EDI Clearinghouse Reports
EDI stands for Electronic Data Interchange and represents an electronic transmission of data sent through a secure format. Let's just focus on medical claims for now. Every day as a billing service I submit claims electronically to the Clearinghouse. I can expect to receive within 10 min - 72 hours a EDI report notifying me if my claims were accepted or rejected by the Clearinghouse.
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If accepted the Medical claim Clearinghouse will transfer our patient medical claims on to the Health Insurance carrier.
A few days later our medical billing office will receive a EDI report from the Health Insurance Carrier (through the medical claim Clearinghouse) alerting us to the acceptance or denial of claims. If claims are denied it will supply a reason and if the claims were accepted it will supply additional payment information. |
In our training videos we display how this works when the electronic claims Clearinghouse is integrated with the Practice Management system. These steps are a bit more simplified over having a PM software that is not integrated wtih a Clearinghouse software; which would require you to log into the Clearinghouse software, upload your patient demographics & charges and transmit the claim.
EDI reports are important to read daily. If any claims are denied either at the Clearinghouse or Insurance Carrier level they should be fixed and rebilled immediately.
To learn more about EDI Clearinghouse Reports please Watch our FREE Medical training video series.
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