Clearinghouse
A clearinghouse is a service that sits between a dental practice and insurance payers, passing electronic transactions such as claims and eligibility requests to the right payer and returning the responses. Practices typically send electronic claims through one, and each payer is identified there by a payer ID.
Why it matters to the front desk
For insurance verification, the clearinghouse is what carries an eligibility request to the payer and brings the benefits response back. Each carrier on a patient's plan maps to an identifier on the clearinghouse side, so an accurate mapping between the practice's carrier list and those identifiers keeps requests going to the right payer.
Payer IDs can change, and some clearinghouses publish a payer directory that lists each payer's IDs and aliases. Checking a carrier's ID against the clearinghouse's directory, or asking the clearinghouse, is a quick way to catch an out-of-date ID before a request fails. The mapping is kept per carrier, so a new carrier on a patient's plan needs an entry of its own.
Related terms
Insurance Verification
Checks a patient's dental insurance with the payer, for one patient or the whole day's schedule, and returns coverage and benefits in a summary you can download.
See how Insurance Verification works