THE BENEFITS OF USING CLEARING HOUSE

  • Claims are sent electronically reducing postage and paper
  • Reduces claim errors
  • Sends claims to several different insurance payers
  • Sends a large number of claims quickly
  • Reduces time to get paid

MOST CLEARING HOUSES ALSO OFFER OTHER SERVICES SUCH AS:

  • Patient statements
  • ERA
  • Eligibility Verification
  • Patient payment processing

COORDINATION OF BENEFITS VS. EXPLANATION OF BENEFITS

  • Coordination of Benefits
    • a process whereby two or more insurance companies or insuring entities each one’s share of the responsibility for payment of a claim for health care services provided to a client who is inured by them.
    • Example: 80/20 payment.
      • Primary Payer – will carry the 80% of payable amount from the charge amount.
      • Secondary Payer – will carry the remaining 20%.
  • Explanation of Benefits
    • The EOB is sent to the patient and the provider to show how the claim processed. It also lets the provider know whether any remaining balance is due by the patient.
    • Alternative terms include Summary of Benefits, Remittance Advisory, Coverage Determination, or Beneficiary Notice.

HERE ARE THE KINDS OF POSTINGS YOU SEE ON THE EOB FOR EVERY CPT CODE LISTED

  • Amount of the procedure before any discounts are applied
  • Amount that the patient is responsible for
  • How much the contract allows for the procedure
  • The type and amount of any discounts that apply
  • The final Amount of the reimbursement after all discounts, deductibles, and so on are applied
  • That no procedure were improperly denied
  • If no payment was received, whether it was due to the entire amount of being applied to the patients deductible, the claim being denied, or some other reason.