Claim.MD
Claim.MD is the comprehensive medical billing and claims management platform designed to accelerate revenue cycles and reduce denials. Integrated with AdvancedCare, it provides intelligent claim scrubbing, electronic submission to thousands of payers, and real-time claim tracking that ensures faster reimbursements and improved cash flow for your practice.
Smart Claim Scrubbing
AI-powered validation catches errors before submission, reducing denials by up to 40%
Faster Payments
Electronic submission and real-time tracking accelerate reimbursement timelines
Compliance Built-In
Automatic updates ensure compliance with changing regulations and payer requirements
Key Features
Intelligent Claims Processing
Claim.MD uses advanced algorithms to validate every claim before submission, checking for completeness, accuracy, and compliance with payer-specific requirements. The system automatically corrects common errors and flags issues that need attention, preventing costly denials. Electronic claim submission to over 5,000 payers ensures fast delivery and processing. Real-time eligibility verification confirms coverage before services are rendered. The platform supports all claim types including CMS-1500, UB-04, and electronic attachments, streamlining the entire submission workflow.
Comprehensive Denial Management
When denials occur, Claim.MD automatically categorizes them by reason code and routes them to the appropriate workflow. The system identifies patterns in denials to help prevent future issues. Automated appeals include the necessary documentation and follow payer-specific requirements. Claim tracking shows the status of every submission with detailed audit trails. Electronic remittance advice (ERA) is automatically posted, matching payments to claims and identifying variances. The platform provides actionable insights into denial trends, enabling proactive resolution.
Analytics & Revenue Optimization
Claim.MD delivers powerful analytics that provide visibility into every aspect of your revenue cycle. Dashboards track key metrics including days in A/R, first-pass acceptance rates, denial rates, and collection ratios. Payer performance analysis identifies which payers pay fastest and which require the most follow-up. Productivity reports show staff performance and workflow efficiency. The system identifies underpayments and suggests opportunities to maximize reimbursement. Customizable reports enable data-driven decision making to continuously improve revenue cycle performance.
Platform Capabilities
Electronic Claim Submission
Submit claims electronically to 5,000+ payers with automatic routing and delivery confirmation
Real-Time Eligibility
Verify patient insurance coverage and benefits instantly before services
Claim Scrubbing
AI-powered validation identifies and corrects errors before submission
ERA/EOB Processing
Automatic posting of electronic remittance advice with payment matching
Denial Analytics
Comprehensive reporting on denial patterns, root causes, and prevention strategies
Clearinghouse Network
Direct connections to major clearinghouses for reliable claim transmission