Insurance Billing: RCMs and Clearinghouses

Healthie offers a number of insurance billing solutions for our customers. This article reviews the available solutions, so that your team may select the integrations that works best for your business needs & workflows.

RCM Options

Revenue Cycle Management (RCM) platforms provide full-service claims management to customers. These API-first platforms use rich data sources and automations to detect, prevent, and fix claim issues. RCMs typically submit claims, follow up with insurance companies, and appeal denied claims 24 hours a day - significantly decreasing the need for administrative work.

Think of an RCM as a way to generally outsource your biller or admin needs for insurance billing (although likely resources will still be needed to collect client owed responsibilities for any portion of the claim that was not covered by insurance).

Healthie offers integrations with the following RCMs:

• Candid Health
• Adonis Health
• More RCM options are available Healthie’s API, learn more here.

Clearinghouse Options

A claims clearinghouse acts as an intermediary between the organization and third-party insurance payers. Instead of submitting claims to each payer’s portal, a Clearinghouse allows the provider or organization to send all claims to the Clearinghouse - and the Clearinghouse submits to the payer (after scrubbing it for errors like missing fields). The claims reimbursement details then pulls back into the Clearinghouse from the payer.

Think of a Clearinghouse as your one central hub to send & manage all claims. It won’t replace the need for a biller per-se. A clearinghouse will not automatically correct and resubmit claims for you, this will still need to be managed by a biller or admin staff.

Healthie offers integrations with the following Clearinghouses:

• Change Healthcare Claims (currently in development)
• Office Ally

All RCMs use Clearinghouses, but not all Clearinghouses are RCMs

• Candid Health uses Change Healthcare as their clearinghouse. They will directly manage the enrollment process for their customer, bypassing the need to self-enroll with Change.
• If you are already set up with Change directly, but want to use Candid as an RCM, the Candid team can work with you to get your permissions transferred over to Candid.

Insurance Billing Automations

There are several planned releases for insurance billing that will help to automate the claims creation and submission processes. Billing automations can also connect to integrations that a your may be using within Healthie (ie. an RCM or Clearinghouse).

Learn more about upcoming Insurance Billing Automations planned for Healthie.