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.
- “You get someone at the other end of the line every time, you get the help that you need and the help is customized.” “You spend less time waiting on the phone.” Dr. Gutierrez”
2. Payer List. (Do you have connectivity to the payers that I need to send claims to?)
- ClaimRev has access to 5000 plus payers.
- If you’re switching from another clearinghouse and can’t change all your payer IDs, we can help. We can create mappings for the payer IDs you’re using, so you can keep using them. Just let us know which payer ID you want to use and where it should go, and we’ll take care of the rest. It’s a convenient way to transition smoothly and keep things running smoothly for you.
3. PM Support. (Does your company integrate with my PM system? Is your support staff knowledgeable about my PM?)
We support the industry-standard format of 837 for claims. If your practice management system (PM) can generate the 837 file and save it to a folder on your computer, we can easily handle that file.
In case your PMS or EHR has custom formats, don’t worry! We can create special modules to import those files. Our goal is to make the process seamless for you.
Additionally, our system generates file acknowledgements (999) and claim acknowledgements (277) files. You can conveniently download these files from our portal or our Windows client connect application and import them into your software.
While we don’t provide direct support for various PMS or EHR systems, we are more than willing to be on a conference call to assist in communicating with your software on our behalf. We can even join training calls with you and your PMS to address any questions related to the claim process. This collaborative approach helps us identify any gaps between our systems, which we can then address through personalized modules or implementing specific rules.
Rest assured, we are here to ensure a smooth integration and provide the necessary assistance throughout the process.
4. Claim Scrubbing & Validation: — What are your rejection rates? Too high=too many payer denials. Too low = too many claim rejections at the clearinghouse level –In our experience +-3% is just about right.
- Supercharge your claims with our awesome scrubbing feature! Unlike other clearinghouses, we fix incomplete 837 claims files instead of rejecting them outright. Our system guides you on the missing details and ensures compliance. We then take it up a notch with our tailored scrubbing process. From basic checks to payer-specific evaluations, we catch errors and prevent unnecessary claim rejections. Plus, we offer custom rule creation, specialized modules, and transparent communication, keeping you in the loop with personalized claim edits. Experience a whole new level of efficiency and accuracy with our cutting-edge scrubbing capabilities.
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.
Easily track the status, receipt dates, payer control numbers, and even receive real-time updates when the ERA (835) is available. We’ve simplified the process by translating numeric codes into plain language, so you can quickly identify and resolve any issues.
Take control of your claim workflows with our customizable tools. Create personalized statuses and automate actions, allowing you to handle claim problems with ease. Whether you’re a solo practitioner or part of a larger team, our system ensures seamless collaboration by assigning claims to specific users in your organization.
No more confusion or lost claims – our intuitive interface puts you in the driver’s seat.
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?
- 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 the 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?
We can create special reports tailored specifically for your practice. These reports will show you important information, called key performance indicators, that help you understand how well your practice is doing.
If we are connected to your EMR/PMS system, we can provide you with even more valuable data that you won’t find in your claims and ERA’s. This means you’ll have access to a deeper level of insights to make informed decisions and improve your practice’s performance.
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