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Thread: Does Anybody Else Submit Claims Direct?

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    OptiBoard Professional jrumbaug's Avatar
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    Does Anybody Else Submit Claims Direct?

    My software is in-house.
    Yes, I wrote it myself.

    I submit Medicare, Medicaid and Blue Cross directly.

    No Clearing House.

    I get the feeling that it's a rare.

    I'm trying to figure out who files direct vs. who uses a clearing house. And possibly, what are typical clearing house fees.

    Jim Rumbaugh

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    Master OptiBoarder OptiBoard Gold Supporter DragonLensmanWV's Avatar
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    Quote Originally Posted by jrumbaug View Post
    My software is in-house.
    Yes, I wrote it myself.

    I submit Medicare, Medicaid and Blue Cross directly.

    No Clearing House.

    I get the feeling that it's a rare.

    I'm trying to figure out who files direct vs. who uses a clearing house. And possibly, what are typical clearing house fees.

    Jim Rumbaugh
    We also submit directly with only a very few going through Eyefinity.
    Caught up with Win 98 yet, Jim?:D:D
    DragonlensmanWV N.A.O.L.
    "There is nothing patriotic about hating your government or pretending you can hate your government but love your country."

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    We submit direct. Don't know that I would reccomend it. It's a whole lot more hassel than it's worth. I could probably submit about 15 pages on the frustrations, lies, deciepts, incompetence, etc. That one must deal with....

    Usually the time and effort dealing with these people is more work that the actual product or service took. And I make artificial eyes, there is a lot of time involved on the labor end.

    Why do I do it. Let's just say, I'm married and my wife insists on being the claim submitter.


    Chip

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    OptiBoard Professional jrumbaug's Avatar
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    Let me clarify my question

    Chip and Mark, do you both file directly and electronically? or is it online? or is it paper,

    Let me clarify my question.
    I may have not been clear enough.
    Who files ELECTRONICALLY direct vs electronically via a clearinghouse.

    I realize that many software aplications prepare a file that is submitted to a clearing house for processing, and there are ussually fees for processing these claims. My in-house application generates a file that I send directly to Medicare, Medicaid, Blue Cross. All other transactions are done via paper, ( until management puts an OK on a clearinghouse ).

    Or are people going online and submitting claims ( double entry )

    I'm trying to figure out what others are doing. A clearing house is easy, but there are per claim fees. EDI Direct submission is quick and economical, but when a claim blows up, it takes a level of expertise to figure out. Paper is easy, but slow. Online is quick, but it's data double entry

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    I believe (it's not my job) that almost all agencies, etc. Now insist on electronic filing. One would think this is a good thing, but we filed a bunch in Septemeber that were almost all paid. Filed another large back in November or December. Called in January and asked where was the money, were told the claims had not been recieved although we had recieved computerized confirmation. After a lot of conversation with a lot of people that should not be employeed anywhere but a Southern McDonalds (dey a lot worse below Memphis) we learned that they had a "crossover" the first of the year and some ID number for the office was no longer allowed. Had to re-submit for a new ID number, resubmitt claims and I still haven't got paid.

    Chip

    I have also had excused in the past that they couldn't accept from a standard speed modum, had to get a slow (25baud) modum which also didn't work. Then last year they converted and told us they could accept standard modum but not accept DSL. Now I think they are taking DSL.
    Like I said, it's a whole lot more cumbersombe than it needs to be.

    I actually think insureance companies are in the business of selling insureance and not paying claims.

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    Master OptiBoarder OptiBoard Gold Supporter DragonLensmanWV's Avatar
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    Quote Originally Posted by jrumbaug View Post
    Chip and Mark, do you both file directly and electronically? or is it online? or is it paper,

    Let me clarify my question.
    I may have not been clear enough.
    Who files ELECTRONICALLY direct vs electronically via a clearinghouse.

    I realize that many software aplications prepare a file that is submitted to a clearing house for processing, and there are ussually fees for processing these claims. My in-house application generates a file that I send directly to Medicare, Medicaid, Blue Cross. All other transactions are done via paper, ( until management puts an OK on a clearinghouse ).

    Or are people going online and submitting claims ( double entry )

    I'm trying to figure out what others are doing. A clearing house is easy, but there are per claim fees. EDI Direct submission is quick and economical, but when a claim blows up, it takes a level of expertise to figure out. Paper is easy, but slow. Online is quick, but it's data double entry

    We generally file directly with the insurers and only use a clearinghouse for a few claims. Most are directly online.
    And who cares about the data entry? I have peons for that! Mwha-ha-ha!
    DragonlensmanWV N.A.O.L.
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    Bad address email on file sharonm516's Avatar
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    Quote Originally Posted by DragonLensmanWV View Post
    We generally file directly with the insurers and only use a clearinghouse for a few claims. Most are directly online.
    And who cares about the data entry? I have peons for that! Mwha-ha-ha!
    I am a peon that files for my doc! (LOL)
    Anyways, we use Gateway EDI with Office Mate...they both drive me nuts...so those insurances that offer direct online claim submission I use those like United, Tricare, Medicaid, etc. The others I use Gateway EDI for and its a pain to get everyone compatible.....let alone the others who "try" to file always seem to make twice as much work for me to fix.
    There are VERY few I would send in on paper...and its rare.
    Im in the process now of cleaning up almost 2 years worth of claims from the other peons that just :shiner:"didnt get it":shiner: when they filed them in the first place. :hammer:
    Oh how I would love to just be in the back...working with patients and not worrying about this stuff....ahhhhh to have that life again! :D

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