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OHMSTM Vs Clearinghouse


OHMS is a Web based Hipaa compliant Claim Management System. Client will have full control of the application & data.

With OHMS, Client manages the patient, claim data and controls the dispatch of claims.

Client needs to enter data manually and store it in a floppy disk and send it to Clearinghouse by mail. Clearinghouse will collect the data from all their clients and puts claims together into a single file and sends it to the payer in X12 format. If there is any problems for any claim inside those files, the whole file will be rejected and chances of delay is very high.
For security, Authentication, Authorization and SSL is used. The system is designed to be completely automated in terms of processing the claims. It is not any more secure with clearinghouse due to many manual interventions. (Ex: floppy disk postage & upload)
OHMS will allow to get paid faster than clearinghouse. The chances of delay for payment are very high due to many factors. There are chances of rejection due to bundling of all provider claims into a single file.
Remittance advice message will be accepted electronically using X12 835 format. Remittance advice messages are received in paper copy only.
Claims generation for Medicaid type of programs are automated and claims will be generated for a scheduled day. Manual process of creating the claims for Medicaid.
Modules can be added to the system using Add-In features available in Administration module. Not possible with Clearinghouse
System is designed to work for Hipaa X12 Professional & Institutional type of claims Manual process
System can handle Medicaid and any number of Insurance company claims. Manual process
Centralized Processing of Claims. Not Possible and security point of view, it is not a good idea to have a decentralized processing.
Provides true ROI with cost-effective solutions Many issues with Clearinghouse
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