Question

If the physician is not sending the electronic claim directly to the carrier, a clearinghouse is used. A clearinghouse is a company that receives claims from providers, pushes them through a series of audits to check for errors, and then forwards them to the appropriate insurance carrier. Do you think clearinghouses might cause additional issues as it relates to the potential of non compliance with HIPPA?

Answer 1

Clearing house are an intermediate team which works on a providers claims submitted ,checks out for any corrections ,and doing the necessary changes and forwarding to the concerned insurance company which are mostly accepted. But is not in compliance with HIPPA because a third person is used in handling the patient details, which puts the details of patient visible and accessible to them.This becomes a security issue,the confidentiality of the patients are revealed toa non medical professionals, high chance of documents to be hijacked in cyber crime.These are some of the few reasons which can make issues when a clearinghouse are used.