A healthcare clearinghouse acts as an intermediary between healthcare providers and insurance payers. During the claim submission process, it receives electronic claims from providers, rigorously examines them for errors and inconsistencies, and formats them to comply with the specific standards required by each payer. This process includes verifying patient information, coding accuracy, and adherence to billing regulations.
The function provides significant benefits, ensuring a higher rate of claim acceptance and reducing denials, leading to faster reimbursement cycles for healthcare providers. Historically, the introduction of these entities streamlined what was once a cumbersome and error-prone paper-based process, contributing to greater efficiency and cost savings within the healthcare system.
