BILLING MANAGER EDI SURVEY — Claim.MD
Here is the complete 2022 clearinghouse review for Claim.MD. Because it is so important for billing managers to obtain accurate data, CH.org does its own primary research and interviews the clearinghouses personally, using standardized criteria. The information below is provided directly from Claim.MD to Clearinghouses.org and is reliable.
1. Call Wait Times. (How long do I have to wait to talk to support?)
Claim.MD utilizes multiple support methods, including telephone support. However, we do not follow a model that requires you to hold in a queue waiting to talk to a person. Our support is built in throughout the system, with a GetHelp button that immediately connects you to our support team. Type your question about the claim (or rejection or other issue), then click “Send Support Request.” From there, we review your data and your question, and we respond to you through the ticket with a copy to your email. The ability to ask a direct question in context with a single click greatly simplifies and streamlines the support process.
Telephone support is most effective when clarification is needed about your question to us, or our response to you. We respond to incoming tickets within minutes or hours, and if your issue requires research taking longer than one day, you can easily review our progress notes and updates to your ticket right from your account.
2. Payer List. (Do you have connectivity to the payers that I need to send claims to?)
Claim.MD is contracted with all major EDI networks for sending commercial claims. We submit directly to all Medicare Part A and B plans nationwide. Additionally, we have direct connections to most Medicaid and many Blue Cross plans. There are no per-claim charges for claims sent where Claim.MD has a direct connection. Check the Claim.MD Payer List for specifics. Any “per-transaction” fees are marked with an asterisk (*) under the Services column on our Payer List. A “transaction” can include a claim, an ERA, or an Eligibility Request.
3. PM Support. (Does your company integrate with my PM system? Is your support staff knowledgeable about my PM?)
The most basic rule is that Claim.MD can read industry claim files, and we can deliver industry standard remittance files (and other ancillary transactions). If your PM allows you to choose a clearinghouse and interchange standard file formats, Claim.MD will work fine. You will have to know how to do these two things to interface any PM/EMR to Claim.MD:
Create a claim file in your PM, locate it on your hard drive – then it’s simple to click Upload in Claim.MD to send the claims.
How your PM imports ERA files once you download them from Claim.MD.
Claim.MD will work directly with PM/EMR developers and vendors who are interested in simple scripted solutions for sending claims, downloading payments and responses, and batch eligibility (contact email@example.com). Beyond that, we do not offer direct support for any PM/EMR for their process of generating, saving, exporting or importing data.
4. Missing Claims. (My payer does not show as having received my claims. I don’t want to wait 2-3 weeks to find this out. How do I tell in real time if I have missing claims?)
In reality, the most common cause for “Missing Claims” is a cryptic EDI response that is either missing or overlooked where the claim quietly rejected. That is not the case with Claim.MD, because we monitor your incoming responses for any sign of rejection or unexpected payment patterns. If we post anything to your account that needs your attention, we put it on your Manage Claims list of “Rejected Claims that need correcting.”
Editing claims is simple with Claim.MD, with interactive HCFA-1500 and UB-04 claim forms. Obvious errors are highlighted for you, and you have access to all fields on the claim when editing. When done editing, click Save – and the corrected claim is ready to go back out, referencing the payer’s Original Claim ID if necessary.
Claim.MD is unique in the clearinghouse industry in how we account for ALL your claims and responses logically through time. We continually reconcile your account to make sure that you have received all the confirmation or rejection responses that you should receive if everything is working in a timely fashion. Claim.MD Manage Claims gives you up-to-the-minute Response Alerts and ERA Alerts if anything appears to be missing or delayed. Alerts automatically resolve if the missing data arrives, otherwise they are on your list to easily view the affected claims, or re-transmit, or clear the alert, or add notes and reminders to the Claim History reflecting your follow up and research.
Another feature where Claim. MD simplifies claim tracking is in cases where claims have been submitted multiple times. Traditionally that leaves a confusing trail of multiple confirmations and rejections on multiple dates, all for the same date of service. Claim.MD ties all this together into a simple and readable PDF file for the entire Claim History of all the submissions and messages that have occurred with this visit through time. The Claim History is the key document if you ever must prove Timely Filing when appealing a claim.
And when you need to file a paper appeal with the payer, Claim.MD gives you a simple template with all the information pre-filled for the Cover Page (just type your message specific to this appeal). Then you get a printable document with your message, a copy of the claim, a copy of the Claim History, and the ERA. Once a claim must be appealed is no longer a “simple” collection, but when you must do it, Claim.MD makes it almost painless by giving you easy access to the information you need.
