Insurance term
Clearinghouse
Definition
A clearinghouse is a company that passes electronic claims, eligibility checks and payment information between a dental practice and insurance payers.
Why it matters for the front desk
Instead of sending claims to each payer separately, the practice sends them to the clearinghouse, which checks them for errors and routes them to the right payer. It also returns eligibility responses and electronic remittances (ERAs). A claim rejected at the clearinghouse never reached the payer, so check the rejection report daily, or those claims sit unpaid without anyone knowing.
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Related terms
- ERA (Electronic Remittance Advice) An ERA is the electronic version of an explanation of benefits, sent by the payer in the standard X12 835 format.
- Eligibility Verification Eligibility verification is the process of confirming, before an appointment, that a patient's dental coverage is active and what it will pay for.
- EOB (Explanation of Benefits) An EOB is a statement from the insurance payer that explains how a claim was processed: what was billed, allowed, paid, adjusted and left for the patient.