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Thursday, 08 May 2014 10:00

What are Clearinghouses and why are they Important to your Dental Practice? Featured

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post 50 picClearinghouses have existed for some time and are a part of many industries:  finance, banking, law enforcement, healthcare…  

These institutions are vital to the operation of businesses whose players are independent and diverse. 

They are the connection point that facilitates communication and cooperation within widespread industries.  

Let’s start with a definition applicable to dentistry.  A clearinghouse is:

A private or public company that provides connectivity and often serves as a “middleman” between healthcare providers and payers.

 

Think of it as one of those old-fashioned telephone switchboards where an operator would physically establish a phone circuit between a caller and the person with whom they wished to speak. 

Without these technology wonders of the past, it would have been necessary for each caller to have a separate wire to each location that they might call. 

Instead a single wire going to a central phone office whose responsibility is to connect your wire to the wire of the party you wish to reach.  Consider it as a clearinghouse for phone calls.  

The healthcare clearinghouse is this central entity that electronically connects your claims, eligibility and claims inquiries with the appropriate insurance company. 

Going the other way, the same clearinghouse connects the insurance company’s eligibility, claims status responses and electronic remittance advice back to your practice.  No need for a separate wire between each partner.

Who are these modern day switchboards?  One of the largest is a company out of Nashville by the name of Emdeon

They describe themselves as a provider of revenue and payment cycle management and clinical information exchange solutions – in other words, a healthcare switchboard

They have wires to approximately 1,200 insurance companies, 5,000 hospitals, 60,000 pharmacies 340,000 physicians and 81,000 dentists.  

Speaking as a dental software vendor, Emdeon has been a key partner of ours in connecting our clients with other healthcare stakeholders. 

We establish the single connection to this clearinghouse and let them connect the wires to pass the claim or other transaction on to the appropriate insurance company. 

If the transaction requires a response, they are the middleman, passing that response back the dental office.  

Did you notice that Emdeon maintains connections to 60,000 pharmacies?  We’ve been able to leverage this connectivity to provide electronic prescribing services.  No paper slip carried to the pharmacy.  The prescription is waiting at the drug store when the patient arrives.

Sometime a single clearinghouse will not cover all of the entities with which a practice may wish to exchange information

Our software maintains six connections, two clearinghouses and four direct insurance company links.  With these our clients can electronically exchange vital administrative and clinical transactions with over 95% of the organizations with which they do business.

A major aspect of healthcare reform is getting the diverse players involved in a patient’s health electronically communicating with one another. 

Clearinghouses facilitate this. In fact they are absolutely necessary to make it all work. 

These modern switchboards are an important partner in your dental practice, albeit a rather silent partner, but an essential right click for your office.

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