Claim MD is a subscription-based clearinghouse, one of the five Kalix directly integrates via SFTP for batch claim processing.
By using the Kalix-Claim MD integration, you can submit claims to Claim MD from within Kalix with a click of a button. You can receive back claim status updates, remittance advice, payment information, adjustments, and patient responsibility amounts without ever leaving Kalix.
The Kalix - Claim integration currently supports:
Professional Claims (837P)
Claim Status (276/277)
Claim Payment/Advice - Remittance (835)
Payer List
Claim MD does not have a free subscription (see pricing below). Hence, there are no participating or non-participating insurers. We still recommend you take a look at their payer list to see if they support the insurers you bill to.
Below is an example screenshot from Claim MD's payer list. The services you need Claim MD to support are 1500 and ERA (electronic remittance advice).
Click on the More Info button to view additional details.
The 1500 and ERA (electronic remittance advice) are used as part of the integration. Claim MD will also list whether ERA enrolment is required.
Claim MD's payer list is also built into Kalix.
Cost
To use the Kalix-Claim MD integration, you need a Claim MD account. Claim MD has a subscription model, and subscription costs range from $25 to $100 a month.
Setting up Claim MD
This article will specifically explain how to set up your Claim MD account and connect it to Kalix for claim submission via our integration. The process is broken down into five stages:
Stage 4: Set up your Claim MD Settings
Stage 1: Create a Claim MD Account & Register Your Business
To use the integration, you are required to create a Claim MD account for your practice.
If you already have a Claim MD account, you can go ahead and skip to Step 3.
1) Please use the button below to commence this process:
Claim MD recommends scheduling a demo before creating an account. To schedule a time, please click here. They offer group and one-on-one sessions.
2) Follow the wizard to create your account and verify your email address.
3) Sign their agreements and then pay the subscription cost.
4) Once your account is created, you can set up your users. Click here to learn more
5) Also set up your billing provider details by clicking Prov. Enrolment
If you bill using a group NPI number, you only need to complete enrollment once for the entire group rather than for each individual NPI number.
For step-by-step instructions, please click on the button below:
Stage 2: Enrollment
Some insurance companies require pre-enrollment forms to be completed before Claim MD can submit electronic claims on your behalf.
Electronic remittance advice enrollment may need to be completed to automatically receive payment information (ERA/835) in your Kalix account against each associated bill.
Claim MD also has enrollment for eligibility checking. This can be completed, but please note that the eligibility check needs to be completed within the Claim MD portal. Kalix does not currently have eligibility-checking functionality.
If you bill using a group NPI number, you only need to complete enrollment once for the entire group rather than for each individual NPI number.
1) Navigate to the Provid. Enrolments.
2) Click on the provider name to review enrollments specific to this provider.
By default, you can view the common payers for your provider's state. However, you can use the search box to look up any specific payer you will be billing for. If you're using a group NPI number, you only need to complete the enrolment process once for the entire group rather than for each individual NPI number.
3) Review the claims column to determine if enrollment is required to submit to a given insurance.
No Enrollment is 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, you must complete additional steps before sending electronic claims to this payer.
3) When clicking the Enrollment Required button, you will be prompted with instructions to complete enrollment steps through an external enrollment portal or with the pre-populated paperwork you need to complete.
When instructions are given, follow each step carefully. Once you have completed those steps, click the Mark Completed button to finalize the enrollment request.
Enrollment for ERA
Electronic remittance advice enrollment forms may need to be completed to automatically receive payment information (ERA/835) in your Kalix account against each associated bill.
Note: This is a separate process from pre-enrollment.
By completing this step, you will not need to go to Claim MD or insurance company portals (unless you want to) to check claim statuses and payment information. Everything will be visible in Kalix.
1) On the Provider Enrollment page in Claim MD, you can see the type of ERA enrollment required under the ERA column. The options are listed below:
Quick Enroll—This means we can submit an online enrollment request with a click of a button. There is no additional paperwork or steps.
Auto-Enroll—This means the payer automatically returns their remittance summary at the end of the claim. No action is required.
Enrollment Required for ERA - Additional work is required for enrolment. Claim MD will either have instructions for enrolling online with the payer or pre-filled forms that must be submitted.
Not Available - Unfortunately, ERA is not supported for that insurer via Claim MD.
Please Note: ERA can only be returned to one clearinghouse. When you enroll for ERAs, all electronic remittances for the selected NPI/Tax ID will be rerouted to Claim.MD, regardless of where the claims were originally submitted.
Stage 3: Obtain SFTP Credentials from Claim.MD
To securely transfer files between Kalix and Claim.MD, you'll need to setup your account's SFTP credentials.
SFTP credentials are the authentication details required to establish a secure connection between two platforms using the Secure File Transfer Protocol (SFTP). These credentials ensure that only authorized users can access and transfer files over the encrypted SFTP connection.
1) Still in Claim.MD, navigate to the Account Settings tab under Settings. Scroll down to the SFTP Settings section.
2) You need to make sure the 'SFTP Active' option is set to 'yes'.
3) Next, take note of the following details:
Account Number
SFTP Username
SFTP Password
Their locations are shown in the screenshot below:
Keep these credentials handy; you'll need them to set up the integration in Kalix.
Stage 4: Connect Your Claim MD SFTP Account to Kalix
Now, let's connect Kalix to Claim.MD.
1) First, open your Kalix account and navigate to the Integrations tab on the Account Settings page. Account Settings is located under Settings (your practice name) on the top menu bar.
Settings (your practice name) -> Account Settings -> Integrations.
2) Scroll down to the Insurance Clearinghouses section. You will want to 'Enable' the Claim.MD option by turning on the switch.
3) Now enter your account number that you copied from Stage 4.
4) Now click Continue.
5) Back on the main page of Kalix, select the Connect button (as shown below).
6) A new pop-up window will appear. Enter the SFTP Account username and password (which you copied in Stage 4. This is not your regular Claim.MD username and password).
7) Click Connect to establish the integration.
Stage 4: Set up your Claim MD Settings
Back in Claim.MD on the Account settings page you also want to make sure the settings match the circled items in my screenshot below:
