Billing accurately and promptly is one of the vital signs of a healthy practice. Here’s how Healthcode’s Clearing Service powers this critical business process.

Billing Private Medical Insurers (PMIs) was once an inefficient and costly paper exercise.

From a practice perspective, it took considerable administrative time to ensure each invoice included all the information required by that insurer in the correct format, such as the patient address, policy number, date of treatment and procedure code. Printing and posting invoices was both costly and insecure. And once an invoice was sent, it was impossible to know when it might be paid – it might be weeks before practices were notified of a query or asked to resubmit the invoice. The whole process was burdensome for billing staff, while from a financial perspective, it was virtually impossible to make accurate cash forecasts.

Nor was paper invoicing popular with PMIs who received thousands every day. Even if only a fraction contained errors, they could take hours to process manually. Eventually, PMIs asked Healthcode to develop an accurate, efficient, secure and cost-effective alternative. We launched the Clearing Service in 2002 and before the pandemic struck, we were processing over 7million invoices each year for practitioners and hospitals, equating to more than £3.3bn of activity.

How does the Clearing Service work?

The Clearing Service is the process whereby Healthcode accepts invoices from providers, validates them for completeness and correctness and then forwards them securely to the relevant PMI. Sometimes referred to as ‘claims scrubbing’, the process entails checking for correct use of codes, formats and prevents time-consuming and costly processing errors that could delay the reimbursement process.

Healthcode’s Clearing Service works like this:

• An invoice or a batch of invoices is generated using Healthcode or third-party billing software
  The software uploads the invoice (or the batch) for clearing and validation by Healthcode’s Clearing Service
  The Clearing Service automatically checks each invoice complies with the relevant PMI’s own validation rules, including:
  – The invoice number and date
  – Provider details, name, provider, number or professional number, specialty and billing address
  – Patient’s full name, birth date, address, insurance company/paying organisation, policy number, diagnosis and description where applicable, lead practitioner
  – Treatment type, date, service delivered, procedure code (and description where applicable), fee
  The Clearing Service sends validated invoices to the relevant PMI for processing and payment. It flags invoices with errors and anomalies so the practice can correct and resubmit them
  The status of each invoice is visible
  The PMI pays and sends remittance advice

   

  What are the benefits?

  Using a Clearing Service to submit bills brings a host of business benefits that don’t generally apply when you do it yourself. These are five of the most compelling:

  Convenient and efficient
  Submit invoices to all the major PMIs from one platform, rather than spend precious time finding contact details and sending them to each PMI separately. Uploading an invoice or batch of invoices takes seconds and invoices are instantly validated in line with the relevant PMI rules so they are ready for payment on receipt.
  Minimise human errors, invoice queries and rejections
  The Clearing Service automatically sends validated invoices to the correct recipient so there is no chance of mis-keying an address or an invoice being lost.
  Errors that would cause an invoice to be rejected or queried by the PMI are flagged immediately.
  Better cash flow and forecasting
  Validated invoices enter the insurer payment cycle quicker. Plus, you have reassuring confirmation that your invoice has been received which helps with cash flow forecasting.
  Protect sensitive data
  The secure, encrypted system complies with data protection law so your invoices are safe from prying eyes. Sensitive patient and financial information should never be sent by unsecure email – in the event of a data protection breach you risk a fine and damage to your reputation.
  Expert technical support
  Healthcode’s knowledgeable customer services team are available to answer queries and help resolve problems straight away which simply isn’t an option if you go it alone. Healthcode has also produced video guides on how to create and submit an invoice.

  If your independent practice is to prosper, billing is one area that you need to get right so it’s reassuring to know that Healthcode’s Clearing Service enables you to send bills quickly, easily and securely.