Clearinghouse

ClearinghouseHeading

ASSERTUS offers a new-generation Clearinghouse service for the processing of transactions between health providers and health insurance companies.

Transactions are processed in real-time, achieving higher efficiency and increased data reliability.

Menos impresión de documentos, mayor eficiencia, más control = Mejores Resultados…

Every transaction runs through our servers located in world-class data centers.  Our Data Centers count on all the security, redundancy, and contingency guarantees necessary for continuous processing, regardless of unforeseen events that might occur.

El procesamiento de las transacciones a través de ASSERTUS Clearinghouse se lleva a cabo en tiempo real (Real Time) 7×24.   Esto le da la flexibilidad al usuario, de procesar sus reclamaciones y demás transacciones cuando precise así hacerlo, con la confianza de que las mismas se procesarán al momento y  que los datos obtenidos serán reales y actualizados.

Transactions

The eligibility of all patients, regardless of health insurance, is processed in a simple and effective manner.

The system keeps a detailed record of each eligibility for every patient.  This helps prevent the need for printing and filing, in case a claim is denied due to patient ineligibility.  Eligibility is only printed when physical evidence is required by the medical insurer, to make sure patient was eligible at the time services were rendered.

Through our ASSERTUS Clearinghouse, claims (837) are sent to all health insurance companies in a secure and efficient manner.  When designing and developing the ASSERTUS Clearinghouse security and efficiency were, among others, main areas of focus.

Acknowledgments of Receipt are received through the ASSERTUS Clearinghouse.  Monitoring these acknowledgments is centralized in a single application and in a standard format for all health insurers.  The system automatically audits all Acknowledgments of Receipt in order to trigger any system alarms that might be applicable. 

  1. Rejected Claims – The system automatically updates those claims that the health insurer was not able to process, so that corresponding corrections can be made within the permissible time frame.
  2. Claims without Acknowledgment of Receipt – These are the claims for which no receipt confirmation has been received from the health insurer.  Usually this happens when claims don’t manage to enter the payment allocation system of the health insurance company.   Consequently these claims won’t be rejected at the payment explanation (835) level, nor will the corresponding payment be received.  This alert is very effective because it points out to the user how much time has transpired from the moment the claim was sent.  The user can therefore detect any acknowledgment that was not received accordingly, and thus follow it up effectively to make sure it is received and processed by the health insurance company.
  3. Claims not Processed – These are those claims the user did not process at the moment due to lack of information, waiting for another user to revise it, or any other applicable reason.  Due to this alert integrated into the system, no claim is left unnoticed regardless of how much time has passed.  Every claim should be processed in the established timeframe in order to avoid expirations or any inconvenience to your collections ($).

Explanations of Payment for all health insurance companies are received through the ASSERTUS Clearinghouse.  ASSERTUS standardizes the document in a simple straightforward format so that users can work with it, without the need for technical knowledge regarding the structure of an 835 file.

 ProClaim comes already integrated with the ASSERTUS Clearinghouse technology, which results in automatic reception and reconciliation of Explanations of Payment.

The ASSERTUS Clearinghouse has incorporated in its service menu the processing and delivery of documents between health insurance companies and health providers, done through ASSERTUS’ portal or the health insurer’s portal.

CORE Phase II Certification

CAQH CORE®, the CORE-certification/Endorser Seals and logo are registered trademarks of CAQH® Copyright 2010, Council For Affordable Quality Healthcare®. All rights reserved.

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