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🇺🇸 Eligibility Checks with Claim.MD [Beta]

  1. US Insurance Billing Additional Resources
  2. 🇺🇸 Eligibility Checks with Claim.MD [Beta]

    3. 6 min read
    Practice Plan Thrive Plan Legacy Plans

Jane’s clearinghouse integration is getting even better: Eligibility Checks with Claim.MD is officially available to Beta test! All US customers with insurance features can choose to join the Beta by connecting their Claim.MD account with Jane to make real-time eligibility checks.

If you’re not already submitting claims, viewing responses, & receiving ERAs right within your Jane account, but you’d like to be, check out our guide on Integrated Claims with Claim.MD.

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

Signing up for a Claim.MD account

If you’re not already using Claim.MD as your clearinghouse, you’ll need to sign up for Claim.MD before you get going with Eligibility Checks in Jane.

You can book a demo with the Claim.MD team to walk through any questions you might have before signing up. If you’re keen to get going, there’s also the option to sign up right away on your own (click here to get started).

🤑 Make sure you indicate Jane is a vendor to receive your 10% discount on the monthly subscription cost!


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Eligibility Enrollment

Before you start making eligibility checks, make sure that you’ve completed eligibility enrollment within Claim.MD. Note that most payers require enrolment for eligibility checks.

If individual providers at your clinic plan on making checks against their own NPIs, they will need to be individually enrolled for eligibility. Payer enrollment is managed directly within your Claim.MD account under the Prov. Enrollment section. You can check out this guide for more information on Claim.MD’s enrollment workflow.


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Connecting Jane and Claim.MD

Even if you’re 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 guide.

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


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Making an Eligibility Check

Once you’ve completed eligibility enrollment in your Claim.MD account & 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 of Jane, including the patient profile (Patient Profile > Billing > Insurance Policies) and the schedule (via the Insurance Info section).

After starting an eligibility check from an insurance policy, you’ll need to let Jane know a couple of things before actually making the check:

  1. The type of services you’d like to check
    1. The default service is “Health Benefit Plan Coverage”, which basically means check all possible benefits, but you can also select a different service from the dropdown or make a check using a CPT code.
  2. The provider of the services you’d like to include in the check (your clinic/location or a particular practitioner at your clinic)
    1. The default is to check eligibility against your default location (likely your Type 2 NPI), but you can also check eligibility using a particular staff member. If you select a particular staff member, remember to make sure they’ve completed eligibility enrollment in Claim.MD!

Once you’ve selected a service and provider, you can go ahead and submit the check to the insurance company! At this point Jane makes a real-time request to Claim.MD, and you’ll receive coverage information from the insurer within a few seconds.

Jane will show the eligibility coverage results by default, but 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

Jane saves eligibility check history for all of your patients, so you can always go back into a patient’s insurance policy to view previous checks!


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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.

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