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.