What Is A "Clearinghouse"?
Clearinghouses gather claims information electronically from various sources via modem. Clearinghouses edit, format and submit this information directly to insurance companies for payment. Clearinghouses have the ability to meet the requirements of each insurance company using their specific computer formats. They can submit electronic claims to any insurance company in a format that will exactly match that of the insurance company's computers. This clearinghouse task is essential for electronic claims as it is too complex and costly for independent billing services to perform on each claim.
Why You Need A Clearinghouse
Clearinghouses have the ability to meet the specific requirements of each insurance company and their particular computer formats. Therefore, they submit electronic claims to any insurance company in a format that will exactly match that of the insurance company's computers. This task is essential for electronic claims as it is too complex and costly for independent billing services to perform on every claim.
To Name A Few...
ELECTRONIC TRANSLATIONS & TRANSMITTALS (ET&T) - Outstanding customer service is offered by this clearinghouse. You can submit both medical and dental claims to ET&T. There is a one-time setup fee of fifty dollars. Thereafter, there are no annual fees or per doctor fees. ET&T charges 35¢ per claim and there is no cost for resubmitting rejected claims. ET&T provides unlimited free customer telephone support.
HEALTH EDI SERVICES - Combines two clearinghouses previously known as CLAIMNET and EQUIFAX. Health EDI is the claims processing arm of National Data Corporation (NDC.) NDC is also the parent company of Lytec Systems. You can file both medical and dental claims through this company. Health EDI charges a $300 annual fee and thereafter the cost is $50 per doctor per year plus 47¢ per claim.
INTERNET CLEARINGHOUSE (claimsnet.com) - This clearinghouse is entirely Internet Web based. There is a $199 initial one-time setup fee. You can submit unlimited claims for $19.95 per month. This clearinghouse provides free support via telephone and e-mail for the first ninety days and free unlimited e-mail support thereafter. There is a per incident charge of $60 for telephone support beyond the first ninety days.
MEDE AMERICA -Previously known as Electronic Claims & Funding, or EC&F. This is the nation's largest dental electronic claims clearinghouse. There is a one-time setup fee of $500 and thereafter the cost is an annual per doctor fee of $50 plus 50¢ per claim.
Note: We recommend and encourage you to use ET&T or Claimsnet.com as these clearinghouses offer excellent customer service. We offer consultation to help you decide which will best fit your needs.