Claims Clearinghouse
Claims Clearinghouses serve as an intermediary between healthcare providers and insurance payers, ensuring that claims are error-free and in the correct format before submission. These entities streamline the claims process by converting non-standard healthcare data into a standardized format, facilitating electronic data interchange (EDI), and ensuring compliance with HIPAA regulations. By performing “claim scrubbing” to minimize errors, clearinghouses help to accelerate the reimbursement cycle, reducing denials and improving the efficiency of the healthcare billing process.
Product Usage: Change Healthcare’s APIs are used for claim submission, claim status, and eligibility checks.
Strengths: The product offers a self-serve option and flexible contract terms that are useful in testing and adjusting business requirements.
Weaknesses: Customer support, onboarding and sales processes are disorganized and unresponsive, making it hard to address custom needs and software issues.
Overall Judgment: Though not entirely satisfied due to several challenges, the company intends to renew the contract due to the high cost of switching to another service provider.
Product Usage: The company uses Stedi to exchange data through Electronic Data Interchange (EDI) files with multiple partners in the healthcare sector.
Strengths: The reviewer praises Stedi’s simplification of complex EDI processes, the user-friendly interface, and the exceptional customer service, including responsiveness and tailored support.
Weaknesses: The only minor issue mentioned is the occasional lag in their API documentation updates and the absence of integration partners in the healthcare industry.
Overall Judgment: The reviewer rates Stedi highly, appreciating their reliability, codebase, engineering, and tools that afford flexibility, speed, and efficiency in handling EDI interactions.
Product Usage: Waystar is used for daily automated claims submissions, ERA enrollment, and eligibility checking.
Strengths: Waystar is user-friendly and simple to navigate with a robust search functionality.
Weaknesses: Waystar’s reporting functionality is lacking, requiring extensive use of spreadsheets for data analysis and tracking; support responsiveness and issues with deeper engineering aspects were highlighted.
Overall Judgment: Despite its user-friendly interface and features, Waystar might not be the best solution for those companies seeking robust reporting capabilities and flawless engineering support.