Supporting Complex, Multiple Clearinghouse, Multi-Submitter Healthcare Business Environments

Clearinghouse ERA processing

Clearinghouses play an important role in how medical claims are submitted and how insurance payors provide reimbursement to healthcare providers. Clearinghouse services go beyond just claim submission and remediation. Their services can also include eligibility and benefits checking, referral authorization, and claims status information. Clearinghouses also make sure that all transmission of claim information and correspondence are HIPAA 5010 compliant. When dealing with multiple Electronic Medical Records (EMR) and Practice Management Systems, Clearinghouses and Banking partners, remittance and reconciliation process within a Central Business Office (CBO) can become complex and prone to errors.

RCMS solutions are vendor agnostic, allowing clients to leverage their existing HIT investments, clearinghouse accounts and banking relationships in complex business office environments. We provide automated processes for posting all types of payments; including insurance payments, patient payments, legal reimbursements, clinical trial payments, and others. For co-mingled Hospital Billing and Professional Billing payments within a single ERA, we provide for automated splitting & parsing of all EDI transactions for more accurate, timely posting.

RCMS leverages your existing clearinghouse accounts with automated remittance processing, data validation and treasury reconciliation for all types of payments.

RCMS Systems Integration Benefits

  • Supports a Multiple Submitter/Single Receiver approach for complex business environments
  • Use of a single corporate receiver for all incoming payments from multiple Clearinghouses and Bank Lockbox accounts
  • All payments and denials are captured and managed on our proprietary ReSolve® A/R Management Platform
  • Automated splitting/parsing of EDI transactions for more efficient processing
  • Hospitals and Practice Groups can maintain existing EMR and PM Systems, Clearinghouse accounts for submission
  • All ERA correspondence can be captured and indexed to the patient account for data validation and efficient follow up
  • BAI integration provides for full bank reconciliation from deposits to the individual billing systems
  • Detailed reporting and data analytics with integration to Microsoft Power BI and SSRS data visualization and reporting tools
  • Workflow solutions for Eligibility (270 / 271) and Claims Status (276 / 277) inquiries

Popular Clearinghouses in Healthcare

Below are just some of the many different Clearinghouses utilized by our Physician Practice Group, Hospital, and IDN Health System clients. RCMS can help to evaluate your current Claims Management and Revenue Cycle Management (RCM) processes and make recommendations with any planned changes.

RCMS can improve your revenue cycle while maintaining existing HIT/HIS investments and Clearinghouse relationships. Contact us today for help with improving your Central Business Office and A/R Management processes.