Medical Claims Processing Frequently Asked Questions
- What makes Apex EDI different from other clearinghouses?
- How do electronic claims work?
- How can I keep control of the claims when I send them electronically?
- What fees do you charge?
- Is there a trial period or some kind of guarantee?
- How long does it take to get going?
- How hard is it to learn to use APEX?
- How long does it take to send claims?
- What kind of support do I get?
- How quickly are payments received?
- Can I submit pre-authorizations electronically?
- Can I send x-rays electronically?
- Can I send secondary insurance claims electronically?
- What if an insurance company does not accept electronic claims?
- Do I have to enroll with insurance companies for electronic claims?
- What types of claims does APEX process?
- Is using APEX less expensive than other methods for sending claims?
What makes Apex EDI different from other clearinghouses?
Unmatched connectivity — Apex gives you electronic access to one of the largest payer networks you'll find anywhere. You will also receive the personal attention needed to have your concerns resolved quickly. Your own personal representative who knows your office will be available whenever you need help.
How do electronic claims work?
Electronic claims are a “paperless” claim sent to the insurance company. Think of APEX as an electronic post office that sends your claims certified mail and then receives verification that the claims were received by the insurance company and entered into their computer. Sending claims electronically is faster, less expensive, and removes many ”human error” mistakes.
When submitting electroni claims, the claim is created in your practice management software as before. It is then stored electronically until you are ready to send a batch of claims. At the end of the day, you click on the Apex icon and the system takes care of the rest. The entire batch is sent to APEX and reports are automatically delivered to you.
How can I keep control of the claims when I send them electronically?
You actually have better control by sending your claims electronically than by mailing them. You receive clear and concise reports tracking the claim each step of the way to the insurance company. With a paper claim, once it enters the mail system there is no way to track it and ensure it arrives at the insurance company in a timely manner, if at all.
What fees do you charge?
Most of our clients choose the flat monthly rate and one time set up fee. With this option APEX does not charge a per-claim fee, an annual fee, or support fees. The registration fee covers everything you need to get going. After that, all you pay is the flat monthly rate which is billed at the beginning of the following month.
Apex EDI does offer other rate options for those practices that do not submit a large number of claims. Please contact our office at 800.840.9152 to speak with a representative on additional options.
Is there a trial period or some kind of guarantee?
Yes. You can try APEX for 60 days risk free. If you decide during that time to discontinue using our service, we will refund your registration fee. In addition, we do not require an agreement for any specified amount of time so you can stop sending claims any time you would like. Just give us 30-days notice so we can close your account without interrupting your claim payments.
How long does it take to get going?
Once you have the APEX software and registration forms on hand, we will arrange a convenient time with you to get your computer systems set up and get you trained. The entire set up and training process is very simple; it takes place over the phone and lasts about 40 minutes. Once you're set up, you can start sending claims immediately.
How hard is it to learn to use APEX?
Not hard at all. If you know how to click on an icon you're more than halfway there. We give you the training you need to be successful at sending electronic claims. We'll watch your first several batches of claims and look for any problems so that we can help you should a problem arise. If you run into any problems or have any questions, call our support line and we will help you through the process as many times as you need.
How long does it take to send claims?
We've designed the system so that sending claims is a fast and easy process. Claims are sent and reports are returned to you in about one minute. That's hard to beat!
What kind of support do I get?
All the support you need. We watch on our end for any difficulties you may be having. If we notice a problem we will give you a call to help you. In addition, we'll call you every few months to check on how things are going and to see if you have any questions. If you have a concern call our technical support line immediately. We can usually have your concern resolved within a minute or two. We are very responsive and want you to be successful at sending your claims electronically through APEX.
How quickly are payments received?
Our clients have told us electronic claims payments average between 7-14 days.
Can I submit pre-authorizations electronically?
Yes. Submit your pre-authorizations at the same time you submit your claims.
Can I send x-rays electronically?
Yes. All you need is an electronic copy of the x-ray. You submit the x-ray over the Internet using NEA Fast-Attach then include a note on your electronic claim indicating the “NEA number” for the x-ray. When the insurance company receives your claim with the note they will know to log in to NEA's system and locate the x-ray that you uploaded.
Can I send secondary insurance claims electronically?
Because secondary claims require an Explanation of Benefits (EOB) from the primary insurance company, it works best to send these claims in the mail along with the EOB. Some insurance companies are working on a way to receive the information from the EOB without having the form submitted. Our recommendation is that you mail these claims.
What if an insurance company does not accept electronic claims?
APEX accepts all claims electronically. If an insurance company does not accept electronic claims from us, we will print and mail the claims for you. We add about eight insurance companies to our payer list every month. When an insurance company is added to our list the only difference you will notice is that payments start coming faster.
Do I have to enroll with insurance companies for electronic claims?
With the majority of insurance companies APEX can automatically enroll your office for electronic claims. However, there are a few insurance companies that require enrollment directly from your office. When you get started with APEX we will send you everything you need to register with those that require it.
What types of claims does APEX process?
APEX is able to submit claims for providers who submit their claims on a standard ADA claim form or a standard HCFA claim form. These include but are not limited to medical providers, dental providers, psychotherapists, chiropractors, eye care professionals, physical therapists, and others.
Is using APEX less expensive than other methods for sending claims?
Yes! Despite the fact that you can put several claims in one envelope, a lot of the expense remains constant. Many national studies indicate that a typical paper claim has an average cost of over $2.00 when you take into account the many “hidden” expenses. Electronic claims are definitely less expensive and APEX has one of the lowest rates for electronic claims. Typically we can save you 20% — 60% over other electronic claims services.