Clearinghouse

A medical clearinghouse sits between your practice and the insurance payers, passing eligibility requests, claims and remittances back and forth. PatientCopilot builds clearinghouse tools into the platform for small practices, so checking coverage, submitting claims and reading remittances happen next to your charts and ledger. It is part of the Autopilot plan.

What a clearinghouse does

Payers expect electronic transactions in standard formats. A clearinghouse formats and routes them, and returns responses. For a practice, that covers four jobs:

• Checking a patient's eligibility before a visit
• Submitting professional claims
• Checking claim status and handling rejections
• Receiving electronic remittance advice (ERA)

Built into the platform

Most small practices use a separate clearinghouse website next to their EHR. PatientCopilot puts these jobs in the same place as the chart and ledger. Eligibility results appear with the patient's coverage, finished visits become claims, and remittances post to the ledger.

The four parts

• Eligibility checks: a 270/271 request shows active status, copay and deductible in plain terms.
• Claim submission: review charges per line, approve in batches and keep a record of who approved.
• Claim status and rejections: see acknowledgments, rejection reasons and claim status, with work items for follow-up.
• Remittance and payment posting: read 835 remittance advice and post payments, adjustments and patient responsibility to the ledger.

You stay in control

Nothing should go out without a person approving it. Claims are reviewed before they are sent, and remittances that do not balance are set aside for review instead of being forced into the ledger. That keeps your books honest.

How it works

1. Check eligibility for the patient's coverage.
2. Document and code the visit in the EHR.
3. Review the charges and approve the claim.
4. Track acknowledgments, rejections and status.
5. Read the remittance and post payments to the ledger.
6. Work any rejection or unbalanced item.

Security

Claims data is protected health information. The platform is designed with encryption and role-based access, and PatientCopilot states that it is HIPAA compliant; see the HIPAA policy and FAQ for the full wording.

Moving to integrated claims tools is easier with a plan. List the payers you bill most often and the transactions you use today, such as eligibility checks, claims and remittances. Gather your practice identifiers and make sure your provider information is accurate. Decide who will approve claims, who will work rejections and who will post remittances. Start with eligibility checks, since they are low risk and useful immediately, then add claim submission and status. Keep a short log of issues you find so they can be resolved. Because these tools sit next to the chart and ledger, your team will spend less time moving between websites and more time resolving real problems.

Where it stands. The clearinghouse features are under development. This page describes what the product is designed to do, not a promise of availability or of coverage with any particular payer. Ask us for the current status before you plan around it.