Overview of Clearinghouses
DME Clearinghouses are intermediaries in the healthcare billing process that specialize in handling claims.
What is a Clearinghouse?
The clearinghouse acts a gateway between healthcare providers and insurance companies or government payers (like Medicare and Medicaid) to facilitate the transmission of electronic claims.
Why Electronic Claims?
Electronic claims processing can eliminate paper and streamline the process of submitting your insurance claims and receiving payments. With NikoHealth, you'll save time and get paid faster from insurance companies so that you can avoid costly delays and disruptions to cash flow.
What can the Clearinghouse do?
Different Payers support different types of electronic claims functionality. This may include:
Electronic claim submission
Electronic remittance advice (ERA)
Insurance eligibility verification
Clearinghouse Integration with NikoHealth
NikoHealth integrates with multiple clearinghouses. These include:
Change Healthcare
Jopari
Carisk
Availity
Inovalon
As mentioned above, different Payers support different types of electronic claims functionality. Claim submissions and insurance eligibility can be run simultaneously out of multiple software systems. ERAs, on the other hand, can only be remitted to a single software system. This means that once approved by the payer, all ERAs (regardless of which system the initial claims were submitted from) will come into NikoHealth.
Clearinghouse Enrollment
To start, you must enroll with each individual insurance carrier (Payer) that you plan on conducting transactions with. For information on how to add a Payer to NikoHealth, visit our help article on Payer Settings.
Once you add your Payers, please notify our team to begin the enrollment process by sending an email to payerenrollment@nikohealth.com.
Note: some Payer enrollments may require authorized signatures, online portal registration, or approval follow-up directly by the provider. In the event any steps need to be taken, a NikoHealth payer enrollment team member will be in contact via email.
For information on integrating with Availity, visit our help section on Availity Clearinghouse Onboarding.