Sycle

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.

Please note that the email address you enter for a user will be used to send the initial verification email.

1. Review the access privileges available to them.
2. 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 form 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.

       Provider Validation Required

       Important: Provider validation calls are on demand. Claim.MD does not automatically initiate the call.

       • Provider validation is normally required when the first enrollment request is submitted for a provider.
       • If required, the provider data row displays a “Validation Required” alert.
       • To complete validation, start the enrollment workflow and click Call Now when prompted.
       • Until validation is complete, the provider may not be able to submit or receive transactions such as Claims, ERA, or Eligibility.

       For more information, see How Provider Validation Works.

       

     • ERA Delivery Options After Validation

       ERA Delivery Options After Validation

       • After completing validation for the first time, providers may see a prompt if another account already has active ERA enrollments for the same NPI/Tax ID. This allows providers to choose whether future ERA should route to the newly validated account.

       • If ERA is redirected, any existing provider records with active ERA enrollments will move to a Pending Validation status until validation is completed again on those records.

       • After completing validation, if another account has active ERA enrollments, you will will see this prompt:

       

     • 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.
    
    Provider Validation Required

    The provider validation step is completed on the payer enrollment page. If validation is required, the Provider Validation screen displays when a Quick Enroll or Enrollment Required button is pressed.

    

  • Auto-Enroll - Means the payer automatically returns their remittance summary to the sender 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 - Submit Claims Through Sycle

Sycle Private Practice connects with Claim.MD using SFTP and submits professional claims in the X12 837 claim format. Complete the following setup and submission procedures to begin sending claims from Sycle to Claim.MD.

Set Up the SFTP Connection

Before claims can be submitted from Sycle to Claim.MD, the SFTP connection must be configured. The setup can be completed by the Sycle Insurance Team or directly within the Claim.MD account.

Option 1: Allow Sycle to Complete the SFTP Setup

To allow the Sycle Insurance Team to complete the SFTP configuration, vendor access must first be granted in Claim.MD.

1. Sign in to the Claim.MD account.
2. Go to Settings > Vendor Settings.
3. Confirm that Sycle, LLC is listed as the vendor.
4. Set Vendor Access to Full Access.
5. Click Save Vendor Settings.

The Vendor Settings page should appear as shown below:

After access has been granted, notify the Sycle Insurance Team. The team will generate the SFTP credentials and enter the required information in the Sycle system.

Option 2: Complete the SFTP Setup Directly

A Claim.MD account must already be created before beginning this process. The Sycle Insurance Team will provide access to a secure ShareFile folder containing the spreadsheet required for the setup.

Two ShareFile emails should be received before continuing:

• An email providing access to the secure ShareFile system.
• An email providing access to the company-specific folder used for the SFTP setup.

1. Open the secure ShareFile folder and locate the spreadsheet titled ClaimMD SFTP PCxxxx.

   Sign in to ShareFile before attempting to open or download the spreadsheet.

2. In Claim.MD, go to Settings > Account Settings and locate the SFTP Settings section.

   Follow the Claim.MD SFTP setup instructions to activate SFTP and generate the required credentials.

3. After the SFTP settings have been configured, download the ClaimMD SFTP PCxxxx spreadsheet from ShareFile.

4. Enter the SFTP username and password from the Claim.MD SFTP settings into the appropriate fields in the spreadsheet.

5. Save the completed spreadsheet and upload it back to the same secure ShareFile folder.

6. Notify the Sycle Insurance Team that the completed spreadsheet has been uploaded.

The SFTP section of the Claim.MD Account Settings page should appear as shown below after setup:

After the completed credentials have been received, the Sycle Insurance Team will enter the username and password into Sycle and activate the connection between Sycle and Claim.MD. A notification will be sent when the connection is ready for a test claim.

Create and Submit Claims in Sycle

Claims should be created and submitted through the Sycle interface. For detailed instructions, review the Creating and Submitting the HCFA Form chapter of the Sycle Private Practice eClaims Guide.

The guide explains how to:

• Create an HCFA claim form.
• Review and complete the required claim information.
• Submit the claim electronically from Sycle.

Transmit Approval Setting

By default, claims received by Claim.MD must be approved by a user on the Manage Claims page before they are transmitted to the payer.

We recommend keeping this setting enabled for at least the first several claims submitted from Sycle. This allows your organization to review the transferred claim information and confirm that the SFTP connection is working correctly.

When claims no longer require review before transmission, an administrative user can disable this setting by going to Settings > Account Settings and clearing the Transmit Approval Required checkbox.

When this setting is disabled, claims that pass Claim.MD validation will be marked for transmission automatically.

Electronic Remittance Advice

Sycle Private Practice does not currently import Electronic Remittance Advice files from Claim.MD. ERA files must be viewed or downloaded directly from the Claim.MD portal.

Continue to View ERA for instructions on locating, reviewing, and downloading remittance information in Claim.MD.

Review Claim Status in Sycle

Use the HCFA Status Report in Sycle to review the status of claims submitted electronically.

For detailed instructions, review the Reports > HCFA Status Report chapter of the Sycle Private Practice eClaims Guide.

You may also review claims and their processing history directly in Claim.MD by going to the Manage Claims page.

Check Patient Eligibility

Sycle does not currently submit electronic eligibility inquiries to Claim.MD. Eligibility inquiries can instead be completed directly in the Claim.MD portal.

Continue to Eligibility for instructions on submitting and reviewing an eligibility inquiry in Claim.MD.