Clearinghouse vs Direct

Some of our customers have asked which method is better for them to use - a clearinghouse or direct to the carrier. Here are several things to consider:

Direct to the carrier is probably the least expensive method if your practice primarily submits claims to only one carrier. However, if you submit claims to more than one carrier, it is probably not the least expensive method.

With the clearinghouse, you only need to dial into one location. If you choose to go direct, you will need to dial into each carrier and/or send paper claims to the rest. With the clearinghouse, all claims can be submitted in one transmission. The ease of simply sending claims to one location cannot be underestimated. Submitting claims to multiple insurance carriers requires your staff to become experts in each of the claims submission modules that you use. Since each carrier is unique, someone must be adequately trained and available to submit your claims or your practice will not be reimbursed. Claims submission to a clearinghouse is all done through a few mouse clicks in the ECLIPSE software and almost anyone can do it after reading the on-line user manual, using the help screens and/or calling our technical support line.

Customers cannot submit claims directly to NEIC or to the majority of individual commercial insurance carriers.

Most carriers that receive claims electronically cannot edit the claims on-line (meaning at the time that you actually are transmitting the claims to them). The clearinghouse can edit your claims for completeness and validity to reduce the possibility of a rejected claim at the same time that you are sending your files. You will be notified before you sign off if there are any problems with your claims.

Many carriers have designated only certain times when claims can be sent. The clearinghouse will accept claims whenever you are ready to send them.

Using the clearinghouse reduces your phone bill. Many carriers will require that you pay for the telephone expense for your claims transmissions. The clearinghouse usually supports a toll-free line for claims transmissions or uses the Internet. Telephone expense is often overlooked when comparing direct transmission to a clearinghouse.

Updates to an insurance carrier's transmission software are free and transparent when using the clearinghouse. When using a direct submission module, updates must take place at the customer's site and often require a programmer's attention, which can be very costly.

With a clearinghouse, a single confirmation report is produced for all insurance carriers. Separate confirmation reports are produced for each carrier where claims are submitted directly.

Some insurance carriers require special communication equipment/software. The only piece of equipment that is required to submit claims to the clearinghouse is a standard PC modem.

The clearinghouse is a priority to the insurance carriers because of the claim volumes they submit.

Unless your practice submits insurance claims to only one carrier and you have a highly technical staff with little employee turnover, we recommend that your practice submit your claims to an electronic claims clearinghouse.


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