EZClaim

Welcome to Claim.MD! 
Please carefully follow each of the steps below on this Quick Start Guide.
If you need assistance, please open a Support Ticket with our support team.

• Step one - Adding Users
• Step two - Provider Enrollment
• Step three - Submitting Claims

Step one - Adding Users

Each individual that has access to Claim.MD, or that may need to speak with our support team, will need their own login credentials. 

From the left hand menu, click Manage Users.
Note, you must have administrative privileges to access the Manage Users menu.

1. First select a user type: 
   • Administrative users are able to control all access to the system, including adding/removing users and their privileges.
   • Standard Users can be limited to access specific areas of the system.
   • Eligibility Only users can only run benefits and eligibility and can be limited to a specific NPI.
   • Accounting/Invoices users can only see invoices from Claim MD as well as make payments or change the payment method for Claim.MD services.
2. Next click Add User.
3. You’ll need to complete at minimum the contact name and email address for a new user.
4. Review the access privileges available to them.
5. Once you click   Add New, we’ll send an email with a setup link to the email address given. The new user will need to follow that link to select a username and password.

Adding Users - More Information

For more detail on adding users, visit the Manage Users article. 

Step two - Provider Enrollment

Some payers will require enrollment before you can submit electronic claims. This segment will show you how to quickly complete these enrollment steps.

From the left hand menu, Click Provider Enrollment.

Add Providers

1. Each organization you bill for will need to be added to Claim.MD. If you do not see your organization’s information listed, click   Add Provider.
2. Enter your NPI and Tax ID.
   A-typical provider (those not required to have an NPI), can leave the NPI blank.
3. The provider information screen will be used to auto populate any upcoming enrollment paperwork. Once you’ve verified the information is accurate on this popup, save the provider record.

Enrollment for Claim Submission

Now lets review which payers require enrollment before submitting claims, and how to set up electronic payment notifications.

1. Click on the provider name to review enrollments specific for this provider.
   Common payers for your provider's state will be shown by default, but you can use the search box to look up any specific payer you will be billing to.
2. Review the claims column to determine if enrollment is required to submit to a given insurance.
   If submitting institutional or UB-04 claims, change the drop down menu above.
   • No Enrollment Required means you can begin sending electronic claims to this payer immediately.
   • Not Available means the payer does not support this type of claim. 
   • If Enrollment Required is shown, then additional steps will need to be completed before you can send electronic claims to this payer.
     
     
     • When clicking the   Enrollment Required button, you will either be prompted with instructions to complete enrollment steps through an external enrollment portal, or with the pre-populated paperwork that you need to complete.
       
       
     • When instructions are given, make sure you follow each step carefully. Once those steps are completed, click the Mark Completed button to finalize the enrollment request.
       
       
     • When paperwork is shown, carefully review the forms and pre-filled boxes. You may make adjustments to these forms before submitting. Some required fields may be highlighted for you to complete, for example a signature may be required.
       In most cases we are able to mail or fax these forms for you. If additional steps are required, these instructions may be shown after you submit the form.

Enrollment for ERA

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.

Enrollment for Eligibility

Finally, we’ll want to activate eligibility for any payers we want to check benefits and eligibility for. Use the Eligibility column to turn this option on.

Step three - Submitting Claims

Getting SFTP Credentials in Claim.MD

How to configure Multiple Providers for ERA in Claim.MD

• If you are receiving ERA directly in EZClaim, make sure to select 835 format in the Receive ERA/835 dropdown under Account Settings.
• If you are separating multiple providers into separate databases/folders, make sure to select Yes in the TaxID Sub-Folders dropdown under Account Settings.
  IMPORTANT

  This step only pertains to billers that want to receive ERAs into their providers' respective folders. Otherwise, this step can be skipped.
  

Configure the EZClaim ERA Settings

When configuring EZClaim, the SFTP setting for the DownloadDirectory field should include the Tax ID Number.  

• Example: /ReceiveFiles/999999999. Replace 999999999 with the provider tax ID that should be loaded into the currently selected provider database.
  

Configuring SFTP Connection: EZ Claim and Claim.MD Integration

After obtaining your SFTP login information from Claim.MD (see section above), follow the steps in this Claim MD EDI Connection Library Setup guide to connect the EZClaim software and transfer data easily directly from EZClaim to Claim.MD.

Claim MD Submitter/Receiver Library Setup

After setting up the SFTP connection (see section above), the Submitter/Receiver Library will have to be configured. Follow the steps in this Claim MD Submitter/Receiver Library Setup guide, so claims can be submitted from EZClaim.

Transmit Approval Setting

Please note, by default, all claims are set to be approved by a user on the Manage Claims page before being transmitted. We recommend keeping this setting enabled for at least the first several claim submissions to ensure accuracy of data after it has been directly entered, uploaded from a batch file, or transferred from another system (SFTP or API). 

However, if no final approval is needed before transmission, this feature can be disabled in Settings > Account Settings. Simply un-select the Transmit Approval Required checkbox. 

If this setting is disabled, valid claims will be marked for transmit immediately. 

Other Important Articles

Once the steps above have been completed, it is highly recommended to review the articles below to familiarize yourself with the functionalities and features of the rest of the Claim.MD software.

Articles for All Users

Provider Enrollment

Article to read: Provider Enrollment.

More detailed information on the provider enrollment process. 

Manage Claims

Article to Read: Manage Claims. 

Understand how to manage your claims that need your attention such as rejected claims (either from Claim.MD, third-party EDI, or payers), missing claim acknowledgements, missing ERA, and reminders. You can do this all on the Manage Claims page. 

Receive ERA

Article to Read: View ERA. 

If you are using Claim.MD for ERA, make sure your enrollment has been submitted with each payer. ERA enrollments generally process between 3 and 30 days. Contact the payer if you are not receiving your ERA by this time. The View ERA page is where you can view ERA transmissions from your payers.

Eligibility

Article to Read: Eligibility. 

Reporting

Article to Read: Reporting. 

Reporting allows you to view an overview of all past history. 

Search

Article to Read: Search. 

You may need to search for claims that have already been transmitted and are not on your Manage Claims page. You can do this in the Search page.  

View/Pay Invoices

Article to Read: View/Pay Invoices. 

This is where your organization will make payments and review service fees to Claim.MD.

Support Tickets

Article to Read: Support Tickets. 

You may need to contact support on an issue related to Claim.MD. There are convenient shortcuts to tickets from the claim form, and the View ERA page, and the Eligibility screen that will automatically attach your example to the ticket. You can also send a general or missing ERA ticket through the Support Tickets page.

Articles for Administrative Users

Article to Read: Manage Users. 

Articles to Read:

• Settings 
• My Settings
• Account Settings
• Account Information
• Claim Grouping