Claim.MD Integration FAQs

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 article covers frequently asked questions regarding the Healthie + Claim.MD integration.

Frequently Asked Questions:

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?

Yes, If you have an active Claim.MD account, you can transfer ownership to Healthie to enable full integration support. This transfer allows us to assist with claim tracking and technical issues across both platforms, ensuring seamless support.

How to Transfer Your Account:

  1. Log into your Claim.MD account.
  2. Submit a support ticket requesting to transfer ownership to Healthie.
  3. Claim.MD will verify the request with Healthie and complete the transfer.

⚠ Important: Healthie cannot support your Claim.MD integration unless your account is transferred. Once completed, Healthie will have visibility into your Claim.MD account, allowing for enhanced troubleshooting and support.

Additionally, your Claim.MD subscription fee will be consolidated into your Healthie billing for streamlined account management.

Get started by completing our Integration Request form.

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?

Eligibility results from Claim.MD typically include the following, but are subject to what the payer will return to Claim.MD. Here is the information that will be sent to Healthie, depending on what the payer will return.

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

For more detailed eligibility results, you can use the search field within your Claim.MD account to search benefit codes (ie. specialty). You'll find the full list of searchable benefit codes available here. You can also search by CPT code, however there may be some limitations in what payers return for some specialty codes (ie. nutritional codes). Most payers do not respond to the Procedure Code and only respond to the Benefit Type.

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).

Do I need to complete ERA and ERI enrollment 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.

Does the "Check Eligibility" feature match against the provider or group NPI?

Claim.MD supports both options — you can check against Type 1 or Type 2 NPIs.

How does Claim.MD handle secondary claims?

You can find a great deep-dive on secondary claims within Claim.MD's knowledge base here.

Can I create UB-04 Claims?

Yes, customers can log in and directly enter UB claims, they can also upload a CSV file. Here is a link to Claim.MD's supported file formats: https://docs.claim.md/docs/supported-file-formats. Please note, Healthie only supports the creation of CMS1500 claims within the platform, so any UB-04 claims will need to be created within Claim.MD directly — these claims are not part of our direct integration configuration.

Did this answer your question? Thanks for the feedback There was a problem submitting your feedback. Please try again later.

Related Articles