Healthie and Claim.MD Integration

Streamline your insurance billing workflows with Healthie's direct integration with Claim.MD. This integration enables Healthie members to run eligibility checks, submit claims, track reimbursements, and manage Electronic Remittance Advice (ERAs) all within Healthie, eliminating the need for multiple platforms and reducing administrative burden. This integration is available on Healthie's Essentials Plan and above.

Watch our demo video here.

Claim.MD Pricing for Healthie Customers

Healthie supports our customers with a direct integration with Claim.MD — and we handle your Claim.MD account creation and billing for you. As part of the integration request process, you'll be prompted to select the Claim.MD plan you would like to move forward with. Healthie offers the same plans & pricing that Claim.MD offers directly, and we do not add on any additional fees.

Basic, Small Volume, and Unlimited are the only options offered by Claim.MD. They do not offer different structures even if you only plan to submit claims or only submit eligibility checks.

Healthie will add the Claim.MD fee to your Healthie subscription.

Please review the pricing chart below in detail to correctly understand the fees associated with Claim.MD.

Basic Plan: This "pay as you go" plan has a low monthly fee, so you can pay only for the services you use.

• Pay only for what you use
• Great for submitters with a small number of claims per tax ID

Small Volume Plan: A good choice for some single provider locations.

• 100 Claims, ERA & Eligibility Included / monthly
• Perfect for single doctor practices

Unlimited Plan: This plan is best suited for facilities that submit more than 100 claims per month, or that prefer the comfort of a set monthly cost.

• Unlimited Claims
• Unlimited ERA
• 1,000 eligibility included/mo
• Alternate file formats

If you have any questions about Claim.MD pricing, we recommend contacting them directly to better under their plans and pricing. Once you have the information you need to select the best plan for your practice / organization, you can complete the Integration Request Form. Please do not create an account with Claim.MD directly — as this is a direct integration, you'll need to create your Claim.MD account through Healthie.

Activate Claim.MD for your Healthie Account

Healthie offers a direct integration with ClaimMD which means you do not need to set up your own personal account with Claim.MD — Please do not create a new Claim.MD account. We will help you get set up with Claim.MD through the integration enablement process!

Ready to simplify your billing workflows? 

Get started by completing our Integration Request form.

Please do not create your own Claim.MD account from their website.

Integration Next Steps

When completing your Claim.MD Integration Request Form you will indicate the name and email address for the person you would like to be the designated Claim.MD account admin. This person will receive an invite directly from Claim.MD to finish setting up your account — if you are a solo provider, you will designate yourself as the admin. As part of setting up your account, you'll be prompted to accept Claim.MD's terms of service and sign a BAA.

Once the admin has created their account, please follow the instructions in the Claim.MD quick start guide to create additional users, add providers, and any provider enrollment.

1. Quick Start Guide
2. Adding Users
3. Provider Enrollment
4. Manage Users (detailed)

Healthie + Claim.MD Eligibility Checks

Healthie's integration with Claim.MD runs real-time eligibility checks and returns results back into your Healthie account. You'll need to review each payer within Claim.MD and complete the required enrollment for Eligibility Checks if required by the payer.

Once Claim.MD has been enabled for your account, you'll need to review your Insurance Settings to ensure Eligibility Checks has been enabled. This will allow the "Check Eligibility" option to show within the client's profile in Healthie.

Insurance Settings > Track Client Insurance Eligibility

When viewing a Healthie patient chart, scroll down to Insurance Eligibility and click "Check Eligibility."

You'll need to have an insurance plan on file within the Client's Profile in order to run an eligibility check. Learn how to collect & store client insurance information in Healthie.

Eligibility results include:

• Health benefit plan coverage (active or inactive)
• Family (deductible, out-of-pocket amounts)
• Individual (deductible, out-of-pocket amounts)

Batch & Send Claims to Claim.MD

Today, Healthie's integration with Claim.MD's claim submission allows you to submit claims via Healthie to your Claim.MD dashboard.

Once you are ready to send a claim:

• From the Healthie CMS1500s page, select the claim(s) you want to submit
• Click Send to Claim.MD to push the claims to your Claim.MD dashboard

To learn more about managing claims once they are received in Claim.MD, read more here.

Claim Status Updates & Remittance Data within Healthie

The status details for each claim will automatically update within Healthie as ERA (Electronic Remittance Advice) file data is received from Claim.MD. This information originates from Claim.MD and is pushed into Healthie. This prevents you from having to log into Claim.MD directly to reconcile claims status, saving time in your billing workflows. If Claim.MD rejects your claim, Healthie will not update the status.

