Healthcare clearinghouses essentially function as electronic hubs that allow healthcare practices to transmit claims to insurance providers in ways that ensure that your PHI (Protected Health Information) remains secure. By protecting PHI, medical billing clearinghouses can ensure that you are staying ...
Medical billing company AdvancedMD goes a step further and uses its clearinghouse partner’s preferred scrubbing tool. In both cases, the vendors’ claim-scrubbing technology catches errors far better and faster than humans can. For the above reasons, when you see the term “claim scrubber,” ...
A covered entity is a person who provides treatment, payment, as well as operations in the healthcare sector. According to the U.S. Department of Health & Human Services (HHS), healthcare providers, health plans, and healthcare clearinghouses fall under the covered entities. The healthcare p...
Most claim scrubbers are automatic tools that third-party medical billing services provide. They’re often part of clearinghouses, where claims go for finalization between when you submit them and when payers receive the bill. Technically, you can have your admin handle claim scrubbing, but the ...
Claims dataresults from processing a healthcare claim. Two types of claims data include open and closed. Open claims datasets come from claims clearinghouses or providers’ revenue cycle management systems. They cover a large scale of patient lives, but may not represent complete claims coverage fo...
HIPAA impacts two main types of organizations: "covered entities" such as healthcare providers, health plans, and healthcare clearinghouses; and “business associates” of covered entities, such as billing companies, electronic health record (EHR) vendors, consultants, or IT providers. What is Prot...
Health plans, which refer to groups or individuals who pay or provide the cost of medical care. Healthcare clearinghouses, which are public or private entities that process health information received from another entity. Examples include repricing companies, billing services, community health informatio...
Business Associates:Under HIPAA, “business associates” are organizations that provide services to covered entities that involve access to PHI. For example, an organization that handles billing for a healthcare provider has access to patients’ name, address, etc., which are protected as PHI under...
For medical offices that do not have EHRs, or choose to do their eligibility checking outside of their EHR, there are many vendors who provide eligibility checking through online portals. This technology functions as a clearinghouse for multiple insurance carriers. The medical clinics usually incur ...
Healthcare clearinghouses:These businesses process nonstandard PHI into a standard format for electronic transmission between covered entities. Business Associates Business associates (BAs) are third-party service providers who access PHI while performing services on behalf of covered entities. Examples inclu...