Electronic Media Claim (EMC): this is an electronically processed and transmitted claim. The claim process starts by the healthcare facility collecting information, such as, the patient’s condition, the physician’s diagnosis and a list of all procedures performed. This information is then sent to the insurance company. Healthcare facilities that submit electronic claims use a clearinghouse.

Clearinghouse: a clearinghouse acts as a third person that takes claims information from a healthcare facility and sends it to the insurance company. The clearinghouse checks the claims for errors and also makes sure that procedures and diagnosis are coded correctly.

Explanation of Benefits (EOB): a document that is sent to patients from the insurance company explaining what services where paid for by the insurance company. An Explanation of Benefits usually includes, patient’s name, patient’s insurance ID number, claim number, provider information, type of service, date or service, charges, total patient cost and the amount the patient is responsible for paying.

Bucket Billing: in bucket billing the healthcare facility decides how much to charge for a procedure, the insurance company reimburses the healthcare facility for that procedure and if that reimbursement does not cover the full bill, what is left over is then billed to the patient. That is called bucket billing.

Benefit of Using Electronic Claims Clearinghouses

Using an electronic claims clearinghouse have a lot of advantages, the first being its good for the environment, because less paper is being used with the electronic claims. It reduces the need for forms, envelopes and money spent on postage. It also reduces reimbursement time. When the claim is sent electronically to the clearinghouse, the clearinghouse also sends it to the insurance company electronically, reducing reimbursement time to a matter