Billing guide · Guide 04 of 04
How to switch billers without losing claims in progress.
The risk in changing billers is not the new one. It is the claims in flight on the day you switch: sent but unanswered, denied but unworked, paid but unposted. Decide who owns each one before the cutover, and keep the two running side by side until the numbers agree.
Read your contract before you give notice
Four clauses decide how hard the switch will be. Find them before you tell your current biller anything.
- Notice period and renewal. How many days of notice, and whether the contract renews on its own if you miss the window.
- Run-out. Who works claims with dates of service before the end date, for how long, and what the biller charges on payments that arrive after you leave.
- Records. What the biller hands back, in what format and by when: claims, remittances, denial history, notes on open claims.
- The business associate agreement. HIPAA requires it to say that when the arrangement ends, the biller returns or destroys your patients’ information where that is feasible. Ask for your full export, in writing, before that clock starts.
If the contract is silent on run-out or records, agree on both in writing before notice, while your current biller still wants to keep you.
Accounts the practice must own
A switch stalls when the accounts your billing depends on belong to the biller. Before notice, make sure each of these is in the practice’s name, with the biller added as a user you can remove:
- The clearinghouse account your claims go out through and your remittances come back to.
- Payer portal logins for eligibility, claim status and appeals.
- Each provider’s credentialing profile. Many health plans read the CAQH profile during credentialing. The provider maintains it, chooses which plans can see it and must re-attest it every 120 days, or it expires. CAQH renamed itself DataSpring in 2026; profiles and logins carried over.
- The bank account payer payments land in. Electronic payments should go straight to the practice’s account. If any payer pays the biller’s account instead, change that first; it takes the longest.
- Your EHR’s administrator login. The biller’s user should be one you can switch off.
Take inventory on the cutover date
Pick a cutover date and ask your current biller for a list of every open claim as of that date, as a file, with its status and its filing deadline. Then agree on the totals. The list sorts into six piles:
| Status | What it means | Why it gets lost |
|---|---|---|
| Not yet sent | Visits with no claim | Nobody owns them between the two billers. The filing clock is already running. |
| Rejected | Claims the clearinghouse or payer refused before processing | They sit in the old clearinghouse’s reports, which the new biller cannot see. See rejected vs denied claims. |
| Sent, no answer | Accepted by the payer but not yet paid or denied | The remittance may arrive at the old clearinghouse after you leave. |
| Denied, not worked | Denials with no correction or appeal yet | Appeal deadlines keep running during the switch. |
| Paid, not posted | Payments received but not recorded in your EHR | Patient balances are wrong until they post. |
| Credit balances | Overpayments by a payer or a patient | Someone has to refund them, and the clock on refunds does not stop for a switch. |
Decide who owns each old claim
Draw the line by date of service, and write it down. Three arrangements are common:
- The old biller runs out its claims. It keeps working claims with dates of service before the cutover for an agreed period, and is paid on what it collects. The new biller files everything after the cutover.
- The new biller takes the old claims. Cleaner for you, but often priced separately, because old claims take more work per dollar.
- Your office works them. Realistic only for a short list.
Whichever you choose, set a date to review what is left, and decide then what to appeal, what to bill and what to write off.
Move remittances and payments
Claims can move to a new biller in a day. Remittances and payments cannot.
Remittances. Each payer sends remittances to the receiver you enrolled, and changing it takes a new ERA enrollment with each payer. Medicare contractors limit it to one receiver: Novitas, for instance, allows one ERA receiver per PTAN for Part B, and changes go through the contractor’s EDI enrollment form. Until each payer’s enrollment changes, remittances keep arriving where they arrived before, so keep access to the old clearinghouse, or have the old biller forward every remittance, until the last payer has switched.
Payments. If payer payments already land in the practice’s account, nothing changes, because electronic payment enrollment follows your bank account, not your biller. If any payer pays an account the biller controls, change that enrollment first: for Medicare with the CMS-588 form, which requires the practice to have sole control of the account, and for commercial payers through each payer’s own enrollment process.
Run both side by side
The safest switch has an overlap. For a few weeks, the new biller prepares and checks every claim from your visits while the current biller keeps filing. Each week you compare: which claims each one would send, what each one found, where they differ. When the two agree, and the new biller’s enrollment is complete, you switch. Cash keeps arriving the whole time, because the current biller never stopped.
The overlap also tells you something no proposal can: whether the new biller finds problems the old one missed. Use the five numbers to compare the months before and after.
A switching timeline
| When | What happens |
|---|---|
| Before notice | Read the contract. Move accounts into the practice’s name. Pull six months of numbers. |
| Notice period | Sign the new agreement and the business associate agreement. Start remittance and payment enrollment with each payer. Begin the side-by-side period. |
| Cutover date | Take the open-claims inventory, agree on totals and confirm who owns each old claim. |
| Run-out | Old claims worked to an answer. Remittances forwarded until each payer’s enrollment moves. |
| Review | Look at what is left. Appeal, bill or write off each item, and close the old accounts. |
How Claims Native handles a switch
Your current biller keeps working until the comparison says we are ready. You send one export of a recent week, with patient details removed, and we show you what we read from it. You sign the agreement and the business associate agreement before any patient record reaches us. We connect your EHR’s visit export and record your payer contract rates. Enrollment with the clearinghouse and your payers takes weeks, and the payer sets the pace; we chase it and tell you where it stands. During a shadow period we prepare and check every claim beside your current biller, and each week you see the comparison. Your office and your provider approve the switch to live filing. Cleanup of older balances is priced separately. See how we start.
Sources
- 45 CFR 164.504(e): business associate contracts. Return or destruction of protected health information at termination.
- HHS, Sample business associate agreement provisions.
- Novitas Solutions, Electronic remittance advice enrollment. One ERA receiver per PTAN for Part B.
- CMS, Medicare Claims Processing Manual, Chapter 24: EDI support requirements. ERA enrollment.
- CMS-588, Electronic Funds Transfer Authorization Agreement.
- DataSpring (formerly CAQH), Provider Data Portal resources. Re-attestation every 120 days.
- DataSpring, For clinicians. Profiles are shared with the plans a clinician authorizes.