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đŸ‡ș🇾 Integrated Claims with Claim.MD [Beta]

  1. US Insurance Billing Additional Resources
  2. đŸ‡ș🇾 Integrated Claims with Claim.MD [Beta]

    3. 12 min read

Welcome to our guide on Jane’s Clearinghouse Integration.

🎉 Integrated Claims with Claim.MD is in beta and we’re so excited for you to try it:


How the beta works

What’s a beta?

A beta provides you access to a feature that is in development. You get early access to all the new functionality while providing us with feedback on anything that might not feel quite right for you. We love that we get to grow Jane alongside you, and betas are one of the best ways to do that.

How will this beta work?

With Integrated Claims, you can connect your Claim.MD account to do the following


  • [Available now] Submit claims (837)
  • [Available now] View claim acknowledgements and manage rejections (277)
  • [Available now] Receive insurer remittances (835)


all right inside your Jane account!

How can I give my feedback?

We’re so glad you asked! You can reach out to our team by email anytime at [email protected]. We’ll also reach out with a quick survey or two, and we may host a roundtable discussion for anyone interested in chatting with our team directly.

I’m in! When do I get started?

We hoped you’d say that. 😉 You can get started right now by connecting your Claim.MD account with Jane. Check out the rest of the guide for detailed set-up instructions.


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Signing up for a Claim.MD account

If you don’t have a Claim.MD account and you’d like to learn more or sign up, head over to Claim.MD’s website.


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How to connect Claim.MD with Jane

In your Claim.MD account

Before connecting your Claim.MD account with Jane, you’ll need to log in to Claim.MD and adjust a couple of settings. Choose Settings from the list on the left and then click the Account Settings tab at the top of the page.

Start by setting the SFTP Active field to Yes.

‌ While on this screen, note down your SFTP Username and Password. The password is only visible once in Claim.MD, so be sure to note down your password before leaving this page.

Next, make sure that the Claim Status Format is set to 277, and Receive ERA/835 is set to 835. These settings will ensure that Claim.MD automatically sends claim acknowledgements (like Rejections) and ERAs to your Jane account.


In your Jane account

Now that you have your Claim.MD SFTP username and password, you can connect your Claim.MD account with Jane in Settings > Integrations > Clearinghouse.

Next, enter your Claim.MD SFTP username and SFTP password — the username and password that you noted down when enabling SFTP in your Claim.MD account.

Note that your SFTP login credentials are different than the username and password you use to login to your Claim.MD account.

And that’s all! You’re ready to start billing through Integrated Claims with Claim.MD!


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Submitting Claims

If you’ve been submitting claims electronically through Jane, this will feel pretty familiar (minus a few steps 😉).

After selecting a batch of claims, simply click the Submit button in the submission preview. When you press this button, Jane will generate a batch submission and automatically send it to your Claim.MD account.

Note that Jane doesn’t send claims to Claim.MD instantly.Your claims will be sent to Claim.MD a few hours after generating a submission (usually within the hour). So if you check your Claim.MD account right after submitting from Jane, you won’t see those claims in Claim.MD.

Once you’ve submitted your claims, they’ll sit in the Submitted folder awaiting claim acknowledgements from Claim.MD and insurance companies.

Pro Tip: Before you start submitting claims through the integration, it’s a good idea to check your Claim.MD Account settings one more time. Make sure that Transmit Approval Required is turned off. If it’s on, you’ll have to log in to Claim.MD to approve all claims submitted through the integration.


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Claim acknowledgements and managing rejections

Let’s start with what claim acknowledgements are, and why they’re important in the billing process.

Clearinghouses and insurers send claim acknowledgements to let you know they have received your claims. A claim acknowledgment confirms whether a claim has made it through to the next billing ‘stage’ (i.e. adjudication by the payer), or if you need to fix your claim and resubmit (i.e. a rejection for invalid information).

In Jane, claim acknowledgements are displayed in the Claim Summary panel, which can be accessed when viewing a claim in your claim submission folders.

If a claim gets rejected by Claim.MD or the insurance company, Jane will automatically move it to the Rejected folder.

From there, you can view the rejection reason in the claim summary panel. You can click the toggle to see the detailed rejection reason.

Once you address the rejection reason, you can mark the claim as unsubmitted in Jane, and resubmit it through the integration.


