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Medical Billing Clearinghouses | What Are They?

Medical Billing Clearinghouses gather claims information electronically from various sources, such as your Billing Service. The clearinghouse then edits, formats and submits this claims information to the various insurance companies for payment. The reason clearinghouses are important is that they have the ability to meet the specific data requirements of each insurance company and their specific computer formats. They can therefore submit claims to any insurance company that accepts electronic claims. This task is essential for electronic claims as it is too complex to perform them independently on your own. You would need to communicate electronically with perhaps dozens of insurance companies.  Instead, you only have to communicate with a single clearinghouse. 

ClaimTek's software provides you with flexibility in working with multiple clearinghouses nationwide. You are not limited to one. When you have your own business, you need the freedom of choice. If you become dissatisfied with one source, you can choose another without interrupting your business or being forced to change your software. You should be concerned if any software you're shopping allows only one choice for a clearinghouse.

While our software is accepted by the majority of clearinghouse across the nation we found that some have better service and pricing than others. We recommend that you use one of the following for their outstanding service.

Gateway EDI | Flat-Fee Based Service
Gateway EDI clearinghouse offers one of the best customer service and online training in the industry. There is no setup fee, no annual or per claim fees. Gateway EDI offers several levels of service based on a flat monthly fee: All the electronic claims that you can send for only $75 per account per month. There are slightly higher level monthly plans that allow you to enjoy additional services like ERA (Electronic Remittance Advice, Online Eligibility Verification, Claims Status inquires...etc.

ENS-Health | Flat-Fee Based Service
ENS-Health clearinghouse offers outstanding customer service and online training. There is a one-time $125 setup fee. There is no annual or per claim fees. ENS-Health offers two levels of service based on a flat monthly fee: (1) All the electronic claims that you can send for only $49 per doctor per month, (2) For $69 per doctor per month, you can add online eligibility verification and real-time claims status inquiry. Remember, this fee includes all the electronic claims you can send for a low flat monthly fee! To sign up with ENS please CLICK HERE

ET&T - Electronic Translations & Transmittals | Per Claim Service
ET&T offers outstanding customer service as well. There is a one-time $100 setup fee. There is no annual or per doctor fees. 
The Fee per claim is $0.35 and no charge for rejected claims. You can submit both medical and dental claims through ET&T.

Automated Clearing House | For Electronic Fund Transfer Service (EFT) 
The ACH clearinghouse is where the Electronic Fund Transfer EFT transactions are sent. The Automated Clearing House (ACH) is the electronic network to which 95% of the nation's banks belong, including the Federal Reserve.

For ACH, there is a one-time fee of $50. The cost per transaction starts at $0.45 but can be reduced to $0.23 depending on volume (this is explained in our Medical Billing Manual). Once you start processing transactions, a $25 monthly fee applies. There is no additional setup fees for new account or any annual fees.

Fees to all clearinghouses are not due until you start processing claims or EFT transactions.
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