CompuClaim’s Healthcare EDI Clearinghouse

What is CompuClaim’s Clearinghouse?

CompuClaim built its own Internet-based medical claims clearinghouse that helps healthcare providers increase profitability through improved claims reimbursement and staff productivity. Our healthcare EDI clearinghouse accepts claim information from all types of legacy claims management systems, runs business logic to check for claim errors, and sends the claim information electronically to third party insurance carriers. 

What are the Benefits of using CompuClaim’s Clearinghouse?

  • Claims are sent electronically to all third party insurance carriers, including Medicaid and Medicare, 

  • Ability to send batch eligibility requests 

  • Ability to batch and send large number of claims quickly

  • Reduces processing time and time to get paid

Who Uses CompuClaim’s Clearinghouse?

Healthcare providers and software vendors who provide healthcare data collection reporting tools use CompuClaim’s clearinghouse to file claims to an any public or private third party insurance carrier using a variety of formats. Each insurance payer has different requirements for submitting electronic claim files. CompuClaim’s clearinghouse takes the claim file from each client and re-formats it into a ANSII standard formats acceptable to all third party insurance carriers. 

How Does The Clearinghouse Process Third Party Insurance Claims?

Healthcare providers uploaded claims  through our Web portals into our clearinghouse where they are “scrubbed” to check for errors to ensure all the necessary information is in the claim.  This allows a chance to correct the claim and resubmit.  Once accepted the claims are  automatically transmitted electronically in a HIPAA 5010 ANSII standard secure format.    The insurance companies then receive the claim batch and either accept or reject the electronic claim.  Once adjudicated a claim status is returned to our clearinghouse; which then provides the status to the user - usually in a report format - that the claims have been successfully transmitted and received. If a claim is rejected, it will require correction and re-submission. If everything is acceptable for the insurance payer within 2 weeks the provider receives payment accompanied by an Explanation of Benefits (EOB) or a Remittance Advice (RA) from Medicaid.

To submit claims electronically without a clearinghouse, you would have to submit to each individual insurance company. This would be a major hassle as it requires a lengthy verification process with each carrier to get the unique submission requirements worked out with each one having different requirements. Can you imagine doing this for each payer? Submitting claims to individual insurance payers is a very time consuming and labor intensive process.

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