Healthie and ClaimMD Integration (In Beta Testing)

Streamline your insurance billing workflows with Healthie's direct integration with ClaimMD. This integration enables Healthie members to:

• Run real-time eligibility checks with ease
• Submit claims directly through Healthie to ClaimMD

This integration is currently in beta testing with a select number of customers. To be notified when this integration is available for broader use, please subscribe to our Portal Card for updates here.

Activate ClaimMD 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 ClaimMD — Please do not create a new ClaimMD account. We will help you get set up with ClaimMD through the integration enablement process!

This integration is currently in beta testing and is not yet available for all Healthie customers.

To be notified when this integration is available for more Healthie customers, please subscribe to our Portal Card for updates here.

When signing the addendum, you will select the plan you would like to move forward with. Basic, Small Volume, and Unlimited are the only options offered by ClaimMD. They do not offer different structures even if you only plan to submit claims or only submit eligibility checks. There is an additional cost for ClaimMD, which will be billed to your Healthie account.

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.

Integration Next Steps

When signing your ClaimMD addendum, you will write down the name and email address for the person you would like to be the designated ClaimMD account admin. This person will receive an invite directly from ClaimMD 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 ClaimMD's terms of service and sign a BAA.

Once the admin has created their account, please follow the instructions in the ClaimMD 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 + ClaimMD Eligibility Checks

Healthie's integration with ClaimMD runs real-time eligibility checks and returns results back into your Healthie account.

When viewing a Healthie patient chart, scroll down to Insurance Eligibility and click "Check Eligibility." In the beta release of this integration, the results return as seen below. In future iterations of the integration, the discrete data will populate into the correct fields.

Tip: 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.

NOTE: For any additional users added to ClaimMD who will be performing eligibility checks, please ensure that they have the setting "Can request eligibility checks" in Healthie turned on (found under Organization > Members > [member name] > Edit Settings > Permissions > Billing).

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 ClaimMD

Today, Healthie's integration with ClaimMD's claim submission allows you to submit claims via Healthie to your ClaimMD 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 ClaimMD to push the claims to your ClaimMD dashboard

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

To fully transmit your claims to the payer for processing:

• When logged into ClaimMD > Select Manage Claims from the left sidebar.
• The CMS1500s that you sent from Healthie to ClaimMD will be in Pending Approval (shown below).
• In order to send these claims to insurance, you will need to click Approve Transmit.

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 ClaimMD. This information originates from ClaimMD and is pushed into Healthie. This prevents you from having to log into ClaimMd directly to reconcile claims status, saving time in your billing workflows. If ClaimMD 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 ClaimMD

To enroll with payers on ClaimMD, navigate to the "Provider Enrollment" section within your ClaimMD account > Search for the desired payer by name or ID > Follow the specific enrollment instructions provided by ClaimMD. 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 ClaimMD

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.

ClaimMD 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

ClaimMD FAQs

Can I use both Office Ally and ClaimMD at the same time?

You are able to have both Office Ally and ClaimMD integrations enabled for your Healthie account, but per documentation from ClaimMD: "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."