FAQs

Reconciliation involves verifying that the claims sent to Claim.MD match the records in your system for accuracy and completeness.  To retrieve the transmitted claim numbers, click the Upload Files page in the left navigation bar. This sc...

Instructions for Locating the Trading Partner ID/Submitter ID Locate the payer enrollment instructions for the payer in question. Click on the Payer link under the 1500 Claim column. (The link may vary based on your specific setup.) Rev...

The ISA13 is a unique identifier within an electronic claim submission, used to track and reference files between the sender and payer. In Claim.MD, the Transmit # in the claim history corresponds  to the ISA13 value, serving as the unique ...

Our system processes claims very quickly—often faster than users can complete their ticket. While larger payers typically check for files on a frequent schedule, smaller payers may do so less often, so it’s always worth verifying a claim's status. ...

Administrative users sometimes need to update their Claim.MD account settings to ensure invoices are sent to the correct email addresses. Follow the steps below to manage invoice distribution by adding the appropriate email under the "Invoices" sec...

An archived claim that is never submitted will be categorized as 'deleted.'  To archive an unsubmitted claim, navigate to the View/Edit Claim screen, and click the red Archive button.  To retrieve and restore a deleted claim: ...

Searching for ERA in Claim.MD Prior to contacting Claim.MD to report a Missing ERA please be sure to thoroughly utilize the Claim.MD tools available concerning ERA. We recommend that you first confirm the Provider has enrolled (Prov. Enrollme...

These warnings inform you that the current method of entering data will not transmit to the payer as expected. To ensure X12 compliance for electronic claims: Issue: Entering the same NPI in both block 31 (rendering provider) and...

No, claim submissions are not dependent on the completion of ERA enrollment. It is best practice to send claims immediately upon receiving enrollment confirmation from payers that require submission enrollment. For payers that do not require this, y...

Re-enrollment may be necessary for various reasons, including if the original enrollment failed or was never processed, if we changed our route for the payer, or if the provider office somehow changed the route. Additionally, there are other reasons...

Attaching files to a claim in Claim.MD Allowing Attachment Please note, not all payers or their claim submission trading partners support attachments. To search for payers that allow attachments, first click on this link to access the pa...

Occasionally, adding documents such as a Member/Insured ID Card, Payer Explanation of Benefits (EOB), or similar documentation to an existing support ticket is required. This step aids in verifying Payer ID Numbers, a standard part of our procedure,...

There are two main reasons why one might delete a provider profile: Data was entered incorrectly when initially adding the provider, such as entering the wrong NPI or Tax ID. These cannot be edited after being added originally.   The provid...

Support Ticket The most efficient way to receive support from Claim.MD is to open a support ticket within the web portal. Login to your Claim.MD account and open a ticket . PHI Requests All support requests that contain Protected Health Infor...

By default our system will identify a claim as an update to a previous record if all of these values match a previous claim: pcn prov_npi prov_id payer_order proc_code (charge line field, 2400) from_date (charge line field) charge...

To find the list of payers while logged into Claim.MD Click Provider Enrollment in the left navigation menu.  Click on a Provider from the list.  Enter the name of the Payer in the Payer Search  field at the top righ...

To initiate a Missing ERA Support Ticket, it is crucial to first confirm your ERA enrollment with the relevant payer. Once this is verified, follow these steps: Navigate to the Support Tickets page. Click on the New Tickets button. Select ...

In medical billing, a corrected claim is a resubmission of a healthcare claim with revised information to rectify errors in the original submission, ensuring accurate details for processing by the insurance payer.  The following are the step...

At times, claims may need to be voided due to errors or discrepancies in the submitted information. In medical billing, a voided claim refers to the cancellation or annulment of a previously submitted healthcare claim. Voiding a claim is done to e...

In medical billing, a corrected claim is a resubmission of a healthcare claim with revised information to rectify errors in the original submission, ensuring accurate details for processing by the insurance payer. Navigate to the View/Edit Claim ...

At times, claims may need to be voided due to errors or discrepancies in the submitted information. In medical billing, a voided claim refers to the cancellation or annulment of a previously submitted healthcare claim. Voiding a claim is done to e...

Move ERA for all payers to a new account If the goal is to move ERA for all payers to a new account: The provider should reach out to their billing company or the previous software provider. Instruct the provider/biller to delete the provide...

Question : How do I look at past claims? I submitted claims over 2 weeks ago and can no longer find them on my Manage Claims. Answer : You can go to the Search page and enter the Member ID Number or the Last Name and it will pull up all cla...

In certain cases, claims on ERA may be denied payment, but instead of appearing as a rejected claim in the Manage Claims page, they should be disregarded. This situation can occur when the denial is actually a reduction for multiple units of the sam...

Healthcare providers may need to make an appeal for a claim to payers for a variety of reasons. One common reason is when a claim is denied due to a coding error. This can happen when the provider has used an incorrect code for the procedure perform...

Question : How do I handle a cross-over claim? Answer : You would bill the Primary Payer first, then check the primary payer's EOB/ERA and verify that they have not already forwarded the claim to the secondary payer.   Question : What if I...

While it is strongly advised to maintain the default setting of "Transmit Approval Required" during the initial weeks of using Claim.MD, certain providers or entities may prefer to immediately send their claims to the payers without having to review...

IMPORTANT! Cancellation of accounts can only be completed by logging into the account and requesting the cancellation online. Cancellations are not accepted via phone or email. To cancel a Claim.MD account, follow these steps:   L...

Templates can be created and utilized in the View / Edit claim  screen to save time when entering repetitive provider data directly into the system.  Creating a Claim Template To create a new template, the first step is create a new bla...

Definition : PTAN (Provider Transaction Access Number) is a unique Medicare identifier required for provider enrollments and interactions with Medicare. Key Points : Usage : Cannot be included on claims but is essential for enrollments. Impo...