Using a Third Party Clearinghouse
Right now, the most common call we receive from doctors that have Medisoft and use a clearinghouse from a third party is they are getting denials for either NPI numbers or legacy numbers and ID qualifiers. This usually is because they are exporting the claims to a file and using the old claim format. If they change to the new claim format, they get a bunch of new errors because the clearinghouse is not mapped to the new format. Many are frustrated and don't know how to proceed to get their claims paid. Let's look at the options below for sending claims electronically.
There are many options for clearinghouses to transmit your claims electronically. For those of you who do not currently send electronically, a clearinghouse is a company that establishes relationships and connections to literally thousands of insurance companies. So, instead of you having to establish thousands of connections to these insurance companies; you can contract one time with the clearinghouse and they will do the rest for you. Plus, they stay abreast of the changes in the electronic and insurance industries.
Each clearinghouse offers different benefits. These are the items to compare.
1) Pricing - Many clearinghouses have very low pricing. However, with this option, there is usually more labor involved; either by keying claims into their site or having to export and import claims. So, in fact, this option could actually cost you more.
2) Enrollment Process - Enrolling with all your contracted payers can be the most arduous task, but current electronic submitters can tell you is well worth it. Find out the typical enrollment time prior to signing a contract with a clearinghouse.
3) Training and Support - Each clearinghouse offers different training and support options. It takes about 30 days to learn the ins and outs of sending electronically. Make sure you understand the training and support policy.
4) Payers - Each clearinghouse has arrangements with different insurance companies. Get a copy of the payer list prior and make sure your payers are on the list.
Medisoft has their own clearinghouse called MedAvant and here is the scope with them:
1) Pricing - There is a one time setup fee of $249 that includes the license, enrollment and initial training. Then there is a monthly fee of $79 per provider. This includes unlimited electronic claims, 150 paper claims (for insurance companies that do not accept electronic claims yet) and a free 1-800 support line. There are price breaks for clinics with more than one provider. For example, 2-5 providers is $158 per month and 6-10 providers is $250 per month.
2) Enrollment Process - This process takes one to two weeks for non-contract insurance companies and two to four weeks for contract payers. (The typical clinic has three to five contract payers.)
3) Training and Support - The initial training is included the setup fee and then there is a free unlimited 1-800 number to call. Also, there are two other forms of free support; "Help" within the electronic module and help online on the Knowledge Base.
4) Payers - Medisoft transmits to literally thousands of insurance companies. Here is their "Payer List".
5) Interface with Medisoft - One of the biggest benefits of using the Medisoft clearinghouse is how it interfaces with Medisoft. To transmit claims electronically, there is no need to rekey claims or export and import; you just click "Send" in Claim Management. Plus, if there are rejects, the information is posted back into the Comment tab of the claim and you have a permanent record of it. Finally, to fix rejected claims, you only need to do it in one spot versus a third parties site and Medisoft.
If you are interested in starting electronic claims or switching to Medisoft: click HERE. Or, if you currently are using Medisoft and are on the Stratus platform and need to switch to Phoenix (Medisoft would have sent you a letter already regarding this), go to our Stratus Conversion site. And, as always, if you have questions, please feel free to call is at (888) 322-2455.
Each clearinghouse offers different benefits. These are the items to compare.
1) Pricing - Many clearinghouses have very low pricing. However, with this option, there is usually more labor involved; either by keying claims into their site or having to export and import claims. So, in fact, this option could actually cost you more.
2) Enrollment Process - Enrolling with all your contracted payers can be the most arduous task, but current electronic submitters can tell you is well worth it. Find out the typical enrollment time prior to signing a contract with a clearinghouse.
3) Training and Support - Each clearinghouse offers different training and support options. It takes about 30 days to learn the ins and outs of sending electronically. Make sure you understand the training and support policy.
4) Payers - Each clearinghouse has arrangements with different insurance companies. Get a copy of the payer list prior and make sure your payers are on the list.
Medisoft has their own clearinghouse called MedAvant and here is the scope with them:
1) Pricing - There is a one time setup fee of $249 that includes the license, enrollment and initial training. Then there is a monthly fee of $79 per provider. This includes unlimited electronic claims, 150 paper claims (for insurance companies that do not accept electronic claims yet) and a free 1-800 support line. There are price breaks for clinics with more than one provider. For example, 2-5 providers is $158 per month and 6-10 providers is $250 per month.
2) Enrollment Process - This process takes one to two weeks for non-contract insurance companies and two to four weeks for contract payers. (The typical clinic has three to five contract payers.)
3) Training and Support - The initial training is included the setup fee and then there is a free unlimited 1-800 number to call. Also, there are two other forms of free support; "Help" within the electronic module and help online on the Knowledge Base.
4) Payers - Medisoft transmits to literally thousands of insurance companies. Here is their "Payer List".
5) Interface with Medisoft - One of the biggest benefits of using the Medisoft clearinghouse is how it interfaces with Medisoft. To transmit claims electronically, there is no need to rekey claims or export and import; you just click "Send" in Claim Management. Plus, if there are rejects, the information is posted back into the Comment tab of the claim and you have a permanent record of it. Finally, to fix rejected claims, you only need to do it in one spot versus a third parties site and Medisoft.
If you are interested in starting electronic claims or switching to Medisoft: click HERE. Or, if you currently are using Medisoft and are on the Stratus platform and need to switch to Phoenix (Medisoft would have sent you a letter already regarding this), go to our Stratus Conversion site. And, as always, if you have questions, please feel free to call is at (888) 322-2455.
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