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We Make Lytec Medical Billing
Software Mobile
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Electronic
Claims Software
Using
electronic claims software for your electronic claims submissions
does several things for your practice:
- Makes
billing simpler
- Minimizes
cash flow disruptions
- Reduces
claims rejections
- Controls
paper flow
Which electronic
claims software is right for my practice?
The decision to use electronic claims software is an easy one.
You save time. You save money. The next step is to determine
how to submit your electronic claims: through an electronic
claims clearinghouse or directly to an insurance carrier. Lytec
Medical provides electronic claims software for both methods.
The method that you choose determines how electronic claims
are sent to your insurance carriers.
Enrollment is first
step to using electronic claims submissions
Whether you choose
to go through a clearinghouse or to submit claims directly to
the carrier, you will need to go through an enrollment process
before submitting electronic claims. The enrollment process
is required so that the company you are working with can be
ready to receive and process information from you on their computer
system. Most government and many commercial carriers require
enrollment. Some also require that you sign a contract with
them.
The enrollment process
typically takes six to seven weeks to complete. The largest
obstacle in getting set up for electronic claims submissions
is getting approved by the state, federal and commercial/HMO
carriers. The approval process is very time consuming — it can
take up to six or seven weeks to get approved — so we encourage
you to begin the enrollment process right away so you can enjoy
the time and money savings of submitting your claims electronically.
Processing
electronic claims through a clearinghouse
Working
together with one of the largest clearinghouses in the United
States, Lytec Medical has developed a seamless (built-in) system
that allows your practice to submit all claims (all-payer solution)
electronically and have your claims validated on-line (real-time).
After subscribing to the clearinghouse and entering your billing
information, a file is created that contains your claim information.
The file is then transmitted to the clearinghouse using the
built-in functionality contained in Lytec Medical.
As
the clearinghouse receives your claims, they are checked for
completeness and accuracy. If you have made a mistake, you are
notified as you complete your transmission to the clearinghouse.
If you are notified that there is a problem with a claim, the
claim information can quickly be repaired and resubmitted to
the clearinghouse (eliminating the costly delay associated with
an incorrectly submitted paper claim). Once submitted, your
claims will be electronically forwarded (in most cases overnight)
to your insurance carriers for reimbursement. Internal tests
by the clearinghouse show that 98% of all claims that are properly
submitted electronically through the clearinghouse are paid.
Processing
electronic claims directly to the insurance carrier
Submitting
claims directly to an insurance carrier is a little more complicated.
As explained above, you must first enroll with the carrier.
Most government carriers and many commercial carriers require
that you enroll with them prior to submitting claims electronically
to them. You will also need some additional software from each
insurance carrier that you wish to submit claims to. Many carriers
have their own software or know of someone who supports direct
transmissions in your area. At 2K Medical Billing, we also work
with many local business people who have created direct submission
software modules. Please call us and we will be glad to help
you find a solution.
The
most common direct claims submission method creates a "print
image" file of your insurance claims and then uses the
direct claims software to send the claims to the insurance carrier.
With Lytec Medical, printing claims to a file is as easy as
printing your claims on paper. The first step is to set up a
new printer in Windows that is designated as a "print to
file" printer. After completing the printer setup and entering
the billing information into Lytec Medical, you are ready to
print your claims to the carrier transmission file.
Select
the "Print Insurance Claims" option within Lytec medical
and select the claims for your insurance carrier. Then, when
prompted to select a printer to print your claims, you simply
select the printer that has been set up to print to file. A
prompt screen will appear requesting that you enter a filename.
Enter the filename that was given to you by the direct claims
software product. Then using the direct claims software, transmit
the file to the carrier. Some of the carriers may "edit"
your claims. You will need to work with your insurance carrier
to determine how to identify and resubmit claims that are in
error.
Is it better to
process electronic claims through a clearinghouse or direct
to the carrier?
