Are You Happy With Your Clearinghouse?

We often get asked about clearinghouses and which one we use. Since starting our business in 1994 we have used many methods of submitting claims electronically. When we started we submitted our Medicare claims using that tedious program that Medicare provided to providers and billing services free of charge. Anyone who used it knows what I’m talking about. It was a DOS program that was very temperamental and required you to double enter the claims information into the program and the practice management system for tracking purposes.

We graduated from that system to using a clearinghouse that charged a per claim fee. The problem was that after a couple of months of not getting any payments we found out that the clearinghouse was actually two guys in a garage and they weren’t successfully transmitting claims to the insurance carriers. So our local Blue Cross Blue Shield hooked us up with another clearinghouse out of NJ that was successfully submitting claims to them. Since BCBS was one of our largest payers this was a start. That clearinghouse actually worked out well for us, and they too charged us a per claim fee. We continued to use this clearinghouse for about 2 years but then they sold out to a larger clearinghouse.

All transitions have their bumps but we didn’t survive the transition from our little clearinghouse to this larger monstrosity. After unsuccessfully submitting claims for several weeks we found ourselves in a position where we needed to find a new way to submit claims.

We decided to investigate submitting claims directly to insurance carriers instead of using a clearinghouse. Basically, become our own clearinghouse. We found a program compatible with our PM system that allowed us to create our own 835 files to upload. This worked out well for many years. We had to pay quite a bit for the program but there were no more per claim fees. Most claims were uploaded directly to the insurance carriers and the overflow or smaller carriers went to a free clearinghouse called Availity. This was our first introduction to a free clearinghouse.

Before Availity we were unaware that there were free clearinghouses out there. Availity worked well for us. After several years the company we bought the software from also sold out to a larger nationally known software company. This meant we would have to either go with the new company or we couldn’t get any updates. Unfortunately the new company wanted to squash out this smaller company because they had a vested interest in a large clearinghouse so they didn’t want providers or billing services to be able to create their own 837 files. So we had to once again come up with another plan.

It was at about this same time that we became aware of another free clearinghouse called Office Ally. Office Ally would allow us to submit unlimited claims to all of our major payers at no or little cost. The only cost with Office Ally is if you submit 50% of claims to government payers such as Medicare, Tricare, etc. then there is a $20 per month charge. In the past couple of years that we’ve used Office Ally we’ve only been charged the $20 fee one time. Office Ally was similar to Availity but for us it was a little easier to use and submitted to more payers that we use. When we used Availity we had created a file in the 837 format and uploaded that. Without the program we were using we could no longer create the file in the 837 format. With Office Ally we only have to create a text file. I’m sure that we could have contacted Availity to change the format in which we uploaded, but Office Ally submitted to all of the same payers and many others as well. Since they were also free we just switched over.

We have now been using Office Ally for a couple of years and are very pleased. Their customer service department is very helpful. They have helped us get to the bottom of any and every issue we have encountered. The transition to 5010, so far, has been fairly smooth. I’m sure there are other clearinghouses out there that may be equally as good. I can only speak of the experience that we have had. Often we are asked about what clearinghouse we use or how we submit our electronic claims. We love to share our knowledge and experience, especially when that experience has been a positive one. We are doubly excited to share Office Ally since it is a free clearinghouse. If you have a clearinghouse that you use and you feel they too are good, feel free to share about it on the free forum at http://www.medicalbillinglive.com/members