Supporting Complex, Multi-Submitter Environments with Existing Clearinghouse Accounts
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.
RCMS solutions are vendor agnostic, allowing clients to leverage their existing clearinghouse accounts and banking relationships. We provide automated processes for posting all types of payments; including insurance payments, patient payments, legal reimbursements, clinical trial payments, and others.
RCMS leverages your existing clearinghose accounts with automated validation and posting processes for all types of payments.
- Supports a multiple Submitter/Single Receiver approach for complex provider environments
- Use of a single Corporate Receiver for incoming ERA remits
- Practices can maintain existing Clearinghouse accounts for submission
- Workflow solutions for Eligibility (270 / 271) and Claims Status (276 / 277) Inquiry and Response transactions
Popular Clearinghouses in Healthcare
Below are just some of the many different Clearinghouses utilized by Physician Practice Groups, Hospitals, Health Systems, MSOs, Dental Support Organizations and Health Insurance Payors. RCMS Consultants can help to evaluate your current Clearinghouse vendors and make recommendations with any planned changes to your Claims Management or Payment Processing.
- Apex EDI – website link
- Availity – website link
- Claim MD – website link
- ClaimLynx – website link
- DataTrans – website link
- DentalXChange – website link
- HealthSmart (for payers) – website link
- Office Ally – website link
- Optum360 – website link
- PNT Data – website link
- Trizetto – website link
RCMS can improve your revenue cycle while maintaining existing PM System investments and Clearinghouse relationships. Ask us how we can help to improve your financial performance.