Home Forums Discussions Coding and Billing Which pediatricians are billing electronically via clearing house

I have been using AC for the past two years , have been fairly happy except that I have to print paper HFCA 1500 forms n mail them. I went to the SW user forum in Houston ,most pediatricians are still doing my way or manually entering info n then sending electronically .
Is there any pediatrician who is happily submitting the claims electronically via clearing house with proper scrubbing of vaccine adm codes
I would be very eager to know n also if there is pediatrician from Texas that has AC n Medicaid population n electronically billing

Hello, I was in similar shoes a year ago. I'm very happy with RealMed clearing house. We got the additional product called RealClean where you can create your own claim scrubbing edits. This has been great since Medicaid is changing rules all the time. (Our panel is 98% medicaid plans, btw.) I think we have 99% error free claim submission after using RealMed & RealClean. However, you do need to get a PM software. We use one that interfaces with AC automatically, but I don't think it's necessary. You can just create the claims in your PM software, sent to RealMed and have the claims srubbed there.

I use EZClaim and Capario

Which PM do you use?

Thanks for the replies- right now I am not using any PM software , sending paper billing
Are EZclaims able to scrub the vaccination administration for Medicaid n modifiers like modifier 25 properly
Is there any one from Texas using AC n clearing house with majority Medicaid pts

Yes. See above.

Hi Serene,
thanks for the reply. Are you electronically exporting the claims to the clearing house or you are entering them manually into realmd and then electronically submitting them.
PS if you don't mind, can you PM me your contact info , so that I can talk with you in detail at mutually convenient time
thanks a lot

We use AC to PM software to Clearing House. We're not manually entering things at the clearing house level (except for the clearing house edits).

But are you manually entering the info to PM or its automatically getting entered once you finish the chart n billing info in AC

Once the doctor codes the visit 9939x or 9921x, that is transferred to TotalMD automatically. If there are also vaccines, the medical assistant circles the vaccines (90700, 90670, etc.) on the paper superbill. In TotalMD, the biller (also our receptionist) will open the patient file and see the 9939x bill in there already with the right date of service. Then she'll input these additional lines manually:

90700
90460
90461
90670
90460

So all the vaccines & admins are manually entered. However TotalMD has a multicode feature where you can set 1 click to equal multiple lines of code. So we've set up a DTaP multicode. When you click it, it'll add 90700, 90460 and 90461 in the right order & the right quantity & charge amount. (When we have a bill with private vaccines, we do it manually w/o the multicode.)

We think this way is faster than the doctor selecting the vaccine codes in AC since we would have to change the order of the vaccines & admins CPTs anyway.

After this point, the biller also makes sure the AM modifier is in there and checks all the other modifiers if there's a sick visit on the same day, strep test etc. Then the claim is created and electronically sent to the clearinghouse.

At the clearinghouse level, we have edits set up to catch if for a medicaid claim there's no AM mod on the checkup code or no QW mod on 87880. These claims will be stopped and I log in to their website to make the corrections.

I am looking into the painful decision of getting eclinical ehr , only because of billing issues, I hear that with eclinicals EHR, at the end of the day , we just have to just hit the download button n that is automatically sent to clearing house in one step process only , please correct me if its not true . I wish AC were more responsive with the billing issues n people did not ave to wait that long to get issues sorted

That is what I have heard about eClinical, but I don't have first hand experience. I know 1 pediatrician (and many other doctors around here) uses eClinical and she loves it. But we also love AC (enough).