Electronic Claim Submission

by Anonymous

Do we always have to use clearinghouse to submit electronic claims?

What about the software that is sold online? Can I just use that software and submit claims electronically from my office directly to Medicare/Medicaid?

The software is quite expensive and I just want to know more about it before spending the money.

You don't have to use a clearinghouse to submit electronic claims. But the value in using a clearinghouse is that they work out the interfaces - format and compatibility issues - with each insurer - both government and commercial.

If you have several different insurance companies to submit claims to, it can be a nightmare to try to work out and comply with all the different submission requirements and formats with each carrier.

The nice thing about a clearinghouse is you only have to get your software setup to create one electronic file and batch all electronic claims to them. They will then scrub the claims for errors and send to each individual carrier.

You can submit electronic claims directly to Medicare/Medicaid but just like with commercial insurance companies they will most likely require some sort of translation to be compatible and acceptable to Medicare/Medicaid.

Some software vendors sell a "Module" that goes with their software and allows you to communicate directly with Medicare. To be honest I've had such a challenging time dealing with Medicare on rejected claim issues that I couldn't imagine trying to workout electronic file format issues with them.

I assume the online software you were asking about some of the new services that work through your browser. There one's I'm familiar with are Kareo, ColaborateMD, and AdvancedMD - and several others.

They all have different pricing options. I have been using Kareo and I think they have an attractive offering and don't require a contract. Priced is from $69 to $199 a month with no startup costs - and it includes clearinghouse services.

You may also want to checkout Office Ally. They offer free or low cost clearinghouse services. They also offer a free practice management software called Practice Mate.

Hope this answers your questions - good luck.


Comments for Electronic Claim Submission

Average Rating starstarstarstar

Click here to add your own comments

Jul 05, 2013
Using Office Ally
by: Michelle D

I wanted to give a shout out to those who are considering using a clearinghouse. I personally use Office Ally and have two clients. I have never used anything else - so I can't compare. I can only imagine what filling out claim forms was like before the electronic requirements came along. I can get help from them whenever I need them and training as well. Oh - I use Practice Mate. Hope this helps.

Click here to add your own comments

Join in and write your own page! It's easy to do. How? Simply click here to return to Your Questions.

Recent Articles

  1. Is it possible to work in Medical Billing or Coding at night instead of during the day?

    Oct 23, 17 09:16 PM

    How common is it that a company would allow you to work from home as well as working at night so you can be with your children during the day? I'm an

    Read More

  2. Should I get my medical billing certificate from AAPC or somewhere else before I start my own business?

    Oct 23, 17 09:15 PM

    Hi! I am contemplating starting my own medical billing business and I was wondering if I should get my medical billing certificate from AAPC or some other

    Read More

  3. What is the CPT code for 'Male Hormone Panel'

    Oct 23, 17 08:57 PM

    What is the CPT code for 'Male Hormone Panel' ...testosterone/estrogen/PSA/IGF- 1 /DHEA -Sulfate/ Progesterone Response: We'll post in hopes our Visitors

    Read More

Disclaimer and Privacy

All-Things-Medical-Billing.com provides this website as a service. Please read our full Disclaimer and Privacy Policy here.

Copyright 2017 All-Things-Medical-Billing.com