Why Insurance Carriers Need to Receive Electronic Claims from Clearinghouses and Why Medical Practices Need Their Service

There are as many distinct kinds of claims clearinghouses as there are different kinds of medical claims, including claims for prescription drugs, dental work, durable medical equipment, in-patient care facilities, and claims for outpatient medical professionals. However, the simplest approach to describe what an insurance claims clearinghouse is and what they do is to draw a picture of the issue they address — their piece of the solution — and how they go about doing it. Consider a scenario in which a large number of millions of licensed healthcare professionals, each using a different claim software, send daily medical claims to more than 4000 distinct insurance carriers across fifty different states, each state having its own insurance regulations, and each insurance carrier having its own internal software infrastructure.