You can review your claims statuses by going to Billing > CMS 1500. All insurance claims will be listed, and you may filter accordingly.

You can find a detailed list of Healthie's claim statuses here. 

Enrollment with Payers in Claim.MD

To enroll with payers on Claim.MD, navigate to the "Provider Enrollment" section within your Claim.MD account > Search for the desired payer by name or ID > Follow the specific enrollment instructions provided by Claim.MD. Steps may include clicking links to the payer's portal to complete the necessary forms and verify your credentialing information.

You can check if enrollment is required for both claim submission and receiving Electronic Remittance Advices (ERAs) within the platform.

Learn more about Payer Enrollment.

Enrollment for ERA in Claim.MD

Now that we’ve enrolled for claim submission, let’s set up Electronic Remittance Advice, or E.R.A. ERA is how the payer sends you an electronic summary of what was paid on the claims you’ve submitted. If your billing software supports automatic payment posting, you will need to setup ERA for each payer so it has the data necessary to complete this process.

• On the provider enrollment page, the ERA column will give you instructions to activate ERA.
  • Quick Enroll - Means we are able to submit an online enrollment request with no additional paperwork or steps.
  • Auto-Enroll - Means the payer automatically returns their remittance summary to the send of the claim.
  • Like the claim enrollments, Enrollment Required for ERA will either have instructions for enrolling online with the payer, or pre-filled forms that need to be submitted.

Learn more about ERA Enrollment.

Claim.MD For API users

• You will be able to make an API Call to automatically trigger an eligibility request (in addition to being able to trigger it in the UI).
• Once done, that data is also all retrievable via the UI

Claim.MD FAQs

Can I use both Office Ally and Claim.MD at the same time?

You are able to have both Office Ally and Claim.MD integrations enabled for your Healthie account, but per documentation from Claim.MD: "ERA can only be returned to one clearinghouse. When you enroll for ERA, all electronic remittance for the selected NPI/Tax ID will be re-routed to Claim.MD regardless of where the claims are originally submitted from."

Can I use my existing Claim.MD account?

Healthie offers a direct integration with Claim.MD — including the creation of your account and technical support on your behalf. We won't be able to port or link your existing Claim.MD account, but we can help you get set up with a new Claim.MD through Healthie.

Can I host multiple Claim.MD accounts for different providers on my team?

Only one Claim.MD account can be linked to a single Healthie account. You will need to add providers to your Claim.MD account and have them bill through your Claim.MD account connected with Healthie.

Can I run eligibility checks for specific Dx or CPT codes?

Most payers do not respond to the Procedure Code and only respond to the Benefit Type. As such, an eligibility check can only be run in general for a patient, and not for specific CPT or Dx codes.

Can I use Claim.MD across sub-organizations?

One Claim.MD account can be linked to one single Healthie account. For sub-organizations, you'll be prompted to set up a unique Claim.MD account for each of your sub-organizations that need claims processing or eligibility checks. Our team will guide you through the application and implementation process for your sub-orgs, which will include ERA enrollment for each sub-organization instance. You'll be able to add a new Claim.MD account integration as you add more sub-organizations.

Why don't I see the option to run eligibility checks within the client profile?

1. Check that you've enabled Track Client Insurance Eligibility within your Account Settings > Insurance Settings
2. Review the Team Member Permissions to ensure that they have permissions enabled for "Can request eligibility checks"
3. For the specific client, confirm that they have an insurance policy on file within Healthie
4. For the payer, check that you have completed enrollment for eligibility checks within Claim.MD directly — many payers require enrollment, and you will need to configure this on a per payer basis.

What is the cost that is involved with using the Claim MD integration?

Healthie offers the same pricing that Claim.MD does, the pricing & plans available are listed in our documentation here.

Does this eliminate the need for Office Ally?

Yes. ERAs can only be returned to one clearinghouse, so when you get set up with Claim.MD and complete ERA enrollment, all claims data will pull back into Healthie regardless of where you submitted the claim from (Office Ally or ClaimMD).

When I originally set up Office Ally so that I could submit electronic claims for certain insurance payers there were special forms that needed to be filled out for the system to work such as ERA and ERI enrollment. Will this be the case with Claim MD?

Yes with Claim.MD you will need to complete ERA enrollment for the payers that require this — this can be done as part of your account setup process which our team will send instructions on. This is a requirement of the payers, not the clearinghouse.

Which Payers does Claim.MD support?

You'll find the Payer List for Claim.MD here.