IN THIS ARTICLE:
- What does a clearinghouse do during claims submission?
- How does a clearinghouse facilitate accuracy and efficiency?
- An exploration of TrueSight’s direct clearinghouse connection
The Role of Clearinghouses in DME Claims
When it comes to DME billing, speed and accuracy are both vital for a healthy revenue cycle. Getting things right the first time means fewer rejections, fewer bottlenecks, and more cash flow. Billing is a complex job with countless moving parts, which is why it’s so crucial to have stops along the chain to double-check for accuracy. The clearinghouse is one such stop.
Clearinghouses serve as a vital bridge between DME providers and insurance payers, streamlining the submission process for the convenience of both parties. Still, some DME professionals may not understand how or why clearinghouses are essential for their process. This article explains what clearinghouses do for your claims submission process.
So, What Does a Clearinghouse Do During Claims Submission?
Your clearinghouse acts as an intermediary to handle the more technical aspects of claims submission. Because accuracy is vital to approval, this often means cleaning up any errors before payer review. Here’s how it typically works:
1. Validation and Scrubbing
When you, the DME provider, submit a claim, the clearinghouse checks for mistakes, missing information, or improper formatting across all fields. This process is known as claims scrubbing. It generally involves:
- Ensuring the accuracy of both patient and insurance information
- Verifying correct procedure (CPT) and diagnosis (ICD-10) codes
- Catching any and all errors that could be cause for denial
2. Standardization of Formatting
Every payer has specific requirements for claim submissions — keeping track of them can be excessively time-consuming. The clearinghouse formats claims on your behalf for each payer to reduce issues and facilitate faster acceptance.
3. Submission to Payers
Once your claims are validated and formatted to standard, the clearinghouse submits each one to the appropriate payer, whether that’s Medicare, Medicaid, or a private insurer. Sometimes this happens in real time; sometimes it happens in batches.
4. Tracking and Feedback
Post-submission, clearinghouses track claims and offer feedback for providers and updates on acceptance progress. This gives the provider some freedom to correct rejected claims as needed and resubmit them once changes have been made.
Empowering Accuracy and Efficiency
The advantages of a clearinghouse for the submission process are plain to see. Manual formatting and validation alone would take untold hours for busy providers, and that doesn’t even scratch the surface of manual submissions and resubmissions to each payer. The clearinghouse streamlines the process by acting as a vital hub for information, formatting, and error correction, all in one.
TrueSight’s Direct Clearinghouse Connection
The benefits of clearinghouses have made them a long-standing staple in DME billing. Now, TrueSight offers a way to take that efficiency to the next level through the power of API integration. Currently, TrueSight is the only DME software to feature a direct clearinghouse connection, providing several game-changing advantages over the traditional approach:
Real-Time Error Feedback
Say goodbye to overnight batch runs. TrueSight empowers your DME billing with real-time error feedback on individual claims. This means your team can:
- Instantly identify what’s wrong with your claims in progress
- Make corrections on the spot before the actual submission
- Develop skills with opportunistic learning instead of textbook knowledge
- Reduce rejections and save time from resubmissions
TrueSight: The DME Platform Designed for Clarity
As the industry and its numerous regulations continue to change around you, your tools should be evolving as well. Elevate your clearinghouse advantages with software designed for clarity — TrueSight puts all the tools for streamlined billing right in the palm of your hand.
Experience the TrueSight Advantage for Free
Want to see what a direct clearinghouse connection, real-time feedback, and comprehensive clarity look like firsthand? Now, you can. Contact the TrueSight team for a personalized demo of the platform and its features — absolutely free.
Seeing is believing. Contact TrueSight for your FREE DEMO today.