Why the Clearinghouse Sends Claims to Another Clearinghouse

Medical billing involves use of intermediaries to help in claim processing. While this is not an easy task, it is simplified with use of the right claim processing software. The claim processing software receives and interprets claim codes sent by a health service provider. The software is managed by the clearinghouses. The role of clearing houses is to scrub claims. They check the claim for errors and verify that is compatible with the payer software. The payer is the insurance company. The clearing houses also check to confirm that the procedural and diagnosis codes submitted are valid. They also verify that each procedure code is appropriate for the diagnosis code it is submitted with. The scrubbing prevents time-consuming processing errors. Learn more about   claims processing software, go here. 


It is the role of each provider to select the clearing house it wants to use to submit claims. The clearing house charge the provider fro each submitted claim. An additional fee may be charged to send a paper claim to the certain payer. The clearing house can send the claim directly to the payer. Sometimes, they may have to send to another clearinghouse before the claim reaches the payer. Find out for further details on 
claims clearinghouse right here.


Here are reasons why a clearinghouse can send the pay claim to another clearing house. One is that the provider software is not compatible with the payer processing software. In this case, the information has to be reformatted before it is sent to the payer. A provider needs to enroll faster to a clearing house to avoid the potential difficulties associated with incompatible software. During the enrollment period, the clearinghouse tests the compatibility between the provider software and the payer software. The period can take up to four weeks. It is good that provides be mindful of thus as it can cause delays in their claim processing. A provider should verify the enrollment before submitting claims.

Another reason why a clearinghouse forwards the claim to another clearinghouse is the payer is not enrolled in the same clearinghouse the provider uses. Both the provider and the payer pay for the clearinghouse. Each payer is identified use the EDI number which serves as the payers address. It tells the clearing house the payer who should receive the claim. If the payer is not enrolled in the same clearinghouse with the provider, the claim is sent to the clearinghouse the payer is enrolled to. If your clearinghouse is one that keeps on sending claims to another clearinghouse, better you look for a larger one for convenience purposes. Take a look at this link  https://www.entrepreneur.com/article/37890 for more information.