9 Questions to ask a clearinghouse!
Frequently Asked Questions
Every question that might be on your mind!
1. Call Wait Times. (How long do I have to wait to talk to support?)
- When you call for help at ClaimRev, you don’t have to wait on hold. The calls are answered by a person and usually the CTO/Developer himself.
2. Payer List. (Do you have connectivity to the payers that I need to send claims to?)
- ClaimRev has access to 5000 plus payers.
- A nifty feature: if our customer is coming from another clearinghouse and doesn’t want to or can’t change all their payer IDs, we can create mappings for the payer id’s they are sending. The customer would just need to communicate to us what the payer id they want to use and what payer it should be going to.
3. PM Support. (Does your company integrate with my PM system? Is your support staff knowledgeable about my PM?)
- We take the industry format of 837, so if your PM can create the 837 and save it to a folder on your machine, then we can take that file.
If your PMS/EHR has custom formats, we will be happy to create modules to import that file.
Additionally, our system will create file acknowledgement (999) and claim acknowledgement (277) files. These can be downloaded from the portal or our windows client connect application and imported into your software.
While we do not offer support for the various PMS/EHR systems, we will be happy to be on a conference call to help talk to your software on our behalf. We have, and will continue sitting on training calls with you and your PMS to help answer questions that come up about the claim process. We find this helps us see gaps between our two systems that we might be able to fill with personalized modules or placing rules in place.
3. PM Support. (Does your company integrate with my PM system? Is your support staff knowledgeable about my PM?)
- We take the industry format of 837, so if your PM can create the 837 and save it to a folder on your machine, then we can take that file.
If your PMS/EHR has custom formats, we will be happy to create modules to import that file.
Additionally, our system will create file acknowledgement (999) and claim acknowledgement (277) files. These can be downloaded from the portal or our windows client connect application and imported into your software.
While we do not offer support for the various PMS/EHR systems, we will be happy to be on a conference call to help talk to your software on our behalf. We have, and will continue sitting on training calls with you and your PMS to help answer questions that come up about the claim process. We find this helps us see gaps between our two systems that we might be able to fill with personalized modules or placing rules in place.
4. Claim Scrubbing & Validation: — What are your rejection rates? To high, means too many payer denials. Too low means too many claim rejections at the clearinghouse level –in our experience +-3% is just about right.
- Having awesome scrubbing is the main purpose of the clearinghouse. Our system will take an 837 claims file that doesn’t fully comply with the standard and fix the claim so that it does comply or at least tell the customer what information is missing so that that it can be corrected. In other clearinghouses, the client would receive a 999 rejection of every claim in the file. Our software will try to pull the good claims out and mark the bad claim as bad and notify the user via portal or 277 file.
Next our scrubbing goes from broad to narrow. What this means is greater control for you as a user. First the claim will go through basic checks that are required for an 837. These checks will usually cause your claims to fail in a 999 rejection, at other clearinghouses. Not us though, these checks will only fail individual claims. An example of one of these checks is check that a birthday is sent.
Next we scrub on payer type, this module checks the claim for data that all payers of that type will need. A good example of a payer type would be Medicare or commercial. Once that check is done, the claim is then looked even closer at the payer level. This is where the magic really happens. If we start seeing many rejections at the payer for a certain problem, we can put a check here to stop the claim for that payer only. This makes sure we don’t a claim for a data problem for other payers that don’t care. We can also create modules that are specific to the client or even PMS. We have a UI that lets the client create rules specific to them, this rules engine can change data sent and even error the claim out if something is missing. If something is more advanced we can create modules specific for the client or PMS system. This will allow us to keep track of all the user edits and let them know exactly what custom changes are happening to their claims (that that requested in the past and have forgotten about).
4. Claim Scrubbing & Validation: — What are your rejection rates? To high, means too many payer denials. Too low means too many claim rejections at the clearinghouse level –in our experience +-3% is just about right.
- Having awesome scrubbing is what you want in a clearinghouse. Our system will take an 837 claims file that doesn’t fully comply with the standard and fix the claim so that it does comply or at least tells the customer what information is missing so that that it can be corrected. In other clearinghouses, the client would receive a 999 rejection of every claim in the file. Our software will try to pull the good claims out and mark the bad claim as bad and notify the user via portal or 277 file.
