Claim.MD Clearinghouse Integration
A healthcare platform needed its billing workflow connected directly to payers for eligibility checks and claims submission, instead of relying on manual, disconnected claims handling outside the product. We integrated the platform with Claim.MD to make that connection standards-based and reliable.
The Challenge
Manual eligibility verification and claims submission are slow and error-prone, and when they happen outside the core platform, they disconnect billing from the rest of the clinical and operational data the team already has. That disconnect creates friction for billing staff and delays visibility into where a claim actually stands — whether it's still pending, denied, or paid.
The Solution
We integrated the platform with Claim.MD as its clearinghouse, using standards-based EDI transactions — 270/271 for eligibility verification and 837 for claims submission — to connect billing workflows directly to payers. Claim and eligibility status is surfaced back into the platform alongside the rest of the patient's clinical and operational data, so billing teams aren't working out of a separate system to see where things stand.
Key Capabilities
- Standards-based EDI integration (270/271 eligibility, 837 claims) through Claim.MD
- Real-time eligibility verification directly within the platform's existing workflow
- Automated claims submission to payers through the clearinghouse
- Claim and eligibility status visible alongside clinical and operational data in one place
Business Impact
- Reduced manual claims handling and the errors that come with it
- Gave billing teams faster, direct visibility into eligibility and claim status
- Connected revenue-cycle workflow directly into the platform instead of a separate standalone system
Have a similar project in mind?
Tell us what you're building. A senior healthcare technologist — not a salesperson — will get back to you within one business day.