Which entity is used to electronically submit medical claims to payers?

Which entity is used to electronically submit medical claims to payers?

• A. Clearinghouse
• B. Billing service
• C. Payer portal
• D. Practice management system

Answer: (A)

Submitting medical claims electronically to payers is done through a clearinghouse. The clearinghouse sits between a provider’s billing system and multiple payers, receiving claims in standard formats (such as HIPAA 837), checking for completeness and formatting errors, translating data as needed, and routing the claims to the correct payer. It also returns acknowledgments and can provide remittance information. While a payer portal is used to interact with a specific payer and a practice management system may generate claims, the clearinghouse is the central, universal conduit that enables electronic submission to many payers efficiently.

Submitting medical claims electronically to payers is done through a clearinghouse. The clearinghouse sits between a provider’s billing system and multiple payers, receiving claims in standard formats (such as HIPAA 837), checking for completeness and formatting errors, translating data as needed, and routing the claims to the correct payer. It also returns acknowledgments and can provide remittance information. While a payer portal is used to interact with a specific payer and a practice management system may generate claims, the clearinghouse is the central, universal conduit that enables electronic submission to many payers efficiently.