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Receiving insurer remittances

Jane checks for new electronic remittances (835) in your Claim.MD account every few hours.

When you’ve been sent a new ERA, Claim.MD will automatically upload it to your Jane account so you can post the payment. If you’re new to posting ERA payments in Jane, check out this handy guide.

The ‘count’ next to your Remittances folder (Billing > Remittances) keeps track of all ERAs that need your attention. When that count begins to climb, you’ll know you’re receiving new ERAs through the integration!


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FAQs

▶ Will Jane upload ERAs that were uploaded to my Claim.MD before I set up my integration?
    When you connect your Claim.MD account with Jane, Claim.MD will automatically send all new remits to your Jane account. That said, any remittance that you received before you set up your integration will not be sent to your Jane account.

    If you have any old remittances in Claim.MD that aren't in Jane yet, head to the View ERA section of Claim.MD, select those old ERAs, and select the Send to SFTP Server option.

    Claim.md interface
    Don't worry if you accidentally select an ERA that's already in your Jane account. Jane will catch and ignore any duplicates!


▶ How often does Jane check for new electronic remittances (835)? How long does it take Jane to send Claims to Claim.MD?
    Jane checks for new electronic remittances (835) in your Claim.MD account every few hours.

    That means that you could see a new remittance within your Claim.MD account that hasn’t yet been uploaded to Jane. But if that happens, there’s no need to worry! Jane will upload that remittance in the next few hours.

    And same thing for claims. Once you submit a batch of claims, Jane will upload them to Claim.MD within the next couple hours.


▶ How can I tell if an ERA in my Claim.MD account has been uploaded to Jane?
    If you’re unsure if an ERA has been uploaded to Jane, you can head to the View ERA section of your Claim.MD account and look for the STFP Download icon. If you see the icon (shown in the screenshot below), that means the ERA has already been uploaded to your Jane account.


▶ Why are you calling this Integrated Claims?
    In the past, we’ve talked about building Jane’s Clearinghouse Integration, and this feature is the first version of that. We chose to call it Integrated Claims because there are some key features of your clearinghouse that you won’t have access to in Jane (yet!).

    This first iteration allows you to manage your day-to-day billing without leaving Jane. You’ll still need to head to Claim.MD to do your eligibility checks and pre-authorizations, and access some of your billing reports. Our vision for the future of Jane’s Clearinghouse Integration is to help you manage all aspects of your billing in Jane.


▶ Why did you integrate with Claim.MD?
    We chose to integrate with Claim.MD for a few reasons


    #1: Our community loves billing with Jane and Claim.MD. Jane users who switched to Claim.MD have told us:

    • It provides a smoother and more likely-to-succeed billing process than their previous clearinghouse
    • Claim.MD is intuitive and easy to navigate

    #2: Claim.MD has helper-first values that align with ours:


    #3: Working with Claim.MD allows us to build a better integration, faster:

    • They have resources that allow us to build our own integration, which creates a more intuitive, cohesive billing experience for Jane users


▶ Will you be integrating with Office Ally, Availity, and/or TriZetto?
    Our honest answer is that we’re not sure yet. If we hear that having choice in clearinghouse is the most important thing for our community, we’ll look at building more integrations. The more integrations we build, though, the longer it will take for us to add more value to the insurance billing experience (things like eligibility checks and pre-authorizations).

    If most of you are loving our Claim.MD integration, we can start working on adding more value right away! So please don’t hesitate to get in touch with your feedback; we want to make sure we’re working on features that will be the most helpful to you in your practice.


▶ I’m not using Claim.MD right now. Should I switch?
    We think so! For all the reasons listed above, we believe Claim.MD is a great choice for Jane users. You will need to be using Claim.MD in order to enjoy our Integrated Claims feature, so if that’s something that will make your billing a lot easier (and we think it will 😉), it’s worth making the switch.


▶ Can I connect multiple Claim.MD accounts to Jane? What about a Claim.MD account used by multiple clinics?
    You can only connect one Claim.MD account with Jane at this time.

    Similarly, you should connect a Claim.MD account that houses only your clinic's claims because you will receive all the ERAs from the Claim.MD account to your Jane account.

    If either of those cause friction for you, we’d love to hear more about what might work better for your practice!
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