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Posts Tagged medical billing clearinghouse

Apex EDI Review: Why Choose Apex EDI

With electronic data integration (EDI) reaching the forefront of electronic data transfer, more and more services seem to offer this option for medical and wellness practitioners. How do you know which service to choose?


Apex EDI offers a host of positive features that will allow your practice to run smoothly, but here are a few reasons why we think you should choose our software for your business.


Not only does Apex EDI offer a user friendly interface, it integrates seamlessly with dozens of existing practice management softwares. Click here to see a list of practice management softwares that Apex EDI currently integrates with; and the list is still growing.

This integration allows for your staff to focus on providing exceptional care to your patients. Instead of fighting with complicated softwares and difficult transitory processes, Apex EDI allows your staff to process insurance claims quickly and cohesively with plug and play efficiency.

Fool Proof Submissions

Another great benefit of Apex EDI is the ability of the software to read and recognize potential errors within insurance claims. Before a claim can be properly submitted, the software scans the claims and checks for errors or misapplied information. When Apex finds the error, it notifies the billing professional of submission errors to correct before the claim can be sent to the payer.

Error identifying technology allows for your staff to catch these mistakes before they can be denied by a patient’s insurance company. Not only does this speed up the process of claims processing, it also allows your practice to get paid faster to maintain a profitable and well managed business.

Compliance & Privacy Driven

You might be thinking, “This is all fine and good, but what about industry standards regarding HIPPA and patient privacy?”

That’s a valid concern, and we’re glad you asked. Apex EDI is fully compliant with HIPPA and state and federal patient privacy practices. We don’t share any patient information with outside parties. Apex EDI is committed to the highest possible service of our clients and their customers. Your privacy and security is of the utmost importance, which is why we have a detailed privacy statement for your review here.

If you have any other questions or concerns about privacy practices at Apex EDI please feel free to reach out to us here.

Commitment to Excellence

At Apex EDI, we live and breathe customer service. We are committed to providing an exceptional experience with our products for your practice, regardless of your specialty.

If you would like to learn more about how Apex EDI can assist your practice, please do not hesitate to reach out to our support team with your questions or concerns.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

Posted in: Apex EDI Review

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Medical Billing Clearinghouse: What is the Role of a Medical Clearinghouse?

In the world of medical billing, there are a few concepts that can get a bit confusing. One of these concepts is that of a medical clearinghouse. What exactly does a clearinghouse do, and why is it important?  Let’s discuss the role of the medical clearinghouse, its benefits, and how to choose one.


What They Do

A medical claims clearinghouse acts as a middleman between the provider (doctor, dentist, chiropractor, etc.) and the payer (insurance company). The practice management software on a billing professional’s computer creates an electronic file (the claim) also known as the ANSI-X12 837 file. This file is then uploaded to your medical billing clearinghouse account.

From here, the clearinghouse then checks the claim for errors, ensuring that the claim can be properly submitted to the payer. Once the claim passes inspection, the clearinghouse securely transmits the electronic claim to the payer with which it has already established a secure connection that meets the strict standards laid down by a HIPAA.  The claim is then either approved or denied by the payer, in which an approved claim generates a payment of services to the provider, and a denied claim may require additional information to procure processing.

Benefits of Clearinghouses

The main benefit of the clearinghouse is efficiency. Clearinghouses scrub medical claims to ensure correct data entry for properly processed claims. Without this error checking, incorrect claims would be submitted to payers on a more regular basis. Incorrect claims cause inefficiency in the workplace, more work for your staff and the payer, and often result in denied claims due to incorrect filing or coding.

Another benefit of using a clearinghouse is the integration between the payer’s software and the provider’s software. Each payer and provider are likely to use different softwares, but these softwares are not necessarily compatible with each other. When using a clearinghouse that integrates with each software separately, the payer and provider are able to allow each software system to communicate through electronic data integration (EDI).

How To Choose One

When choosing a clearinghouse, it is important to keep the following aspects in mind:

  • User-friendly Interface
  • Integration with Existing Practice Management Software
  • Customer Service & Support
  • Privacy Practices & Compliance

With a friendly user interface that integrates with dozens of existing practice management softwares, Apex EDI is the premier choice for medical claims processing. Our clearinghouse is dedicated to upholding exceptional practices with regards to customer service, as well as compliance with federal privacy practices such as HIPPA.

For more information, be sure to reach out to us on our Contact Us page.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

Posted in: Medical Billing Clearinghouse

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Sleep Apnea Claims: How to Code and File a Sleep Apnea Claim Correctly

As the practice of wellness becomes a more congruous and cohesive effort between practices, many medical and wellness practices begin to file insurance claims that might normally be filed with a specialist.


One such claim is that of sleep apnea oral appliance therapy (OAT) devices. When filing for a patient to receive treatment for sleep apnea, it is important to file the claim correctly in order to ensure claim approval.


Prior to filing an OAT claim, it is important to get in touch with the patient’s medical insurance in order to verify eligibility and benefits. Questions that need to be asked include:

  • Is OAT covered by the plan?
  • Will a preauthorization be required?
  • What percentage will be paid?
  • What is the deductible, how much of the deductible has been met, and when does the new plan year begin (to determine if a new deductible will apply)?
  • What is the replacement time period?
  • Is a referral necessary from the primary care provider?
  • Do you require modifiers for the appliance?
  • What is the claim mailing address?

These questions verify which services, procedures and medical devices the patient is eligible to receive through their insurance provider. Verifying eligibility allows for your clinic to grab a better sense of which services the patient can have billed to insurance, and which will most likely be paid out of pocket.


