Integration Best Practices: Billing and RCM

This article is for Marketplace Partners looking to integrate with the billing and revenue cycle areas of the Healthie platform.

Integrating with the Healthie's payments and insurance billing platform offers the following benefits to Practices that use Healthie:

• Process Eligibility Checks
• Automate Claims Submission to preferred vendor
• Support Advanced Revenue Cycle Management
• Submit and track Superbills
• Capture related Out-of-pocket Payments

Developer Resources

• Learn more about Healthie's API and SDKs
• API Documentation
• Sandbox Account Access

Benefits of Marketplace Partners

Marketplace Partners extend the functionality of Healthie's in-product offerings and in total, provide a comprehensive, modern experience for Organizations that offer Superbills & Submit Claims for Services.

Here is an overview of what Healthie offers In-Product:

• Eligibility Checks via Change and Tracker
• CMS 1500 Claims Creation
• CMS 1500 Claims Submission
• Superbill Generation
• Out of Pocket Payments

Eligibility

In Healthie, every patient's insurance information is stored under their patient profile where organizations can track the patient's benefits. If your company runs automated eligibility checks, you can retrieve and fill out the necessary information via the Policy object.

Currently, a customer will need to initiate the eligibility check outside of the Healthie platform. Upon running the check, your platform can send the results back into Healthie.

CMS 1500 Claims Creation & Submission

Using Healthie's API you can push claims data from Healthie to your billing platform and then subsequently send back claim statuses into Healthie. This integration is ideal if your organization processes and manages claims on behalf of customers.

• You can List, Retrieve, Create, and Update CMS1500s via the CMS 1500 object.
• The full list of fields available can be found in the API explorer here.

CMS1500s may be manually created after the appointment, or automatically generated after an appointment w/ API work.

Currently, integrations built to Healthie will need to pull claims from our platform. This could be done in batches, once per day, or as your customer's request.

It's important to continue to send back status updates, so Healthie customers are up to date on their claims. Current Status options can be found here.

Superbills in Healthie

• Here is some information about Healthie's Superbills Feature
• Superbills can be Listed, Retrieved, Created, and Updated, via the Superbill Object
• The full list of fields can be found here

We typically see Marketplace Builders extend the functionality of our Superbills feature via the following:

• Support patient submission (and reconciliation) of Superbills as part of patient financing initiatives

Out of Pocket Payments in Healthie

The Healthie platform has a built-in integration with Stripe to handle payment processing within our platform. More information is available here.

Healthie uses Stripe connect, so Healthie customers do NOT have their own Stripe accounts that they link to Healthie.

We typically see Marketplace Builders extend the functionality of our Out-of-pocket Payments feature via the following:

• Charge payments for card payments on file (one-time or recurring)
• Manage Invoices
• Automatically update payments collected outside of the platform (and record those as transactions)