Electronic Billing Clearing House -
How to Choose the Right One For Your Needs
By Michele Redmond, co-owner of Solutions Medical Billing
How do you go about finding the right electronic billing clearing house for you? It is fairly easy to find the right one when you know what to look for.
You need to get a little information together before you start comparing benefits. If you get your information together before you start, you’ll find it a lot quicker to find the electronic billing clearing house that is right for you. Remember, not all insurances can be submitted electronically. Medical claims processing is changing with emerging technology, but not everyone is on board yet.
We suggest that you check at least 2 - 3 different companies – the more the better. Over time, the difference in cost can be substantial. You’ll need to know:
• Which insurance companies are the most important to you to send electronically? Or another way to ask it is which insurance companies are the biggest for your area? Usually Medicare is a big one, followed closely by Blue Cross Blue Shield. Choose the ones that you send the most claims for and which companies are mandating electronic submissions.
• How many claims do you send in a week or a month that are capable of going electronically? Once you know what insurance companies you want to submit electronically and about how many claims you submit you are ready to start comparing the options. Now you want to know:
• Is this electronic billing clearing house capable of submitting electronically to the insurance companies I want? They will have a list available to you of all of the companies that they are currently set up with for electronic transmission. Check their list to make sure your big companies are on it. If there are one or two that are not on it, but most are, make sure you check to see how often the list is updated. You may want to check with a representative from the Clearing House to see if that company has been recently added, or if they are in the testing process, which means they will be on the list soon. How much do they charge? Is it a per claim fee? Is there a monthly minimum? How much if they drop the claim to paper? Do they have a set up fee? Do they offer support with their service, or is there an extra charge?
Some of the ones you check on may not be equipped to submit electronically to all the companies that are important to you. You’ll need to decide how important the company is, or find out if they will be adding them soon.
The prices will vary between clearing houses. But you will want to compare all aspects, not just the price. Be careful when choosing the one that is right for you, but don't be afraid to change if somewhere down the road it doesn't work out. We started out with an Electronic Billing Clearing House that we thought was good, and it turned out to be run by a couple people in their garage! We had to switch and we had to switch quick. Thankfully, we didn't have much money tied up with the first one. The second one we used worked great, until they got bought out by a bigger company. Then we switched to software that allowed us to act as our own electronic billing clearing house. That worked well for several years, but another buyout later and we were searching again. We have bought yet another program to do it ourselves and it's working great. This may seem like a lot of switching around but considering it was over a 14-year period, it really isn't. My point is, if something isn't working, find something that does!