Thorough SOAP note documentation is essential when filing a claim for sleep apnea. An example of SOAP notes for a sleep apnea case would be:

  • A detailed report of exactly what the patient is struggling with. Be sure to include diagnosis codes within the note to ensure proper coding and approval from the clearinghouse.
  • Examination findings including gender, height, weight, blood pressure and heart rate, etc.
  • An assessment of the findings that determines the cause of the symptoms.
  • A clear plan of treatment that includes the recommendation for an OAT device to treat sleep apnea.

The more detailed and clear the note is, the more likely the patient is to be approved for the OAT device for sleep apnea based on their current medical benefits. A lack of information or unclear SOAP notes does not provide an insurance company with enough valid information to approve a sleep apnea claim.

Sleep apnea claims that include proper billing and diagnoses codes, detailed SOAP notes, and verified eligibility allow for your practice to serve your patients needs more fully, and provide exceptional care.

For more information about the cross coding capabilities of Apex EDI for sleep apnea claims, be sure to sign up for more information here.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

Posted in: Sleep Apnea Claims

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Physical Therapy Claims: Top Tips for Filing a Physical Therapy Claim

As a physical therapist, you have a lot on your plate. Filing claims shouldn’t take up the majority of your time and resources. We’ve compiled the top three tips for filing physical therapy claims to increase efficiency, profitability, and patient care.


Optimize Claims

The first step is to optimize your claims. Be sure to use an up to date practice management software that allows you to keep track of each patient’s information, including their insurance information. Be sure that when you are writing the SOAP notes for each patient, that the billing and diagnoses codes are cohesive.

A great way to do this is with a clearinghouse. Medical billing clearinghouses scrub claims to ensure that each claim is correctly filled out before it can be submitted to a payer. If a claim is missing something, the clearinghouse will find it and notify the claims professional of the error. For more information on physical therapy claims billing clearinghouse services, click here.

Increase Efficiency

Increasing efficiency through a clearinghouse as discussed above is one way to start seeing more efficient workflows in your physical therapy practice. However, this is just the tip of the iceberg. Increasing efficiency can also be implemented through ensuring that your claims are optimized (as discussed above), so that inaccurate submissions can be avoided.

Also, it is important to assign roles among your billing staff. Who is responsible for filing claims? Who is responsible for following up on submitted claims? By assigning clearly articulated roles among your claims and billing staff within your practice, efficiency will be increased by minimizing redundancy of workplace tasks.

Digital Filing

Let’s face it, paper filing was great. But it had its day in the sun. The future is now, and the future is digital filing. Most insurance companies, Medicare included, will not accept paper claims. It’s simply not an efficient way to run an organization, and it costs businesses thousands of dollars each year to maintain a paper-only business.

If you’re not filing digitally, you’re going to run into a ton of road blocks. The first step is to ensure that you are using an efficient practice management software to keep track of your patient information. Next, you’ll want to get in touch with a claims clearinghouse in order to electronically transfer data to payers (insurance companies). If going digital seems too complicated, feel free to reach out to our friendly customer support staff here at Apex EDI. We can walk you through the process and demonstrate how user-friendly and efficient our services truly are.

For more information about filing physical therapy claims, and for efficient and integrative systems to use for your practice, be sure to contact us to discuss the best options for your business.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

Posted in: Physical Therapy Claims

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Urology Claims: The Do’s & Don’t’s of Filing Urology Claims

As a urology professional, you know the ins and outs of your practice. Here are a few helpful tips to ensure that your claims billing process maintains an even keel.


Do Verify Patient Information

As with any claim submitted to insurance, verification of patient information is critical. Be sure to obtain the patient’s insurance information, verification of date of birth and Social Security number, as well as home address, and SOAP notes from the physician after the exam. Correct information for the patient will allow for urology claims to be approved within the patient’s coverage.

Do Verify Provider Information

It’s also important to verify your own information! When filing a urology claim, be sure to provide your practice’s correct address and contact information, as well as identification numbers and EDI processing numbers.

Do Scrub Claim With a Clearinghouse

Using a clearinghouse to verify the claim helps to increase efficiency and avoid errors within the claims process. An efficient clearinghouse will check your urology claims in order to ensure that each claim is error free before final submission. If an error is found, the clearinghouse notifies the billing professional. Fixing errors before final submission minimizes weeks of headache down the road for incorrectly filed or coded claims.

Don’t Resubmit Denied Claims

If a claim has been denied, it probably has been denied for a good reason. Before you automatically resubmit the denied claim, verify that the claim is error free. If the claim contains errors such as incorrect diagnosis codes, then it is possible that this is the reason for denial. Verify with the attending urologist which diagnosis codes should be assigned to the patient within the claim before proceeding with resubmission.

Don’t Double Bill for Visits

Some visits are not able to be submitted for claims twice under specific insurance coverage provisions. Specifically, Medicare has very clear regulations about billing for postoperative visits. Click here to read more about those regulations.

Don’t Forget the Clearinghouse

We really can’t say this enough. The purpose of a clearinghouse is to ensure that each urology claim is error free. A properly designed clearinghouse identifies errors, and notifies the claims professional of errors to be corrected before final submission.

Without the clearinghouse, it is possible and likely that claims will be submitted with errors. Error filled claims are likely to be denied based upon the errors within, causing your practice to resubmit the correct claims a second time. This submission and resubmission takes additional time and resources, causing a deficit in both time and money for your urology practice.

Follow these simple steps when filing a urology claim, and you’ll be sure to receive payment from payers in no time. For more information on clearinghouses for urology practice, visit this page.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

Posted in: Urology Claims

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