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Customer Experience and Design

Choosing a Clearinghouse/VAN

Choosing your clearinghouse or VAN is a very important step, especially if you are in healthcare. In healthcare you need to make sure they are HIPAA compliant, which means they will be able to handle all the mandated transaction sets. Other industries have different requirements. Whichever clearinghouse you choose, you need to make sure they can handle all the transaction sets you might want to utilize.

When shopping for your clearinghouse or VAN, make a check list of your requirements. Here are a few of the most common questions you’ll want to address in creating your list:

  1. What transaction sets can they handle? In healthcare, some of the transaction sets would be 834, 837, 835, 270/271, 276/277, etc.
  2. What is the problem resolution process? Who do you contact? How is the issue resolved? If there is a programming change how long does it take for the change to be effective?
  3. How is data transmitted? Is this done via web connection, SFTP, FTP, etc?
  4. How often is data transmitted? Is data transmitted real time, batch, once daily, etc?
  5. What is the cost per transaction set? Is the charge per ISA, transaction set, or bytes?
  6. What is the initial set up fee?
  7. What is the contract period?
  8. What additional expenses are required? Do you need additional hardware, software, programming, etc. to trade data with the clearinghouse?

It is a good idea to have at least 2 different proposals put together. Best case and acceptable scenarios, with justification for each. This will give management a good idea of why you are proposing a particular clearinghouse/VAN.

Once you have gathered all the information you can put together the proposed budget for this implementation.

Whether this is an implementation of its own or part of a larger implementation, keep in mind to get all affected parties involved. This will help eliminate issues further down the road.

Are there any additional questions you would consider for your requirements list?

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Deborah O'Rear, Sr. Technical Consultant

Deborah O’Rear is a business-focused, outcomes-driven consultant with more than 15 years of healthcare industry experience. She has a vast depth of EDI and BSA knowledge to support healthcare clients. Deborah is well versed in articulating, clarifying, and writing business requirements, establishing implementation strategies, QA, user stories, and testing.

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