Filing Electronic Claims
Unlike paper claims, you cannot just start sending electronic claims to an insurance company. Before you can file electronic claims to an insurance company, you must first:
Apply to that insurance company to be able to do so.
Submit a test claim and be approved before you can send claims for production.
Then for each insurance company you must upload the claims to the insurance company and download the reports. Each insurance company can have its own report format.
That's why it has always been our recomendation that if you are submitting claims to more than say three insurance companies, you should seriously consider submitting your claims through a clearing house.
Benefits of a Clearing House
You will only have to make one application to submit electronic claims and that is to the clearing house itself. The clearing house will then submit the the individual applications to the different insurance companies.
You submit your claims only to the clearing house. Your claims should be in a single file that you upload. The clearing house will then direct all the claims to the respective insurance companies.
When the insurance company pays (adjudicates) your claim, you receive the reports from only the clearing house. Your reports therefore come from one source and are in the same format.
Gateway EDI
Although there are many fine clearing houses on the market today, we recommend Gateway EDI.
Gateway is a stable company that started out doing chiropractic claims. They have been in business for many years and are currently buying up other clearing houses. (It's a real aggrivation when your clearing house goes out of business - it has happened to some of our users.)
With Gateway you will only have to make one application to file electronic claims. Gateway will then submit the individual applications to the different insurance companies on your behalf.
When you submit your claim to Gateway, you can immediately check to make sure they received the claim and Gateway will do a premilinary check on the claim before it is forworded to the insurance company.
You receive your reports from one source and they are in the same format.
From Gateway you can recieve the electronic remittance - the 835. FormSmith can read this file and do the posting of your insurance claims for you.
Gateway can automate the fileing of your secondary claims. If you file a claim with two insurances on it, Gateway will file the primary and wait for it to pay. Once the primary has paid, Gateway will automatically file the secondary for you. You don't have to touch it.
FormSmith can create a file with the information needed to bill your patients and Gateway will use that to print statements for you and mail them. This can save a lot of time and money as they are mailed at a bulk postal rate instead of first class.
