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EDI Clearinghouses

eClaim Services

Send medical billing claims electronically & get paid faster with a convenient online location to process and manage all of your claims.

Ability Network Logo & ABILITY offer an easy solution with many benefits:
  • All-in-one, simple, secure web portal, WebLink™
  • Flexible, customizable pricing plans
  • Over 2,220 insurance connections
Phicure & Phicure offer an easy solution with many benefits:
  • Simple, clean, state-of-the-art Claims Management Application
  • Up to 25% reduction in monthly EDI costs for qualified providers
eClaim Services

What is an EDI Clearinghouse and why is it important?

The industry of medical billing is a complex realm, filled with obstacles and pitfalls. There are numerous companies that function as intermediaries between healthcare providers (doctors, chiropractors, dentists) and payers (insurance companies). These are known as Clearinghouses.

Essentially, Clearinghouses check the claim for errors and checks to make sure that VALID procedural and diagnosis codes are being submitted. In addition, they also ensure that each procedural code is appropriate for the diagnosis code submitted with it and verify that it is compatible with the payer software. These services help prevent time-consuming processing errors.

Our HCFA-1500 & UB-04 Form Software creates a file that when submitted with one of our partner Clearinghouses, converts our file into an ANSI-X12 837 file. This file is then uploaded to your medical billing clearinghouse account.

Our partnered clearinghouse companies charge the providers for each claim submitted, and they also charge an additional fee to send a paper claim to a certain payer.

Clearinghouses may submit claims directly to the payers, or they may have to send a claim through other clearinghouse sites before reaching the payer(s). The claims may go through other clearinghouses for the following reasons:

  • The provider billing software isn’t compatible with the payer processing software, and the information needs to be reformatted prior to being sent to the payer. Because of the potential difficulties caused by incompatible software, clearinghouses require an initial enrollment period prior to sending claims for the first time.
  • The payer isn’t enrolled in the same clearinghouse the provider uses. The provider pays the clearinghouse, and the insurance companies pay the clearinghouse.

Efficient claim submission is necessary to optimize the claims process and the revenue cycle continuum. The main benefits offered by insurance billing clearinghouses are fast payment, error scrubbing and assistance, reductions in administrative costs, and finally a single source of handling claim submissions and status. The faster Medicare, Medicaid or a commercial payer are billed correctly, the faster they pay. The faster a patient is provided an accurate bill for an amount not covered by insurance, the quicker the money can be collected and utilized to improve another patient’s health.