others may require full integration with their practice management system. Additionally, while some providers prefer handling their own edits, many want a service that manages all revenue cycle stages.

A more comprehensive clearinghouse solution includes:

  • Eligibility verification
  • Detailed reporting and analytics
  • Converting paper EOB’s to ERA’s
  • Claims management (scrubbing, validation and claim edits)
  • Patient statement preparation and delivery
  • ERA storage
  • Workflow management
  • Ability to submit and track dental, institutional and professional claims

It’s essential that your clearinghouse offer the additional functionality you need to manage claims. As your needs change over time, your clearinghouse should adapt with you. Clearinghouses with limited additional services force you to piece together a revenue cycle toolkit from multiple vendors.

Is your clearinghouse making you more productive?

At a minimum, you need a clearinghouse that lets you quickly and easily submit your 837’s so payers can reimburse you quickly. Unfortunately, many providers are forced to deal with managing rejections and denials when they should be working to prevent them.

The goal of any clearinghouse is to help you submit the cleanest claims possible. Clearinghouses will typically offer reporting on denied claims. If your denial rate is above average, it may be time to consider a clearinghouse that offers stronger scrubbing and editing capabilities to help you lessen your denial rates. If your clearinghouse isn’t showing you the exact cause of claim denials, then you may struggle to improve your reimbursement rate. Yes, you need a vendor that makes edits and corrective workflows simple, but they should also be guiding you toward improving your overall clean claim rate.

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Are you improving your data integrity?

The healthcare industry today generates enormous amounts of data. From practice management systems to patient wearables, the industry is constantly generating data that must be validated and processed to ensure it’s accurate and useful. The information your clearinghouse generates is no different.

You need a vendor that places a high priority on data integrity for both incoming and outgoing data, so that you can be sure the data generated on your claims is correct.

Having accuracy in your claim data requires a clearinghouse that does more than just submit your claims. Your vendor should constantly strive to offer additional functionality that takes a more holistic approach to your revenue cycle management process. When deciding on a clearinghouse, it’s essential that a vendor not only meets your current needs, but also has a road map to grow along with you. Don’t be afraid to ask what their plans are to expand capabilities down the road.

What connections do you have access to?

If your clearinghouse doesn’t offer enough direct connections to payers, you could be setting yourself up for problems. Far too many clearinghouse vendors rely on third party services for access to certain payers. If billing problems occur with these payers, a clearinghouse with limited connections won’t be able to directly engage with the payer, effectively slowing down reimbursement. By using a clearinghouse with more direct connections, you can be more confident your billing issues will be resolved quickly.

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What level of integration do you need?

Your clearinghouse might do an adequate job processing your claims, but if it’s hard to integrate claim info into your patient management (PM) system, your team is likely facing more manual entry or analysis work. You need seamless clearinghouse integration with your system to ensure that claim information is accurate and available where you need it.

If the need to change PM systems arises, your clearinghouse vendor should adapt with you. The cost and stress associated with making a switch will undoubtedly cause some stress. The ability of your clearinghouse to integrate with your new PM system shouldn’t create extra headaches.

Next steps

If you’d like to explore a new clearinghouse option, we invite you to learn more about eSolutions’ ClaimRemedi. We’ll show you how and why ClaimRemedi is more than just a clearinghouse. We think it might be exactly what you’ve been looking for.

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About Us

eSolutions is a leading healthcare technology company trusted by thousands of providers and payers throughout the industry. Our best-in-class suite of products provide powerful data analytics and workflow automation that ensure healthcare providers get paid quickly, securely and accurately. eSolutions’ unique platform delivers clear intelligence, allowing providers of all types and sizes to understand their data and use it to make informed decisions.