Clearinghouse 101

     By definition, a clearinghouse is a company that functions as an intermediary between the provider's PM system and the insurance payer.  Clearinghouses check for things such as common errors and provide a pathway for the payer to return electronic files that contain processing information, in lieu of paper EOBs.

 

Clearinghouses allow for things such as:

  • EDI Connection - allowing claims to be submitted electronically to the insurance payer

 

  • ERA Connection - allowing claim processing information, including payments and denials to flow into DrChrono and post electronically, eliminating quite a bit of work for billing staff members.

 

    Currently, DrChrono utilizes Change Healthcare (fka Emdeon), TriZetto, Waystar, iHCFA and Jopari.  If you are new to DrChrono or DrChrono billing and have an existing account (aka site) with one of these clearinghouses, it could be possible to transfer it under the DrChrono umbrella and keep all of your existing connections intact.  Please notify your Implementation Specialist if you have an existing relationship with one of the above mentioned clearinghouses.

     In order to establish the EDI and/or ERA connections with payers, usually paperwork is required.  Some can be completed online, while others will require a wet signature from the office.  You will work with your implementation specialist to identify which payers you bill so that the enrollment requests can be submitted to the clearinghouse.  A representative from the clearinghouse will reach out to you directly and assist with the paperwork needed to establish the connections between your DrChrono PM and the payers you will be billing.

 

 

** Please note, not all payers allow for electronic claim submission (EDI) or electronic remittance advice (ERA).  Your Implementation Specialist and/or clearinghouse representative will work with you to identify and establish a work flow for those payers.

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