What is the top performer indicator for a provider in business? With millions of claims to process and millions of dollars at stake, getting the first-resolution pass is ideal. The dental clearinghouse partner selection can be a paradigm shift for the revenue cycle.
A clearinghouse equipped with tools and the claim scrubbing that they provide is not a vague quality check. Rather, every last detail is correct before the final submission. How are you handling the claims? The process from chair to payment can affect the RCM if not managed properly.
PMS generates claims electronically. The clearinghouse receives the file and does things that improve RCM. First, it checks the claim against the payer’s requirements within seconds to minutes of submission.
Does the claim have all necessary details with valid CDT codes? Are there any discrepancies in the tooth number and the procedure? Does the claim have a correct subscriber ID? Secondly, it translates the standardized claim file into each payer’s specification format and transmits the claim over a secure VPN using a payer ID.
Now that you have an idea of how important a clearinghouse is to reduce denials and accelerate payments, and provide insights on RCM.
Look for these points when choosing a dental clearinghouse:
Is the clearinghouse client-friendly and easy-to-use? You are choosing a clearinghouse to make the claim process simple and easy, so the first question to ask is how easy it would be to work with the clearinghouse. The right partner is not vague but offers substantial experience with claims and dashboards, so that everything is handled in one place.
Issues are inevitable, and the clearinghouse should clearly communicate information about each claim. What dental practices get wrong about the clearinghouse is that they treat the clearinghouse rejection as a denial. But it means that the claim did not reach the payer due to errors. All your team has to do is fix and resubmit without an appeal.
The clearinghouse has reports that update the status of each claim to minimize delays and check progress. Choose a clearinghouse that offers real-time support and staff training to utilize the platform. For effective implementation and to reduce response time, look for a partner with industry expertise.
Does this clearinghouse have connectivity to all regular payers, or do we need to engage an additional clearinghouse utilized by the practice? Outsourcing should benefit the practice. The providers must check with the clearinghouse to see if it can handle a mix of cases, including
outpatient, inpatient, and dental. It is a helpful reason to opt out of options.
Many clearinghouses operate in specific regions. Submitting claims outside regions might require another clearinghouse.
Connectivity is a benefit for the practice. A single vendor enables easy claim submission and faster payments. Clarity on what services you want from your clearinghouse, like electronic claim submissions, eligibility and coverage verification, tracking of claims, and ERAs. Most
clearinghouses perform these functions, while others look at one or two areas.
Do not accept hollow words but verify the clearinghouse error rate. Before you compare vendors and come to a conclusion, ask how they accelerate corrections. Major denials stem from either eligibility or registration.
Look for features to minimize and immediately flag potential errors when choosing a dental claims clearinghouse, to fix as and when discovered. Practices that adopt claim scrubbers to reduce the risk of errors and review before sending them to the clearinghouse have high acceptance rates.
A standard benchmark would be a more than 95 percent acceptance rate with claims less than 30 days in A/R. If a payer’s denial rate jumps from a standard to 10 percent, investigate coding or contract negotiations, as it might highlight a pattern with the payer that could need proactive fixes.
Does the clearinghouse have extra fees to watch out for in the contract? A reasonably priced clearinghouse is the first option for providers with relatively low claims. Many offer a fixed monthly fee. Others have a variable fee based on the volume of claims. In addition, remittance
receipts, claim status, and eligibility checks are independently charged.
Establish clear contract discussions regarding frequent changes around claims. Providers should prefer short-term contracts. Without a doubt, clearinghouses offer several benefits: reduced denials, improved cash flow, optimized staff productivity, lower administrative overhead costs, and access to reporting tools.
Clarify the termination details if it feels disconnected. An ideal clearinghouse should factor everything important into the contract discussion and take responsibility from the patient appointment until the last payment to deliver a seamless experience.
When searching for a clearinghouse, look for service fit rather than a brand name. The one with a clean rate and compresses the cash cycle. MGMA shared a report estimating that denial work is costly, and resubmissions can go up to $100 per claim.
To learn more about how Capline Dental Services is supporting many dental offices, request a call today to streamline the entire process.
A clearinghouse is a software infrastructure, whereas a billing service is tied to real billing experts.
Firstly, because payers require electronic claim submissions rather than paper ADA claim forms.
Secondly, a single practice cannot submit claims to hundreds of payers' systems individually.
Thirdly, it connects with all payers.
They are both validation processes at the clearinghouse for checking errors and invalid data before transmitting it to the payer.
Yes, you can use more than one clearinghouse depending upon the payer's specifications. However, most payers allow one clearinghouse at a time. To switch a clearinghouse, start by enrolling the NPI and Tax ID with the new partner. Enrollment takes 5 to 30 days.
