ClaimTek - Medical Billing (800) 224-7450

Medical Billing - Clearinghouse

Clearinghouses

Real-time electronic claims processing, for FREE!
Earn residual income from clearinghouse commissions!

Medical Billing - Clearinghouse

Keeping clearinghouse costs low is a key element for the success of your medical billing business.

When you have your own business, controlling expenses is often a key element for reaching a good level of profitability. You also need flexibility and the freedom of choice. After all, that's one of the main benefits of having your own independent business. You should be concerned if a company you're interested in doing business with allows only one choice for a clearinghouse. We advise you to analyze and learn about all fees before making a decision. We say this because it's not uncommon for competitors that offer basic web-based software to charge a flat monthly fee of $250 or more per doctor per month or charge nearly $1.00 per created claim, which is far above industry standards of 35 cents. What's more, they charge you another 95 cents if you discover an error, correct and re-save the claim!

If you're looking to start a new billing service business without prior experience, we advise you to be alert to this kinds of secret business tactics. High fees and limited choices are not the norm in this industry and will hurt your business.

Compare costs for yourself!

If you are a ClaimTek client and have 10 doctors for example, your clearinghouse fees will be free or around $500. With some competitors that use browser-based systems, you're looking at a cost of around $250 per provider per month ($2,500 for 10 doctors!) or $4,400 per month if you pay per claim. If you have 20 clients, your fees will double to $5,000 or $8,800 per month. With ClaimTek your cost would be around $1,000 or much less and you have many choices of clearinghouses:

Number of Doctors You have:

Number of claims per month based on the national average

Browser-Based Competitors charging $250 per Provider per Month or $1 per claim!

ClaimTek (FREE or average of $50 per doctor/month).

1 Provider 440 claims/month Per Month: $250 flat fee or $440 (if based on per claim) $50
2 Providers 880 claims/month Per Month: $500 or $880 $100
3 Providers 1,320 claims/month Per Month: $750 or $1320 $150
4 Providers 1,760 claims/month Per Month: $1,000 or $1,760 $200
5 Providers 2,200 claims/month Per Month: $1,250 or $2,200 $250
10 Providers 4,400 claims/month Per Month: $2,500 or $4,400 $500
20 Providers 8,800 claims processed per month $5,000 or $8,800 cost per month. This is money out of your pocket UNNECESSARILY! $1,000 or much less

ClaimTek claims processing is fast and inexpensive. you can send claims direct & FREE to many insurance companies. ClaimTek will save you thousands of dollars each month adding tens of thousands to your bottom line each year.

Clearinghouses and how they work...

Billing Services typically submit claims electronically for real-time processing at a national clearinghouse (there are dozens of them nationwide). The clearinghouse scrubs, formats and submits claims in real-time to hundreds of insurance companies for payment. The reason clearinghouses are important is they have the ability to meet the specific data transmission requirements of every insurance company that accept electronic claims. This task can be time-consuming to perform independently on your own. You would need to communicate electronically and individually with hundreds of insurance companies, which can be a tedious process. Instead, you only have to communicate with a single clearinghouse. For this, you pay a small fee to some clearinghouses but with some other clearinghouses, this service is FREE!

You may wonder, why FREE? In order to understand this, it's important to know how clearinghouses make the bulk of their income. Clearinghouses receive rebates paid by the insurance companies for every claim that's submitted electronically to them. Insurance companies do this to encourage electronic billing and cut the cost of manual processing. Most clearinghouses make additional income by charging consumers (doctors and billing services) a small fee as well. So some clearinghouses make money from both side of the equation: (1) From insurance company rebates, and (2) From consumers (end-users of various software, like doctors' offices & billing companies). In recent years, several reputable clearinghouses decided to offer this service FREE to the consumer side in order to attract higher volume of claims submissions and capitalize only on the handsome rebates paid by insurance companies.

Now, the majority of the clearinghouses that charge consumers, the fees they charge are typically small and reasonable. For example, some charge 35 cents per claim and some charge a flat monthly fee that's around $50 per month per account, on the average.

With ClaimTek's software, you're in control to decide which clearinghouses fit your need the best. You are free to make many important decisions for your business. Our software allows you to:

  • Submit claims electronically, directly, and FREE to several clearinghouses
  • Submit claims electronically and directly to several clearinghouses that charge reasonable fees
  • Submit claims electronically and directly straight to insurance companies (You may elect to do this if you have a doctor that deals mostly with one or two insurance companies. i.e. Medicare and Blue Cross). You can go direct and bypass the clearinghouse altogether!

Your decisions to choose one clearinghouse over another depend on several factors. You may sign up a client in a different state and some insurance companies may not be on the list of payors with your current clearinghouse. In this case you may want to choose another clearinghouse for this new doctor account. Another reason can be customer service. If you become dissatisfied with one clearinghouse, you need to be in a position to choose another without interrupting your business or being forced to change your software. Also, a clearinghouse may increase their fees. If they're your only choice, you cannot go elsewhere.

Does ClaimTek benefit from clearinghouses fees? Can I benefit as well?

Yes, ClaimTek receives commission of a few cents per claim from most clearinghouses. We've built close relationships with reputable clearinghouses to provide you with several choices and ensure that you receive top notch service. However, you're not limited to the clearinghouses that we recommend. Our software submits claims in a compliant EDI format that's accepted by all clearinghouses.

ClaimTek also benefits from Merchant Transaction Processing when our clients use the credit card module of our software.

As a reseller of our software, we can set you to earn monthly residual income from our approved clearinghouses and merchant services when your doctor clients use our software to submit electronic claims and credit card transactions! This can amount to thousands of dollars monthly when you have a healthy client base. Such income is paid as long as you have your business, even for a lifetime!

As you can see, while ClaimTek has vested interest in your success, your relationship with ClaimTek is built on mutual benefit, mutual respect, and mutual balance. You're charged reasonable fees for services, and allowed to participate in generating residual income as you grow your business.

Below is a list of some clearinghouses on our recommended list:

Medical Billing - Clearinghouse $69/mo Flat-Fee for 1st Provider
Price drops to $36 per provider per
month with more than one provider
Medical Billing - Clearinghouse Gateway EDI: $86/mo Flat-Fee
Medical Billing - Clearinghouse Ingenix: $60/mo Flat-Fee

Automated Clearing House | For Electronic Fund Transfer Service (EFT)

The ACH clearinghouse is where the Electronic Fund Transfer EFT transactions are sent. The Automated Clearing House (ACH) is the electronic network to which 95% of the nation's banks belong, including the Federal Reserve.

For ACH, there is a one-time fee of $50. The cost per transaction starts at $0.45 but can be reduced to $0.23 depending on volume (this is explained in our Medical Billing Manual). Once you start processing transactions, a $25 monthly fee applies. There is no additional setup fees for new account or any annual fees.

Fees to all clearinghouses are not due until you start processing claims or EFT transactions.