Clearinghouse

ASSERTUS Clearinghouse, offers service to the different sectors of the health field.

ASSERTUS offers a new generation of Clearinghouse service for the processing of health transactions between healthcare providers and insurance companies (Medical Plans).

The transactions are processed in real time (real-time), achieving efficiencies and greater reliability in the data.

Less document printing, greater efficiency, more control = Better Results ...

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.

Transaction processing through ASSERTUS Clearinghouse is carried out in real time (Real Time) 7×24. This gives the user flexibility, to process their claims and other transactions when they need to do so, with the confidence that they will be processed at the time and that the data obtained will be real and updated.

Transacciones

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 ASSERTUS Clearinghouse claims (X12-837) are sent to all medical plans in a safe and efficient manner. For the design and development of the Clearinghouse, among others, the safety and efficiency aspects were given relevance.

The Receipt Acuses of the insurers are received through the ASSERTUS Clearinghouse. The monitoring of all the Receipt Acuses is centralized in a single application and in a standard format for all insurers. The system automatically audits all the Receipt Acknowledgments to feed the different Alerts.

  1. Rejected Claims – The system automatically detects those claims that are not processable by the medical plan, so that corrections are made within the established term.
  2. Claims without Acceptance of Receipt – Are those claims for which the confirmation of receipt by the Medical Plan has not been received. The reason for this is that these claims probably failed to enter the medical plan’s payment award system. Consequently, they will not be rejected at the level of the payment explanation (835), much less the corresponding payment will be received. This Alert tells the user the time that has elapsed since the claim was sent, to detect any Accuses that have not arrived within the established time, in order to be able to follow up effectively and get them to be received and processed by the Medical Plan .
  3. Unprocessed claims – These are those claims that the user decided not to process for the time being, due to lack of information, pending that some other user reviews it, in order for any reason that he / she had to not send it. In this way, no invoice is left untreated, no matter how much time has elapsed. All claims must be processed within the established period of time to avoid expiration or inconvenience for collection.

The Payment Explanations (X12-835) of all medical plans are received through ASSERTUS Clearinghouse. ASSERTUS standardizes the document in a user-friendly format, so that the user can work it without the need for technical knowledge of the structure of an 835 file.

ProClaim® has integrated ASSERTUS Clearinghouse technology, which allows you to receive the Payment Explanations and automatically reconcile them.

ASSSERTUS Clearinghouse has incorporated into its service menu, the processing and sending of documents between insurers and health providers, through the ASSERTUS Portal or the medical plans portal.

CORE Phase II Certification

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