The function of the medical billing clearinghouse is to act as the middleman between the medical service provider and the insurance company. The professionals have a medical billing program that will be used to generate a claim file that they then forward to the clearing houses. The function of the medical billing clearinghouses will then be of importance at this point because they will check for errors in this file that have been committed during the filing process and then forward to the insurance companies. The clearinghouses ensure that the electronic claims pass the inspection tests. The file submitted to the insurance company will then be accepted or rejected. Once the claims are evaluated by the insurance company, they can be accepted and the doctors paid and those rejected will then have to be refilled. The medical billing clearinghouses have many advantages that it brings. The benefits are discussed below.
One benefit associated with the medical billing clearinghouse is that they will bring convenience to both the payer and the provider of the medical services. To be paid by the insurance companies, the medical service providers will need to give all relevant information in the files that are generated by the medical billing software. At times, the information that is in the files that are generated by the medical billing software may not be enough or may be irrelevant. This is where the medical billing clearinghouses come in to ensure that they scrutinize all these claim files and make the job simpler for the staff who work in the insurance companies.
The next importance of the medical billing clearinghouse is that they act the integration between the payers’ software and the medical service provider’s software. There are different programs are used for the medical billing by the doctors and the insurance companies. These are not compatible with each other and the files that they give as the claims may not be accepted by the other programs. The medical billing clearinghouse is of great importance when it comes to this as it will ensure that the different programs communicate through the Electronic Data Integration (EDI) such as the Apex EDI.
The medical billing clearinghouses bring convenience to the people. Many people have medical bills that require being settled by their insurance companies. Most of this would not be possible for most of them because some complications can be so expensive to the patients. The medical billing clearinghouses have brought the advantage of preventing medical billing corruption by the insurance companies and this has prevented the presence of surprise medical bills.