If you work as a medical biller, you’re almost certainly familiar with the term “clearinghouse.” But to those looking to get into the field or to transition from front desk work to the billing side of things, knowing the basics behind these organizations can be a valuable asset.

The process begins when the clearinghouse receives a claim and rejects either some or all of the reimbursement based on issues within the claim. It is the biller’s job to correct these issues and resubmit the claim in order to get proper reimbursement. If the errors are never addressed, the claim will wait in limbo in the accounts receivable of the practice, which in turn can cause them to believe that all their claims have gone through.

Once the errors in the claim have been amended, the claim should be resubmitted to the clearinghouse. This can cause confusion in a few select cases, as clearinghouses also audit their own work, meaning that it is possible for them to discover that the denial was a mistake and fix it themselves. In most scenarios, however, it will be up to the practice to make whatever changes the clearinghouse insists on. Much of the time, this process takes place electronically, but a few rare clearinghouses may still conduct their business the old-fashioned way on paper. On the opposite end of the spectrum, the best ones will even allow billers to make the changes live by logging into the clearinghouse’s website, but this is far from a common feature yet. Even when billers are able to fix denials this way, they must then go back and update their practice’s file as well.

Though handling denials is never fun, dealing with clearinghouses is an integral part of working as a medical biller. If you have questions about denials or about specific policies, always ask a coworker or contact the clearinghouse directly rather than making assumptions and costing the practice potential money down the road.