Some
of Lytec's customers have asked which method is better for them
to use — through a clearinghouse or direct to the carrier. Here
are several things to consider:
·
Direct
to the carrier is probably the least expensive method if your
practice primarily submits claims to only one carrier. However,
if you submit claims to more than one carrier, it is probably
not the least expensive method. READ ON.
·
With the clearinghouse,
you only need to dial into one location. If you choose to go
direct, you will need to dial into each carrier and/or send
paper claims to the rest. With the clearinghouse, all claims
can be submitted in one transmission. The ease of simply sending
claims to one location cannot be underestimated. Submitting
claims to multiple insurance carriers requires your staff to
become experts in each of the claims submission modules that
you use. Since each one is unique, someone must be adequately
trained and available to submit your claims or your practice
will not be reimbursed. Claims submission to a clearinghouse
is all done through the Lytec software and almost anyone can
do it by reading the user manual, using the help screens and/or
calling our technical support line.
·
Customers cannot submit
claims directly to NEIC or to the majority of individual commercial
insurance carriers.
·
Most carriers that receive
claims electronically cannot edit the claims online (meaning
at the time that you actually are transmitting the claims to
them). The clearinghouse can edit your claims for completeness
and validity to reduce the possibility of a rejected claim at
the same time that you are sending your files. You will be notified
before you sign off if there are any problems with your claims.
·
Many carriers have designated
only certain times when claims can be sent. The clearinghouse
will accept claims whenever you are ready to send them.
·
Using the clearinghouse
reduces your phone bill. Many carriers will require that you
pay for the telephone expense for your claims transmissions.
The clearinghouse supports a toll-free line for claims transmissions.
Telephone expense is often overlooked when comparing direct
transmission to a clearinghouse.
·
Updates to an insurance
carrier's transmission software are free and transparent when
using the clearinghouse. When using a direct submission module,
updates must take place at the customer's site and often require
a programmer's attention, which can be very costly.
·
With a clearinghouse,
a single confirmation report is produced for all insurance carriers.
Separate confirmation reports are produced for each carrier
where claims are submitted directly.
·
Some insurance carriers
require special communication equipment/software. The only piece
of equipment that is required to submit claims to the clearinghouse
is a standard PC modem.
·
The clearinghouse is
a priority to the insurance carriers because of the claim volumes
they submit. Unless
your practice submits insurance claims to only one carrier and
you have a highly technical staff with little employee turnover,
we recommend that your practice submit your claims to an electronic
claims clearinghouse. If your practice submits claims primarily
to one carrier, you are probably better off going direct to
that carrier. If that is the case, please call us.
We
work with many independent business people who have created
direct insurance claim submission modules using our software.
We work closely with these people and know which ones have created
or support products that are compatible with Lytec Medical.
We offer direct electronic billing modules for Medicare, Medi-Cal, Medicaid, Blue Cross, Blue Shield, and THIN (Texas Health Information Network).
Most of these modules work specifically in California; however,
our Medicare module may work in your state.
Make
the choice to submit your claims electronically now!
Whichever
method you choose, it is a proven fact that your claims are
processed much faster and your reimbursement time is shortened
using electronic claims software. Lytec Medical makes submitting
your claims electronically very easy. Hundreds of our customers
do it every day using one of the two methods outlined above.
If you are new to electronic claims, let our friendly customer
support staff help you. We have trained professionals that will
take you through the entire process, step by step. Start the
process today to enjoy the benefits of submitting your claims
electronically.
Electronic
Claims Clearinghouse
A
clearinghouse is a company that receives claims from many providers
and specializes in "consolidating" those claims so
that they can send one transmission to each carrier.
Direct
to an Insurance Carrier
Submitting
your claims directly to an insurance carrier means that you
are dialing into the insurance carrier and sending your claims.
This method involves creating a "print image" file
of your insurance claims on your computer and then using a separate
software package to send that file directly to the insurance
carrier.
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