EAC  SUBMISSIONS
EAC  SUBMISSIONS
Your solution for electronic ambulance claim submissions

 

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Clearinghouse Basics

A clearinghouse is a centralized computer entity that receives claims from providers, validates and customizes those claims for the various carriers, then submits them to the appropriate insurance carriers.

All insurance carriers must accept electronic claims.  Many are large enough that they have their own submissions structure and claims are submitted directly to them.  Others may require the use of a specific agency to accept their claims.  In all cases, the submitter must be registered for the carrier and electronic claims must be tested and validated prior to submissions being accepted from that submitter. 

As an ambulance provider, it is typically impractical to submit electronically to a variety of carriers on your own.  Some states provide software that can be used to submit directly to their Medicare or Medicaid carriers.  These systems can work well for the claim submissions, but they have no ability to track accounts receivable, produce invoices, track past dues, or submit claims to other carriers.  This results in the provider having to double-enter the information into another program in order to perform the necessary accounting tasks and to print-out or submit claims to other carriers.

A clearinghouse serves as a technical "middle-man" by accepting claims in a standardized manner, then customizing them for the specific carriers before submitting them.  The registration, testing and technical headaches of submitting to multiple carriers is performed by the clearinghouse. 

If the billing software produces an acceptable electronic claim output file, the provider can submit to multiple insurance carriers through a clearinghouse without double entry of data and without multiple registrations and submission requirements.