5. Claim Scrubbing & Validation. (What are your rejection rates? Too high = Too many payer denials. Too low = Too many EDI rejections.)
Effective Scrubbing and Validation of claims is the standard clearinghouse industry approach to catching cash flow issues early, before they show up in Aging of A/R. Claim.MD takes that further by applying the same concept to individual payers or individual provider accounts. In most cases, “custom edits” and “hard coding” to help you either catch or reduce rejections are simple with Claim.MD (just open a support ticket on an example and describe your edit issue). Of course, standard edits are built in at the system level and maintained daily in the shifting landscape of medical billing, and we learn new things every day!
6. RCM Dashboard — to detect slow payments, cash-flow issues, and excessive A/R days. (Does your service help me manage unattended Claims, manage rejections and denials. Does it report errors as codes or as full explanations. Does your service report back to my PM with error messages, ERAs, etc.?)
Claim.MD’s answer to a “RCM Dashboard” is our Manage Claims page. That is where you see a graph of recent claim activity, claims that need to be corrected, and Alerts for any responses or ERAs that are missing or delayed. We track everything about the claim and the insurance remittance through the entire lifecycle of the transaction, and Manage Claims is where it all comes together.
Everything in Claim.MD is in English instead of codesets, with the exception of specific messages that we sometimes receive from payers or trading partners (which can have some variability).
Claim.MD can return Response Files and ERA files to PM vendors (see Item 3 – PM Support above).
7. Real Time RCM Reporting. (Do I have to wait until the end of the month to detect blocked cash-flow, lost or unattended claims?).
Several items above include information about Claim.MD’s “Manage Claims” features, and that is the biller’s home base for “Real Time RCM Reporting.” That is where you will see anything that is late or missing, anything rejected, and payments that fall outside of your normal reimbursement patterns. Your Manage Claims page is updated continually, so you see prompts in Manage Claims to address problems within seconds of us receiving the data from payers or trading partners throughout the day and night. In Claim.MD, our approach is that it is more effective to interactively work and review your claims instead of printing and shuffling reports!
But of course, reports must ultimately be shuffled. Claim.MD has standard reports showing what you have billed, what has rejected, and what has paid. They can be printable reports, but they are interactive with graphs in the system (click any segment of the graph to view claim detail).
Set up “Claim Groups” to report on criteria you select, which can be multiple layers deep. This is a very powerful feature that we can help you customize to easily View Reports or Manage Claims for subsets of your billing data.
Reports can be generated for standard time periods (Today, Yesterday, Last Week, This Month), or by Month and Year. You can specify other ranges of time for custom views.
8. Patient Payments. (How does your service help me estimate payment responsibility to determine the patient portion upfront, so our front office can collect patient payments during the appointment?).
Claim.MD offers an eligibility portal where you can obtain payer information that includes deductible information and co-payment/insurance rates.
Check the Claim.MD Payer List for payers that offer real-time eligibility through industry trading partners, with an asterisk (*) under the Services column if there is a per-transaction charge.
9. Analytics. (How does your service/technology give me insight into financial and operational performance across our organization?)
The concept of “analytics” is integral throughout Claim.MD, because there is nothing more frustrating than not being able to see the forest for the trees! Our job is to give you the information you need to do YOUR job, and to do that as clearly as possible.
With “Claim Groups” you can select detailed subgroups of your billing data for any report.
The most standard report is Billed Charges, which you can run by Payer, Billing Provider, Rendering Provider, Facility or Procedure Code.
Beyond standard reports, our “Age of Billing Report” shows you in a simple graph how much lag time occurs between the Date of Service and when the claim was actually billed. We take the same approach for “Top Rejections,” “Payments and Adjustments,” “Time Until Payment,” “Claim Activity,” and other useful report templates.
10. Proactive Revenue Controls. (How does your system proactively and continually monitor key performance indicators (KPIs) to enable us to act in real time to address revenue leakage before it significantly impacts our cash-flow?)
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All of the responses above detail the many ways that Claim.MD helps you monitor the health of your cash flow and the performance of your billing methods. Our company started in 1982 when a doctor asked us to “make his computer talk to Medicare over the phone,” and Claim.MD is the culmination of that work and commitment to date. And to repeat from Item #5 above, “we learn new things every day!”