Clearing House
This organization acts like the "post Office" of medical billing, routing claims to payers.
What is a clearinghouse?
This tool checks claims for coding and medical-necessity issues before they are submitted.
What is a scrubber?
This is the process insurance companies use to review and pay or deny claims.
What is adjudication?
This term refers to the portion of a medical bill the patient is responsible for after insurance pays.
What is patient responsibility (or member responsibility)?
This type of error occurs when the subscriber ID is missing a prefix or contains invalid characters.
What is a clearinghouse rejection?
These edits prevent “double billing” when two procedures should not be billed together.
What are NCCI edits?
This document explains what the payer covered, denied, or adjusted.
What is an EOB or ERA?
This type of insurance protects students or families if a student must withdraw from school unexpectedly.
What is tuition insurance?
This electronic form is often returned by a clearinghouse to indicate acceptance or rejection.
What is a 999 or 277CA?
This common scrubber error happens when the diagnosis code does not support the procedure code.
What is a DX/CPT mismatch?
During adjudication, the payer checks this to verify the patient’s coverage on the date of service.
What is eligibility?
This number describes the estimated count of health insurance companies in the U.S.
What is about 1,000 (roughly 900–1,172)?
When this number is incorrect or missing, a clearinghouse may reject the claim before it reaches the payer.
What is the NPI?
A scrubber may flag this required number when the provider didn’t obtain approval from the payer before service.
What is prior authorization?
This adjudication outcome means the payer needs more information before making a decision.
What is pended?
This type of insurance protects businesses from theft or loss of cash on premises or during transit.
What is money insurance?
This type of error occurs when the payer ID in the claim doesn't match the payer directory of the clearinghouse.
What is an invalid payer ID rejection?
A scrubber may detect that a CPT code does not match this field, which indicates where services were performed.
What is place of service (POS)?
When adjudicating claims, payers apply these rules to determine the amounts the patient owes.
What are plan benefits or contract terms?
These two types of 529 plans help families save or pay for future education costs.
What are prepaid tuition plans and education savings plans?