Ask practices why they use a clearinghouse solution and they typically say something like, “We wanted to improve our billing efficiency.” Reaching maximum efficiency, however, requires using every tool at your disposal. Here are just a few of the time-saving tools offered by some clearinghouses to help increase your efficiency. Make sure you check with your clearinghouse to see which are available, and then make sure that you take full advantage of them:
Duplicate Claim Edit. This type of functionality allows you to work rejections faster and catch duplicate claims before they get to the payer. It usually works by comparing the current inbound file to previously sent claims. If you submit a claim that matches data provided previously, the claim will reject. In most systems the claim should not reject if the original is a non-active claim (i.e. deleted, cancelled, rejected, or filing complete). An optimal system will allow you to either “bypass” and resubmit the claim or cancel the submission.
Auto Cancel. Similar to Duplicate Claim Edit is Auto Cancel; you typically activate one of these functionalities or the other. Auto Cancel helps maintain workflow by preventing the need to manually cancel claims. With Auto Cancel, the rejected claim is automatically cancelled and the new inbound claim becomes the active claim. Practices that re-bill from their software may find Auto Cancel particularly useful.
Automated File Transfer Protocol (FTP). FTP is simply a software protocol for securely exchanging information between computers over a network. It prevents the need to manually upload or download files. With software or IT assistance you can automate the process to “set it and forget it.” It is best to work with your PMS vendor, since some have integrated FTP.
Saved List. This “save-and-go” functionality is a way to create and save custom reports and work lists, so that running them again requires only a simple mouse-click. You’ll want to look for functionality that lets you create a list name and assign it to all users, or a specific user, or a list of users.
Schedule Alerts. Find out whether your clearinghouse gives you the ability to set up daily, weekly, or monthly automated e-mail alerts based on your rejection ratio. The ratio often is calculated by dividing the number of registered providers by the number of rejected claims. You should be able to set the threshold that triggers an alert to a selected e-mail address or an e-mail list.