Clearing House
Clearing House
Use the Clearing House form to create and configure the billing clearinghouses your lab uses for electronic claim submission and remittance processing.
What is a billing clearinghouse?
A billing clearinghouse is an intermediary that:
- Receives your electronic claims (EDI 837) from the LIS,
- Scrubs and validates them for format and payer-specific rules,
- Routes them to the correct payer,
- Returns acknowledgments (e.g., 999, 277CA),
- Delivers electronic remittance advice (ERA 835) back to you for payment posting.
Clearinghouses reduce rejections, centralize payer connections, and streamline the claim lifecycle
How it works (high level)
- Claim creation in LIS: The LIS generates 837 Professional claims (005010X222A1) and sends them to the configured clearinghouse.
- Scrub + route: The clearinghouse validates claim data and routes to payers using payer IDs.
- Adjudication: Payers process the claims.
- ERA 835: The clearinghouse delivers ERAs (005010X221A1) for payment posting and reconciliation.
Benefits
- Fewer front-end rejections via automated edits/scrubbing.
- Faster payments through standardized EDI and payer routing.
- Centralized management of many payers (Medicare, Medicaid, Commercial).
- Electronic remittance (835) to enable auto-posting and reduce manual work.
- Visibility via acknowledgments and submission logs.
- HIPAA-compliant transport and processing of PHI.
Tip: From Transaction Search > More options > Export EDI, the LIS will generate 837 claims and upload them to the clearinghouse you configure here.
Best practices
- Start in Test; send sample claims and verify acks before Production.
- Complete payer EDI/ERA enrollments and confirm payer IDs.
- Keep NPIs/Tax ID/addresses consistent with payer records.
- Enable daily ERA retrieval and auto-posting with clear exception workflows.
Troubleshooting
- No acknowledgments received: Verify credentials, endpoint, firewall, and test/production flags. Done by OCL LIS support team.
- Payer rejects claims: Check payer ID mapping and enrollment status; validate diagnosis/procedure coding and dates.
- ERA not posting: Confirm 835 enrollment, payer mapping, and NPI/tax ID matches; review auto-post rules.
- Duplicate/replace claim issues: Confirm claim frequency code and control numbers; avoid resubmitting identical files unintentionally.
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