Navigating Change: Top Reasons Hospitals are Switching Healthcare Clearinghouse Vendors

September 25, 2023

In the intricate and increasingly digital world of healthcare, clearinghouses play a pivotal role. Acting as intermediaries, healthcare clearinghouses take medical claims submitted from providers (hospitals, physicians, dental practices, etc.), check them for errors, and submit them to appropriate payers or insurance companies. As a bridge between healthcare providers and payers, they simplify billing processes, ensure compliance with insurance regulations, and enhance the overall efficiency of revenue cycle management. But change is a constant in this dynamic environment, and due to numerous factors, many hospitals have started to explore new horizons with a different clearinghouse vendor. Let’s dig deeper into the why hospitals or physicians practices might change to a different clearinghouse.

The Why: Top Reasons for Switching Healthcare Clearinghouse Vendors

As a nationally recognized clearinghouse, SSI has fostered partnerships with healthcare provider organizations and payers for more than 35 years. Although the motivating factors for changing clearinghouses can be diverse, we have observed numerous reasons that consistently recur from a provider standpoint. Here are the most common ones.

1. Product Functionality Issues. This holds the prime position in the roster of reasons, and rightfully so. Some providers have been grappling with a multitude of challenges that hinder their productivity and operational efficiency, including:

• Challenges reconciling and capturing 277 rejections
• Inability to attach electronic documents
• Delayed delivery of 835 remittances
• Concerns over altered claims
• Issues with remit parsing and remit split
• And more

As a result, there’s a resounding demand for a solution that offers better functionality and reliability.

2. Slow Response Times and Support Issues. In the brisk-paced and high-stakes realm of healthcare, lagging response times can result in consequential bottlenecks, disrupting the rhythm of a fluid medical claim workflow. The need for swift and precise actions is paramount to ensuring operational efficiency. Additionally, a highly-experienced, ideally US-based support team is instrumental in efficiently addressing questions and resolving technical complications. An on-shore support team can offer quicker turnaround times, clearer communication, and a better understanding of the unique aspects of US healthcare revenue cycle systems. Regrettably, with some vendors, prolonged wait times and unresponsive support services have emerged as considerable irritants, nudging healthcare providers to seek more responsive alternatives.

3. Payer Enrollment Concerns. The payer enrollment process is a critical step in the healthcare revenue cycle, connecting healthcare providers to insurance networks. But, when the process is too complicated and lacks transparency, it can become a source of significant stress and inefficiency. Some clearinghouses fail to provide an easy-to-navigate portal, leaving providers uncertain about the status of their applications and leading to wasted time and effort.

In response, revenue cycle leaders are increasingly seeking out vendors who simplify enrollment. They prefer clearinghouses that offer a user-friendly, transparent portal with real-time updates on the enrollment process. This level of clarity not only alleviates unnecessary stress but also allows for better operational planning. Additionally, it’s important to seek out vendors that enable easy switching by enrolling your top 25 payers in a short period of time.

4. User Unfriendliness. The user-friendliness of a system is not just a perk; it’s a crucial determinant of operational efficiency. When revenue cycle professionals have to wrestle with complex interfaces, puzzling features, and clunky workflows, the outcome is usually an uptick in frustration, errors, and payment delays. This environment not only raises stress levels but also reduces the time available for core tasks, directly impacting productivity and staff satisfaction.

On the other hand, an intuitive, user-friendly system does more than make daily tasks less frustrating; it reduces the learning curve for new users and speeds up the time it takes to process claims. Therefore, the promise of an intuitive, user-friendly experience with a new vendor often holds significant weight in the decision to switch clearinghouses.

5. Inadequate Integration with EHR Systems. Integration with leading Electronic Health Records (EHR) systems like Epic, Cerner, and Meditech is a linchpin for smooth, streamlined operations in healthcare. A well-integrated clearinghouse platform ensures it integrates as extensively as the EHR is capable, promoting accuracy and reducing friction in processing claims.

However, some vendors impose constraints, making specific features accessible only through expensive upgrades. Others simply don’t have deep integration capabilities. This creates a bottleneck in the workflow and puts undue financial pressure on physicians. Such hindrances erode the overall efficiency and productivity of revenue cycle operations, prompting providers to seek vendors with more comprehensive integration options.

6. Lack of Perceived Value for Cost. Value for cost is more than a simple comparison of price tags; it’s an evaluation of what you’re getting in return for your investment. For healthcare organizations, a clearinghouse should offer services and solutions that substantiate its cost by not only meeting the essential needs but exceeding them in ways that contribute to efficiency, reduce workload, and optimize the claims processing experience.

Unfortunately, some clearinghouses fail to provide a high-quality, robust solution that aligns with a buyer’s goals or objectives. When the cost of a service doesn’t reflect its quality or fails to deliver the necessary functionality, it can result in significant financial drain and a potential increase in Days Cash on Hand.

This mismatch of cost and value propels many healthcare providers to explore other vendors that offer more “bang for their buck.” These providers seek a clearinghouse that is more than just a solution but rather a strategic partner that brings a high-quality product, exceptional customer service, comprehensive features, and seamless integrations, all at a competitive price. When a vendor can offer superior functionality and support at a fair price, they embody better value for the cost that healthcare organizations are increasingly seeking.

