Why You Should Always Submit Your Claims to Your Clearinghouse First

Medical billing isn’t easy. But you already knew that.
As you know, there is a ton of work and steps that go into submitting medical claims. There are so many steps that over 200 million claim rejections happen every single day.
LINKS:
____________________________________________
etactics.com/b...
____________________________________________
But what if I told you that there was one step you could take that could single-handedly increase your revenue overnight?
If you take anything away from this video it should be this…your medical clearinghouse is your best friend. Medical clearinghouses usually have a negative connotation associated with them but they are actually one of your biggest allies. They exist to get you paid by insurance payers. Payers are the enemy here.
Now that we’re on the same side, let’s answer the burning question, “Why should you submit your claims to your clearinghouse before an insurance payer?”
The short answer to that question is utilizing clearinghouse-level rejections…which is also sometimes called claim scrubbing. Clearinghouse level rejections are better than payer level rejections. Here’s why.
Insurance payers are massive organizations that receive and process hundreds of thousands if not millions of claims every year. Let’s run some quick numbers on that statement.
Aetna estimates on its website that 39 million Americans rely on its services. According to the National Center for Health Statistics, 83.4% of adults and 94% of children visited the doctor in 2020. Let’s assume that Aetna isn’t including children/dependents in its estimated number.
If you take the number of Americans that rely on Aetna and multiply it by the percentage of adults who went to the doctor in 2020, you get 32,526,000. That’s the total number of claims that Aetna processed in 2020 based on those assumptions.
If you took 32,526,000 and divided it by the total number of days in a year (365), you’re left with an estimate of 89,112 claims submitted to Aetna every day.
Even as an organization that has over 45,000 employees (per my Google search), staying on that heaping pile of claims to process leads to delays.
Thus, counting on your payers to provide you with your rejections prior to processing leads to delays. What’s worse, sometimes payers (usually smaller ones) don’t provide rejections and all of the claims you submit go straight to processing.
If you submit your claim to a payer, it usually takes around two days before you’d receive a rejection status. Denials usually take between two weeks and a few months before they come back.
Although rejections happen faster, two days is still a lot longer than clearinghouse level rejections. What’s worse is that payers don’t keep a record of rejected claims since it never processed them within its system. In other words, you only have one opportunity to reveal why your payer rejected your claim. After that, it's gone.
You see, your clearinghouse exists as the middleman between you and the payer. They should act as your right-hand person when it comes to claims. Thus, you should be able to submit your claims to your clearinghouse for its review before you do anything with the payer.
Submitting claims for clearinghouse review leads to claim rejections, but that’s not a bad thing. You see, clearinghouse level claim rejections act as another layer of the medical billing process to ensure that you don’t receive denials...which increases your revenue. Think of it as a spell check before you submit a final paper to a teacher.
Clearinghouses can provide your rejections back to you instantly AND a history of your rejections exists within the system. Much better than payer level rejections.
► Reach out to Etactics @ www.etactics.com​
►Subscribe: rb.gy/pso1fq​ to learn more tips and tricks in healthcare, health IT, and cybersecurity.
►Find us on LinkedIn: / etactics-inc
►Find us on Facebook: / ​
#clearinghouse #medicalbillingandcoding