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🇺🇸 Eligibility Checks with Claim.MD

  1. Insurance Billing Additional Resources (US)
  2. 🇺🇸 Eligibility Checks with Claim.MD

    3. 7 min read
    Practice Plan Thrive Plan Legacy Plans

Jane’s clearinghouse integration got a big improvement: Eligibility Checks with Claim.MD is officially available! All US customers with insurance features can now connect their Claim.MD account with Jane to make real-time eligibility checks.

Not signed up with Claim.MD yet? Learn more about how to get started.

We’ve been making some updates to make insurance billing simpler. Check out what’s new and see how our Claim.MD integration can help you manage your entire revenue cycle in Jane.

Here’s what you’ll find in this guide:

Eligibility Enrollment

Before you can start making eligibility checks for a patient’s benefits, you’ll need to make sure that you’ve completed eligibility enrollment for your clinic within Claim.MD. This is required by most payers.

If individual providers at your clinic plan on making eligibility checks against their own NPIs instead of using the clinic’s, they will need to enroll for eligibility separately.

Payer enrollment is managed directly within your Claim.MD account under the Prov. Enrollment section. For more information, check out Claim. MD’s guide on enrollment


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Connecting Jane and Claim.MD for eligibility checks

Even if you’re already using Jane’s Integrated Claims with Claim.MD feature, you’ll need to create a new connection between Jane and Claim.MD in order to use Eligibility Checks.

To enable Eligibility Checks with Claim.MD, you’ll first need to head to your Claim.MD account and generate an API key. The API key will be used to establish a real-time connection between your Claim.MD and Jane accounts. You’ll find it in Settings > Account Settings.

Take note of your API key once it’s generated, as you’ll only be able to see it once. (If you forget your API key you can delete it and create a new one.) For more information on generating an API key in Claim.MD check out this quickstart guide.

Once you have your API key, log in to your Jane account and head to Settings > Integrations > Clearinghouse.

In the Claim.MD section, click Connect beside Eligibility & Benefit Verification.

Enter the API AccountKey from the previous step and click Connect once again.

You’re now all set to start doing eligibility checks right in your Jane account!


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Making an Eligibility Check

Once you’ve completed eligibility enrollment in your Claim.MD account and entered your API key in Jane, you’ll be able to initiate an eligibility check from a patient’s insurance policy in Jane. You can access insurance policies from a few different areas, including the patient profile (Patient Profile > Billing > Insurance Policies):

And the Insurance Info section of an appointment in the schedule:

After clicking View on the patient’s insurance policy, go ahead and click Check Eligibility.

After starting an eligibility check from an insurance policy, Jane will ask for a few pieces of information:

1. The type of services you’d like to check

  • The default service is “Health Benefit Plan Coverage”, which basically means that you’d like to check the patient’s general benefits, but you can also select a different service from the dropdown. Sometimes payers won’t send all benefit information when asking for “Health Benefit Plan Coverage”. So, for the best results we recommend that you use a more specific service code, especially if you aren’t having much luck with the default. You also have the option to make a check using a CPT code instead, but note that results will vary by insurer!

2. The provider of the services you’d like to include in the check

  • The default is to check eligibility against your location — this is likely your Type 2 NPI — but you can also check eligibility using a specific staff member. When you’re checking eligibility for a particular provider, remember to make sure they’ve completed eligibility enrollment in Claim.MD.

Once you’ve selected a service and provider, you can submit the eligibility check to the insurance company. Jane will make a real-time request to Claim.MD, and you’ll receive coverage information from the insurer within a few seconds.

When reviewing a patient’s eligibility information, you can easily find what you need using the filters at the top of the Coverage tab. You can filter by service type (i.e. Chiropractic), coverage scope (i.e. Individual), and provider network status (i.e. In-Network) to quickly find what’s most relevant to your practice!

You can also click on the Policy Details tab to see information pertaining to the patient’s insurance policy returned by the payer.


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Viewing Previous Eligibility Checks

If you ever need to see a previous eligibility check, you can do so by heading into the patient’s insurance policy (Patient Profile > Billing > Insurance Policies). Click View beside the eligibility check you’d like to see.


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FAQ

Where can I find a list payers supported for eligibility?

  • You can find that information on Claim.MD’s website here.

Can I make eligibility checks using a different clearinghouse?

  • No. Integrated eligibility checks are only available through the Claim.MD integration.

I’m receiving the benefit information I need, what should I do?

  • If you’re making checks with the “Health Benefit Plan Coverage” service code, we recommend trying a more specific service code! That said, electronic eligibility checks do have their limitations, so it’s possible that the payer will not send what you’re looking for even if you use a more specific service code. In these cases, it’s best to reach out to the insurer directly for more information.

If you have additional questions or feedback on the feature, please reach out to our support team at [email protected].