Clearinghouse Capabilities
Primary Claims
Primary Electronic Claims Submission
- Reduce the number of errors, rejections and denials by using our Scrubbing System and creating unlimited rules and edits for your claims - at no charge
- One interface to transmit UB-04, CMS 1500 (HCFA-1500), and Dental (ADA J400) Claims
- Track the status of your claims at all times
- Access claim data and payer responses at any time with our Lifetime Claim Data Storage
- Cost: Standard electronic transaction rate is $0.55 (Decreases as volume increases) and you are only charged once the claim is ACCEPTED by the payer
Secondary Claims
Secondary Electronic Claims Submission
- Create secondary claims with the click of a button
- Auto populate the CAS codes for all electronic secondary claims
- Payers unable to accept electronic secondary claims are printed and mailed secondary claims along with the original 835
- Guaranteed delivery of both secondary and electronic secondary claims
- Cost: Secondary electronic transaction rate is $0.55 (Decreases as volume increases)
Electronic Remits
Electronic Remittances
- Receive electronic remittances from all payers that offer the electronic 835
- Ability to auto-post 835 file
- Remittance is attached to original claim and can be accessed at any time
- Faster response from payers
- Cost: FREE
Eligibility Verification
Primary and Secondary Eligibility Verification
- Real-time or batch verification options
- Transactions stored for one year and can be viewed any time - at no charge
- Reduce financial risk by knowing current general benefit information, such as deductible and co-pay amount prior to services
- Learn details of coverage, including plan type
- Cost: Standard electronic transaction rate is $0.55 (Decreases as volume increases)
Claim Status Inquiry
Claim Status Inquiry
- Schedule automatic reports on the status of claims based on your average A/R days with each payer
- Know sooner if your request was accepted or denied
- Save time and money by keeping staff off the phone/internet with follow-ups on aging claims, allowing more focus on patient care
- Cost: Standard electronic transaction rate is $0.55 (Decreases as volume increases)
Getting Started:
- If you would like to enroll today, please click here to e-mail us, call 866-829-2763 x 6
(Clearinghouse Division), or speak with a Live Chat representative
- A dedicated Implementation and Training Manager will walk you and your staff through the initial implementation
- There are NO IMPLEMENTATION or SETUP FEES
- The cost to your organization is only a transaction fee, charged when the claim is accepted by the payer
- Our software works seamlessly with the clearinghouse, but you may also utilize and map your software with our clearinghouse
- Our clearinghouse is fully HIPAA compliant, converting Print Image format to ANSI 837 format to the payer
- Payer lists are available upon request; however, these lists are not always indicative of our capabilities, as we have always delivered claims to their proper location regardless
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