Healthcare IT Terms
What is Clearing Houses?
Electronic claims clearinghouses are a vital link in the chain that connects healthcare providers to payers. While some providers directly bill their larger payers, such as Medicare and Blue Cross/Blue Shield plans, most claims go through claims clearinghouses to the multitude of health plans and government agencies that provide health insurance. Clearinghouses edit the claims so that they can be processed by the many different systems of private insurers and government intermediaries. In some cases, clearinghouses bounce claims back to providers if they’re missing information or were submitted in the wrong format. In addition, the clearinghouses submit and return responses to provider inquiries such as eligibility and claims status requests. They also route electronic remittance advance that providers need for payment posting and claims denial management.