Medical Billing Coding - direct claim submital, cpt, codes
medical billing and coding forum

BC Advantage Magazine


Medical Billing / Coding from home

New Topic  |  Search

Thread Topic: direct claim submital
Topic Originator: YZ
Post Date May 20, 2009 @ 10:10 AM
direct claim submital

May 20, 2009 @ 10:10 AM Reply  |  Email Friend   |  |Print  |  Top

If I am would want to submit the claims direct and not use the clearinghouse, what is the process?

May 22, 2009 @ 12:44 PM Reply  |  Email Friend   |  |Print  |  Top

You might want to check your contract with your clearinghouse.  IT may have language that doesnt allow direct claims submission.  It may allow you to send claims to carriers they are not contractd with.

Sending claims directly to the carrier depends on the carrier.

May 22, 2009 @ 3:56 PM Reply  |  Email Friend   |  |Print  |  Top

Steve thanks, what you are saying that in most cases you have no choice you have to use a clearinghouse.
Someone said using the Medisoft software you can bill direct.
This is why I figured there was a way not to deal with the clearinghouses.


May 22, 2009 @ 7:47 PM Reply  |  Email Friend   |  |Print  |  Top

When you use Medisoft, there is a way you can use their clearinghouse interface and send claims directly but it is stil going through a clearinghouse like a Relay health. HOWEVER, if you did not want to use thier clearinghouse you can create a TEXT FILE of teh claims and upload that file to the clearinghouseof your choice like Anvicare, OfficeAlly, Availity or the million others out there. Personally I see no real advantage to using Relay health especially sinc eit is very expensive. Creating a TEXT file and uploading it is very easy to do and depending on which clearinghouse you choose to go with you can literally send your claims for FREE on some of these clearinghouses.

May 25, 2009 @ 11:55 AM Reply  |  Email Friend   |  |Print  |  Top


Hope you are having a great holiday weekend, I thank you for your detailed reply, I finaly got an answer to my question!
You have been a great help.


May 25, 2009 @ 12:01 PM Reply  |  Email Friend   |  |Print  |  Top


Any recomendations on the clearinghouses would be appreciated.
What target rate should I strive for when negotiating with the clearinghouse?


May 22, 2009 @ 9:56 PM Reply  |  Email Friend   |  |Print  |  Top

Nope, I was saying, if you have a contract with a clearinghouse, you want to check your contract to see what it saya about sending claims directly to carriers.

if there is no clearinghouse or contract, you need to check with the insurance company to see if they can receive claims from your software.  Some may and some may not.  

Some insurance companies may have the ability of using their website to send claims to them.  Some may require you to send claims using their proprietary software.

David, If I can add, please try sticking to one location to ask your questions.  It becomes confusing to answer the same question over and over again with the same answer.

Copyright © 2008 Billing-Coding Inc