What’s The Difference Between a Clearinghouse and Aggregator?

Ever scratched your head thinking that these platforms are only one thing? They can be. 

At the highest level, a clearinghouse is an aggregator (sender and receiver) of a lot of electronic claims information. Most of that’s managed by software. What a clearinghouse does is translate the claims from visit to revenue. 

Some aggregators offer added billing services, while others don’t. Clearinghouses typically work with your billing services to close out the revenue cycle, checking the data for accuracy, etc.

If you have questions about what technologies you need and which ones you don’t, we’ll go over each in more detail. 

And you’ll walk away with a better understanding of how each claim goes from your computer to money in your agency’s bank account. 

What is a home care clearinghouse? 

At its core, a clearinghouse takes the electronic file of each claim generated by your home care software and it’s sent to your local billing clearinghouse account. Then, each claim is scanned and crawled for any errors. 

Once the claim is error-free, it sends the claim to the selected payer. From there, it is either paid, partially paid, or rejected. When a decision is made, you should receive a status update on where the claim is. 

At this stage, you can make any fixes to rejected claims and resubmit them. 

What’s the importance of using a clearinghouse?

According to Clearinghouses.org, “the average error rate for paper claims is 28%. But using the right clearinghouse can reduce that to 2-3%.” 

The move from paper claims to electronic claims:

• Makes the payment process quicker 
• Streamlines the claim correction process
• Keeps information more secure 

The VA, as an example, made this shift to “improve its claims submission and processing capabilities.” By following their lead, you can expect to see similar results on the receiving end. 

What is a home care billing aggregator? 

An aggregator captures visit information via electronic visit verification (or EVV) and gives visibility to a managed care organization’s provider network. 

The Cures Act (the one that brought EVV to life at the federal level) made provisions for these data points to be collected: 

• Service type
• Care recipient’s name
• Date of service
• Location where the service was delivered
• Caregiver’s name
• Time(s) the service began and ended

Think of an aggregator as an assembly line putting pieces of information together to tell a story about each visit that your caregivers make with a client. First, the caregiver clocks in at the client’s home upon arrival.

They check off each task in real-time as it’s completed, logging a timeline of work, and concluding with clocking out as they leave. 

From start to finish, the aggregator would have access to the information provided by each caregiver, giving the payer a 360° view of what happened and when. 

What’s the importance of using an aggregator? 

A billing aggregator collects data from your electronic visit verification system to the proper provider to provide transparency to their networks. EVV, in general, functions to reduce fraud, waste, and abuse. 

All states have implemented some form of EVV, and that required a decision to adopt one of five EVV models. Those are: 

1. Provider choice
2. Managed Care Organization choice
3. State-mandated (in-house)
4. State-mandated (external)
5. Open vendor 

The majority of states have an open choice model, giving you more control and flexibility over the one you pick. 

What are some examples of billing aggregators?

• CareTime is one example of an all-in-one revenue cycle system with full CRM and operations administration capabilities
• Sandata 

What do you need to have? 

At the very least, you need to have basic access to a clearinghouse. 

As far as aggregators go, you need access to a system that is compliant with EVV regulations and is approved by your state (or able to connect to the right system). 

With CareTime, you get instant updates in one clean dashboard about all of your claim statuses, so you know your claims aren’t going into a black hole. Before you even submit a claim, the system will automatically flag any shifts that are likely to be rejected and why. 

Interested in making a switch for your aggregator? Check out CareTime V3 today.