Questions to Ask a Clearinghouse
by Leigh-Ann Renz, 12.18.13
You’re ready to use a clearinghouse for mental health billing—but what questions do you ask to help pick the right one for your practice?
Which insurance companies do they bill?
If the clearinghouse doesn’t bill the insurance companies you use for your clients, that’s usually the end of the conversation. However, if you find there’s a gap, ask them if there is a process to add the necessary insurance company. It may be simple & easy for them to integrate a new payer. They may also already have it in the works.
Are the 835s electronically processed?
This is a really critical piece: 837s are the format in which your billing is processed electronically, but not all clearinghouses provide ERAs (Electronic Remittance Advice). This means you might send the claims for payment electronically but receive paper remittance forms that then have to be processed manually! Make sure your remittance forms (835s) are electronically processed and of course integrated into your EHR to make billing seamless.
Do they process Medicaid / Medicare?
Each clearinghouse has their own way of processing Medicaid and/or Medicare (or any government entity) claims—if you utilize this billing, estimate what percentage of your billing this comprises, and make sure the clearinghouse can handle it.
When do they charge?
Check how the timing may affect the rest of your monthly payables.
How do they charge?
Do they charge for mistakes made? Most clearinghouses charge a percentage of each claim processed. Some charge you only if the claim is successfully remitted; others bill regardless. If they error when submitting a claim, are you still charged? What if the error is on your end? We all know billing mistakes happen—how much will it cost you? And is there any difference whether the mistake is yours or the clearinghouses?
Do they offer eligibility checks?
If you’d like to have access to eligibility checks, make sure this service is offered, see how much it costs, and ask them to show you what it looks like in a live demo.
Do they support EAPs?
If you provide EAP services, make sure EAP billing is offered. If paper claims and/or supporting documentation are needed, can they mail the claims for an additional charge?
Is a time zone difference going to affect your deadlines?
A clearinghouse’s submission deadline of Fridays at 5 pm might sound completely achievable for your practice—until you realize that means 1 pm due to a time change! Check on that small but vital detail.
The best way to see these inquiries in action is to request a live Web demo—ask the applicable questions via phone to whittle down your vendor list; then schedule a demo with the 2-3 most promising options. During the demo, ask detailed questions, and have them show you exactly what your practice’s billing scenario would look like.
Leigh-Ann Renz is the Marketing & Business Development Director of PIMSY mental health EHR. To learn more about PIMSY, check out our free video demo or get a customized quote. For more information about electronic solutions for your practice, check out Behavioral Health EHR.