Theralytics Quick Start Guide for Claim.MD
Purpose: Explains how to set up Claim.MD for use with Theralytics, including users, provider enrollment, SFTP claim submission, ERA/EDI enrollment, and eligibility setup.
Welcome to Claim.MD! Please carefully follow each of the steps below to set up your Claim.MD account for use with Theralytics.
If you need assistance with Claim.MD, please open a Support Ticket with our support team. If you need assistance with your Theralytics setup, contact the Theralytics onboarding team at onboarding-team@theralytics.net.
Step One - Adding Users
Each individual who has access to Claim.MD, or who may need to speak with the Claim.MD support team, will need their own login credentials.
From the left-hand menu, click Manage Users.
- First, select a user type:
- Administrative Users can control all access to the system, including adding or removing users and managing privileges.
- Standard Users can be limited to specific areas of the system.
- Eligibility Only users can only run benefits and eligibility checks and can be limited to a specific NPI.
- Accounting/Invoices users can only view invoices from Claim.MD, make payments, or change the payment method for Claim.MD services.
- Click Add User.
- At minimum, complete the contact name and email address for the new user.
- Review the access privileges available to the user.
- Once you click Add New, Claim.MD will send an email with a setup link to the email address provided. 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 require enrollment before electronic claims, ERA, or eligibility transactions can be used. This section explains how to complete enrollment in Claim.MD and includes Theralytics-specific setup reminders.
From the left-hand menu, click Provider Enrollment.
Add Providers
- 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.
- Enter the provider’s NPI and Tax ID.
- The provider information screen will be used to auto-populate future enrollment paperwork. Review the information carefully, make sure it is accurate, and save the provider record.
Enrollment for Claim Submission
- Click the provider name to review enrollments specific to that provider. Common payers for the 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.
- Review the Claimscolumn to determine whether enrollment is required for each payer.
- No Enrollment Required means you can begin sending electronic claims to this payer once your Theralytics SFTP setup is complete.
- Not Available means the payer does not support that type of claim.
- Enrollment Required means additional steps must be completed before electronic claims can be sent to that payer. When you click Enrollment Required, Claim.MD will either display instructions to complete enrollment through an external enrollment portal or provide pre-filled paperwork that must be completed.
When instructions are provided, follow each step carefully. Once those steps are completed, click Mark Completed to finalize the enrollment request.
When paperwork is shown, carefully review the forms and pre-filled fields. Some fields may be highlighted for completion, such as a required signature. In many cases, Claim.MD can mail or fax the forms for you. If additional steps are required, those instructions may be shown after the form is submitted.
- Provider validation is normally required when the first enrollment request is submitted for a provider.
- If validation is 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.
Step Three - Set Up SFTP for Theralytics Claim Submission
Theralytics submits claims to Claim.MD through SFTP. The SFTP account information is configured and tested by Theralytics from the back end. Providers do not need to manually enter Claim.MD SFTP settings inside Theralytics.
Theralytics provides the SFTP setup information in the provider’s Initial Onboarding Document, along with additional steps for enrolling with Claim.MD.
Set Up SFTP
- Once your Claim.MD account is created, review the instructions for registering your SFTP account.
- After completing the SFTP setup, send your SFTP credentials to the Theralytics onboarding team at onboarding-team@theralytics.net.
Claim Submission Workflow
After payer enrollments are completed, provider information is confirmed, and SFTP credentials are sent to Theralytics, Theralytics will test the connection and use the SFTP setup to transmit claims to Claim.MD.
Step Four - ERA and EDI Enrollment
ERA, or Electronic Remittance Advice, is how payers send an electronic summary of what was paid on submitted claims. If Theralytics will be used for payment posting or ERA review, ERA enrollment must be completed for each applicable payer.
From the provider enrollment page in Claim.MD, review the ERA column for each payer.
| ERA Status | Meaning |
|---|---|
| Quick Enroll | Claim.MD can submit an online enrollment request with no additional paperwork or steps. |
| Auto-Enroll | The payer automatically returns the remittance summary to the sender of the claim. |
| Enrollment Required | Claim.MD will either display instructions for enrolling online with the payer or provide pre-filled forms that need to be completed and submitted. |
Theralytics ERA/EDI Enrollment Instructions
Theralytics provides a video with detailed instructions for enrolling in ERA and/or EDI for each payer. Providers should follow the Theralytics ERA/EDI enrollment instructions in addition to completing the required enrollment steps in Claim.MD.
If a payer requires additional forms, external portal steps, or payer-specific approval, those steps must be completed before ERA files can be delivered and used in Theralytics.
ERA Delivery via SFTP
ERA delivery for Theralytics is handled through the SFTP setup coordinated during onboarding. Providers do not need to manually enter Claim.MD ERA SFTP information inside Theralytics. Theralytics configures and tests the connection from the back end after receiving the provider’s SFTP credentials.
Step Five - Eligibility Enrollment
Eligibility allows you to check patient benefits and coverage information electronically. Use the Eligibility column on the Provider Enrollment page to activate eligibility for any payers you want to check benefits for.
If enrollment is required, follow the payer-specific instructions shown in Claim.MD.
Transmit Approval Setting
By default, claims in Claim.MD are set to require user approval on the Manage Claims page before being transmitted. Claim.MD recommends keeping this setting enabled for at least the first several claim submissions so the provider can confirm the data is accurate after it has been transferred from Theralytics.
If no final approval is needed before transmission, this feature can be disabled in Settings > Account Settings by clearing the Transmit Approval Required checkbox.
If this setting is disabled, valid claims will be marked for transmit immediately.
Other Important Articles
After the steps above have been completed, it is highly recommended that users review the following Claim.MD articles to become familiar with the rest of the system.
| Article | Why to Review It |
|---|---|
| Provider Enrollment | More detailed information about adding providers and completing payer enrollment. |
| Manage Claims | Manage claims that need attention, including rejected claims, missing acknowledgements, missing ERA, and reminders. |
| View ERA | View ERA transmissions from your payers. ERA enrollments generally process within 3 to 30 days. |
| Eligibility | Check patient benefits and eligibility electronically. |
| Reporting | View an overview of past activity. |
| Search | Find claims that have already been transmitted and are no longer on the Manage Claims page. |
| View/Pay Invoices | Make payments and review Claim.MD service fees. |
| Support Tickets | Contact Claim.MD support and attach examples from claims, ERA, eligibility, or general support workflows. |