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Claims Clearinghouse: Are Claims Management Companies Worth It?

At Apex EDI, we’re interested in helping you find the best solutions to your medical claims issues, and avoid pitfalls that cost you time and money over the long run. We know that the world of insurance can be confusing and intimidating, so we want to help pull back the curtain a bit on what goes on behind the scenes of filing insurance claims.

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Something we get asked about a lot are the viability of claims management companies, companies that file complaints against financial institutions on behalf of a client. They go after these financial institutions for you for unpaid claims and disatisfaction with service, and promise great large and timely compensations.

These claims companies will do all the work for you. They will represent you to the company that you are filing a complaint against and fight on your behalf for the highest payout possible. They employ professionals who know the ins and outs of how to settle disputes with financial institutions, and may have more insight than you do into the value of your claim.

Financial institutions have an incentive to keep their liability as low as possible, and it can be difficult for a lay individual to catch them in the act or know how to combat them effectively. Hiring a claims management company can help you get the best payout possible. If you choose to use a claims management company, make sure that it is a reliable one. You can vet the company by checking that it is regulated by the Ministry of Justice and a member of a professional body.

Looking for more professional help with claims? Filing insurance claims is our specialty at Apex EDI, and we offer the professional support and high tech features you need to save time and money on processing your medical, dental, or vision claims. Contact us today to learn more about how we help you get the most out of your team and your software by making it easier than ever for you to reduce the number of denied and rejected claims you receive.

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Claims Clearinghouse: Medical Claims Clearinghouse

With all the regulation changes that have happened and have yet to happen, navigating the healthcare revenue cycle can be overwhelming. So much of what physicians do is overseen by one regulatory committee or another. In fact, often it is multiple committees that oversee one aspect of healthcare. Understanding what the healthcare professional needs to comply with can be costly. That is why having a medical claims clearinghouse on your side is a powerful partnership that no healthcare practice should be without.

In 2010 congress passed the Affordable Care Act (ACA). This law put into place numerous regulation changes. Some of those changes were obvious, like increased patients with insurance, others were not so obvious, such as insurance companies providing administrative and financial transactions that are compliant with the standards set forth. A medical claims clearinghouse is there to help manage these changes on behalf of the physician. They can help physicians by cutting through overwhelming documentation and let them know what they need to act on. They also maintain the relationship with the insurance company when it comes to the electronic interchange of data. This allows the medical claims clearinghouse to advocate for the provider when it comes to establishing connections for the administrative and financial transactions the insurance companies are now required to provide physicians. These transactions include, but are not limited to, electronic eligibility and benefit verification and electronic explanation of benefits (EOB’s).

With the ACA a number of regulatory bodies became prominent in the healthcare industry. One of those bodies is the CAQH body. They are responsible for the CORE operating rules. CORE operating rules are mandated operating rules in section 1104 of the ACA. The purpose of these operating rules is to:
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