Healthie Insurance Claims and Medicare or Medicaid

Healthie's CMS 1500 feature makes it easy for you to create CMS 1500 claims and submit them (electronically or physically) to an insurance company for reimbursement for services.

For providers in-network with Medicare or Medicaid, Healthie can be used to quickly create claims that can exported and submitted to CMS.

Please Note: while our CMS1500 feature supports billing Medicare/Medicaid, Healthie is not currently registered as certified EHR technology with CMS. This means our platform cannot be used in the Promoting Interoperability Programs offered by CMS.

Medicare and Medicaid Basics

You must be credentialed with Medicare or Medicaid before they will accept claims from you. Credentialing is a separate process that does not happen through Healthie. If you are not credentialed directly with Medicare or Medicaid, they will not accept your claims created in Healthie.

Credentialing can be done through the CMS website if you are eligible, learn more here.

Creating Medicare or Medicaid Claims in Healthie

Claims creation can be done in Healthie for any insurance payer, including Medicare and Medicaid. We follow CMS guidelines, to make claim creation a breeze. You'll find an up-to-date library of CPT codes and ICD-10 codes.

You can walk through the basics of creating an insurance claim here.

Note: If Medicare has 2 NPI numbers on file for you (a billing NPI and a provider NPI), be sure to use your billing NPI when filing CMS claim forms.

Submitting Claims to CMS

Once you're enrolled as a Medicare provider, you'll be prompted by Medicare to enroll in your state's provider portal for electronic claim submission to Medicare. You'll need to follow the steps outlined by Medicare to enroll in their provider portal. Alternatively, you can use your clearinghouse of choice.

Download and Print a Claim

In some cases. Medicare or Medicaid in your state may require that your first claim be printed and submitted by mail, before you can be set up with your state's electronic payer portal for Medicare. Claims created in Healthie can be downloaded and printed, and match up with standard CMS claim form.

Medicare however does not accept photo copies of a form, or printed version of a form on regular paper. The form must be printed on a standard CMS 1500 pink claim form. This paper form is available from various retailers, such as Amazon, Staples, and Office Depot.

More guidance can be found here: Print and Insurance Claim on Red-Ink CMS 1500 Form

Export a Claim

If submitting claims to a payer portal, you can export your claim as a TXT file in Healthie, and then upload it to your payer portal or clearinghouse.

Export a Claim to Office Ally

Healthie offers an integration with Office Ally for direct claim submission. Claims can be submitted to CMS through Office Ally, however there may be an additional fee as Medicare/Medicaid are non-participating payers.

If using Office Ally, Medicare and Medicaid require an additional payer enrollment process before claims can be electronically submitted via Office Ally. Learn how to enroll here.