7. Edit Deficiencies that Lead to Denials. A robust edit suite, complemented by the expertise of those responsible for crafting these edits, is paramount to a clearinghouse’s value proposition. It’s essential to emphasize that the “who” behind the edits—the seasoned professionals with extensive experience—carries as much weight as the edits themselves. While automation and algorithms, like robots, have made strides in adapting to the ever-evolving landscape of healthcare regulations, they often can’t match the precision and foresight of a human touch, particularly from those with extensive industry knowledge.

Furthermore, it’s not only about having an array of edits but also about how frequently and adeptly they’re updated. Top-tier vendors are proactive, deploying new edits on a regular basis to stay in sync with payer regulations. This dynamism is vital for navigating the intricate web of requirements that can change at a moment’s notice.

Edits are a critical line of defense, guarding against the high cost of claim denials that can drastically impact revenue cycle efficiency. When a clearinghouse lacks this capability, it becomes a breeding ground for increased rejections and denials, leading to a hampered revenue cycle and elevated operational costs.

Consequently, the current trend indicates a pronounced shift toward vendors who can promise and deliver robust edits, including built-in edits with payers. In essence, vendors that have the breadth and depth of edits are rising as the preferred choice in the healthcare industry, enhancing their value and strengthening their place in the market.

8. Lack of Collaboration. A high degree of collaboration is paramount in healthcare, where multiple stakeholders work together towards a common goal. Clearinghouses play a pivotal role in this equation, and their approachability, both in terms of being easily reachable and having transparent channels to the executive team, becomes crucial. When healthcare providers can swiftly get in touch with a clearinghouse and receive timely responses—even from the top echelons of leadership—it fosters a deep-seated trust and mutual respect.

However, when clearinghouses fall short in fostering this essential collaborative environment and fail to ensure open communication lines, it can leave healthcare providers feeling unsupported and disconnected. This lack of cooperative synergy, compounded by barriers in communication, can impede smooth workflows and compromise service quality, leading to growing dissatisfaction among providers.

Consequently, these providers find themselves actively seeking a more collaborative partner—a clearinghouse that not only understands the importance of teamwork but also emphasizes accessibility and swift responsiveness. This partner would be one that’s willing to uphold its role as an active, supportive participant in the healthcare journey, ensuring that there’s always a listening ear and a responsive voice at the other end. This heightened level of collaboration, combined with clear communication pathways, has increasingly become a defining factor influencing the shift in clearinghouse preferences.

Now that we’ve identified the top reasons providers are switching clearinghouses, here’s a brief overview of how to start the transition process.

The How: Steps in the Transition Process to a New Healthcare Clearinghouse Vendor

• Identify Needs and Set Goals: The first step is to clearly identify the needs and set goals based on the challenges encountered with the existing clearinghouse. This can include the need for better response times, more efficient workflows, better customer support, enhanced product functionality, and robust integration with EHR systems.
• Research and Evaluate Options: Once the goals are set, providers can research and evaluate different clearinghouse vendors. This includes assessing their depth and breadth of expertise, features, compatibility with their EHR system, client reviews, pricing structure, and more.
• Request Demos and Trials: Requesting a demo or trial from potential vendors helps to gauge their interface, ease of use, functionality, and the quality of client support. This hands-on experience can provide valuable insights into whether the vendor is a good fit.
• Select a Vendor and Plan Transition: Once a new vendor has been chosen, the provider, in collaboration with the new vendor, can plan the transition. This involves setting goals and expectations, an implementation timeline, preparing a data migration plan, and aligning resources for the switch.
• Data Migration and Setup: The next step is to transfer data from the old clearinghouse to the new one. This should be done with the utmost care to prevent any loss or corruption of data. It also involves setting up the new system according to the specific needs of the provider.
• Training and Support: It’s essential to train staff to use the new system effectively. The new vendor should offer comprehensive live and on-demand training and continuous support to ensure a smooth transition.
• Monitoring and Evaluation: After the switch, continuous monitoring and evaluation are necessary to ensure the new clearinghouse meets the set goals and delivers the expected improvements.

By understanding the ‘why’ and ‘how’ of switching to a different clearinghouse, healthcare providers can navigate this process smoothly and effectively, ensuring a successful transition that meets their specific needs and goals.

Choosing the Right Clearinghouse Vendor

It’s crucial for hospitals to regularly evaluate their vendor relationships and be open to change when their needs aren’t being met effectively. After all, in the world of healthcare, the quest for excellence never ends.

Selecting a new clearinghouse vendor requires careful consideration of various factors, including value, service quality, features/functionality, and more. Conducting a thorough market analysis is essential, and planning for a smooth transition can help avoid disruption.

Time for a Change: Embrace the SSI Difference

The SSI Group, LLC (SSI) is dedicated to delivering an exceptional client experience through innovative technology, optimized workflows, and a spirit of collaboration. With SSI, you can count on highly experienced experts who have dedicated decades to SSI, personalized attention from specialists and executives familiar with your needs, and tailored support with an appreciation for urgency. We’re proud to stand unmatched in experience and service.

In addition, our team has extensive knowledge of edits and integration—and consistently innovates to stay ahead in the industry. This ensures our clients always have access to the latest tools and technology, empowering them to excel and succeed.

An Easy Transition

SSI recognizes that changing partners can be daunting, but we also know that sticking with a mediocre one can lead to decreased financial stability. To make the transition seamless, our team employs a results-driven process to make switching and starting with us easy, fast, and smart.

 Contact us today to learn more or schedule a demo.