If you’re of a certain age, you most likely associate the word clearinghouse with an image of Ed MacMahon carrying around a comically oversized check. If this is all that comes to mind, you might be a little confused why Renaissance talks about its relationship with Tesia Clearinghouse. The reality is that clearinghouses play an integral role in daily financial and medical transactions.
It’s all about clearing checks.
In the banking world, clearinghouses serve as an intermediary (or “middleman”) between financial institutions. The act of clearing, turns the promise of payment, such as a check or electronic request, into the movement of money from one account to another. Clearinghouses facilitate these transactions between separate banks. A great example of this is services like Venmo or PayPal enabling customers of different banks to transfer money to each other.
How insurance payers use clearinghouses.
Medical and dental clearinghouses fulfill a similar role for patients and insurance payers. In this setting, the promise of payment is the insurance claim submitted on behalf of the patient to their financial institution, which is an insurance company. However, unlike a check from a bank, the criteria for clearing an insurance claim to pay for the medical provider is much more complicated.
All that’s required for a check to clear is the accurate account and routing number, along with the required funds in the account holder’s bank. For an insurance claim to clear, the insurance payer needs the valid procedure codes and patient information. Additionally, the patient’s insurance benefits actually has to cover the treatment.
An added value of insurance clearinghouses is that they scrub this information to help ensure the claim isn’t rejected due to minor clerical errors. Additionally, clearinghouses like Tesia will return information to the provider on why a claim was rejected and recommended next steps to resolve the issue.
Am I able to choose my clearinghouse?
Chances are that unless you’re using RPractice with Remote Lite, you process claims through whatever clearinghouse your practice management system has partnered with. The downside to these default clearinghouses will often charge an average of $0.50 for each claim you process, unlike Tesia.
When you process your claims through RPractice with Remote Lite, you partner with Tesia Clearinghouse. Not only does your practice save thousands on dental claims annually, but you also receive helpful information on why your claims are rejected and how to fix them.
If you would like to know more about how our partnership with Tesia Clearinghouse can help your practice, you can set up a time to speak with a representative here.