Next our scrubbing goes from broad to narrow. What this means is greater control for you as a user. First the claim will go through basic checks that are required for an 837. These checks will usually cause your claims to fail in a 999 rejection, at other clearinghouses. Not us though, these checks will only fail individual claims.
Next we scrub on payer type, this module checks the claim for data that all payers of that type will need. Once that check is done, the claim is then looked even closer at the payer level. This is where the magic really happens. If we start seeing many rejections at the payer for a certain problem, we can put a check here to stop the claim for that payer only. This makes sure we don’t stop a claim for a data problem for other payers that don’t care. We can also create modules that are specific to the client or even PMS. We have a UI that lets the client create rules specific to them, this rules engine can change data sent and even error the claim out if something is missing. If something is more advanced we can create modules specific for the client or PMS system. This will allow us to keep track of all the user edits and let them know exactly what custom changes are happening to their claims (that that requested in the past and have forgotten about).
5. Missing Claims: — My payer does not show as having received my claims. I don’t want to wait 2-3 weeks to find this out. How do I tell in minutes if I have missing claims on your system?
- The client will never have any missing claims in our system. Claims are recorded instantly when they go in to the system. In the input file screen, you can see every claim associated with the file. Once the user is looking at the claim, they can see at a glance that the claim was sent to the payer. The same screen tells the user if a 999 acceptance or rejection was received from the payer for that file the claim was in. The screen also shows if a 277 claim acceptance was received for the claim. It also will put the payer control number with the claim to help the client talk to the insurance company for other issues.
6. Claim Dashboard: — How well does your service help me manage unattended claims, rejections, and denials. Does it report back errors merely as numeric codes or as understandable explanations.
- From the claim search screen, the user can see everything about the claim, they can see when it was received, if it was received by the payer, the payer control number and if an 835 (ERA) has come back for the claim. All numeric codes are translated into text to help determine what is wrong.
We have claim workflow screen that allows the client to create custom claim workflows for working claim problems. The workflow tools allows the client to create their owns statuses and even tell the system when to put the claim in a status automatically. Additionally, if the client has multiple users the claim can be handed to other users in their company.
7. Claim Dashboard: — Does your service report back to my PM with error messages, with ERA’s, with alerts on slow payments and potential cash-flow issues, such as excessive unpaid claim days?
- Every PM is different, however wo do create the necessary files that can be imported back to your PMS/EHR system. If the payer returns an 835 (ERA) we return the file exactly as how the payer sent it to us.
- If the PM has a way to send additional data about the claim or ERA status, we would be happy to investigate what can be sent and what we can do for more integrations.
8. Real Time RCM Reporting — Revenue Cycle Management (RCM): — How long do I have to wait to detect blocked cash-flow, or lost or unattended claims? Do you offer Proactive Revenue Controls? How well does your system proactively/continuously monitor key performance indicators (KPIs) that enable us to act in real-time to address revenue leakage before it significantly impacts our cash-flow?
- This can happen in 2 different areas of the system. The claim search screen will help the user find all the claims that are unattended, and the ERA reports screens will help the users search ERA files directly for any issues and really dig into ERA files. These ERA reports can all be sent to excel as a CSV file, and the translated ERA can be printed to a PDF for easy download. We will create custom reports that are needed for ERA’s or claims. We want to portal to be custom to you and your workflow.
9. Productivity Analytics : — How well does your service and technology give us insight into financial and operational performance across our organization against similar provider benchmarks?
- This falls into the dimensional data warehouse tools. We can create the reports that are custom to the clients practice helping the client see the key performance indicators. If we are integrated with your EMR/PMS we can give you better data that isn’t available in claims and ERA’s.
it's like your own software development department
The clients should think of our system as if it’s their own portal written by their own IT department. We want to help with your own unique problems and difficulties. If you need your own reports we can make that happen! While everything we do will be included in the portal as a whole for all users, we can and will create specific UI modules that are “outside” of the portal that are very unique to the client or PMS system. This could mean the client could browse to an additional web application such as clientname.claimrev.com for their custom tools or for PMS/EHR a new API could be created such as EhrApi.claimrev.com