The Navicure Solution vs.
Traditional Clearinghouses

The landscape of the 1500 claims clearinghouse industry has not changed much in the last twenty years. In the 1980s, when the claims clearinghouse concept was introduced, it was hailed as a progressive step to more effectively and efficiently process insurance claims.

Over the years, several national corporations have entered the 1500 claims processing market. In addition, approximately 150 local clearinghouse vendors have stepped into this arena.

Most of these vendors offer a strikingly similar solution, a prototypical clearinghouse network utilized to accept claims electronically and pass any available payer information back to the end user. In fact, most of the infrastructure and processes utilized to forward claims and retrieve payer reports has not changed since the advent of 1500 electronic claims more than twenty years ago, even though the healthcare insurance market has changed dramatically during that time.

Consequently, physicians’ staff are offered solutions that were designed for yesteryear, when managed care and increased payment rules and complexities did not exist. Evidence of this lackluster progression surfaces when one evaluates two critical areas: 1) the vast majority of clearinghouses have high customer turnover rates and have seen their electronic claims transaction volumes stagnate over the last 5 - 7 years, and 2) there is a steady drumbeat of dissatisfaction and unhappiness emanating from physicians and their staff that the reimbursement process is designed to deny and delay payment.

With the constant and steady evolution of the healthcare insurance industry, and the ever increasing convoluted payment rules introduced by all payers, Navicure has seized an opportunity to operationally and technologically advance the 1500 electronic claims industry. In order to serve as a more effective conduit between billing staff and payer, Navicure offers a proactive solution that adds several additional layers of functionality to decrease the cost of collections while increasing overall profit. Equally important, Navicure serves as a partner to physician practices to enhance other areas of the reimbursement cycle.