Set up insurance

Open Insurance > Setup to connect Claim.MD or Stedi. These steps apply to workspaces with Insurance enabled. Insurance appears in the Apps group in the sidebar.

Insurance navigation:

• Overview, Eligibility, Claims, Remittances, Authorizations, Ledger, Reports, Imported claims, Setup
• Usage billing for workspace owners and administrators

Select Production, Test environment, or Legacy results before you enter patient or account information.

Before you start

You need a Claim.MD account key or a Stedi API key, plus each provider’s billing name, NPI, Tax ID, taxonomy code, and billing address. Ask your workspace owner or an administrator to complete connection and enrollment setup.

Workspace owners and administrators can submit claims, upload claim documents, and reconcile payments. Staff and editors can check coverage, prepare claims, and manage authorizations and estimates.

Connect Claim.MD or Stedi

1. Select Production or Test environment in the Insurance navigation.
2. Select Add connection.
3. Choose Clearinghouse: Claim.MD or Stedi.
4. For Stedi, select Enabled Stedi features: Eligibility checks, Claim submission, Claim status and history, Remittance syncing and history, Provider directory import, Payer enrollment syncing and history, and Batch eligibility history. Batch eligibility history is available for production connections.
5. Choose Environment: Production or Test account.
6. Enter the Claim.MD account key or Stedi API key.
7. For a test connection, confirm the synthetic-record statement for that clearinghouse.
8. Enable Enable external transaction writes when your workspace is ready to send requests through that connection.
9. Select Save connection.

The connection appears under Clearinghouse connections, with its status, external-write setting, last poll time, and import summary. Saving a connection does not confirm a payer enrollment or a successful transaction.

To replace a key, select Manage connection, enter the new key, and select Save connection. Leave the key blank to retain the stored key. Clear Enable external transaction writes to pause new external writes.

From the connection menu, select Refresh payer directory. When history import is available, select Import Claim.MD history or Import Stedi history.

Add a billing provider

1. Select Add provider.
2. Select the Rendering provider and Connection.
3. Enter the provider’s NPI, Tax ID, taxonomy code, billing name, and billing address.
4. Select Save provider.

The provider appears under Billing providers. Use Edit to correct the billing identity. Saving the provider profile does not establish participation with each payer.

Complete payer enrollment

Hosted enrollment (Start payer enrollment and Continue enrollment) is available for Claim.MD connections.

1. Select Refresh payer directory for the connection.
2. Under Start payer enrollment, select the provider, enter the Claim.MD payer ID, and choose Eligibility, Claims, or Electronic remittance.
3. Select Start enrollment.
4. If Continue enrollment appears, open it and complete the payer’s hosted enrollment process.
5. After verifying the payer’s response, select Record verification on the payer entry. Record the verified status, payer reference, source, and verification date. Confirm the statement and select Save verification.

For Stedi, import enrollment history from the connection, then use Record verification on the payer entry. Repeat for each required payer and transaction. An eligibility enrollment does not establish claims or electronic remittance enrollment.

Automatic review

On a billing provider, Automatic review reviews claims, eligibility, and remittances. It moves imported claims into the workspace when patient, policy, provider, encounter, and service matches are confirmed, and it matches remittances. Uncertain items stay for review.

Turn automatic review on for that provider. Select Run AI review to queue a review immediately.

Check setup problems

Next, check eligibility and prepare visits.