Managing Insurance Claims with Claim.MD

📍 Note: Claim.MD is Practice Better's only integrated clearinghouse partner. Without the integration, claims can be created in Practice Better but cannot be submitted or managed through the portal. 

In this article:

• Before You Begin
• Viewing Claims
• Understanding Claim Statuses
• Resyncing Claims
• Submitting Claims
  • Updating a Claim to Ready to Submit
  • Submitting a Single Claim
  • Submitting Multiple Claims at Once
  • Submitting Claims to Secondary Insurance
• Viewing and Tracking Claim Status and Reconciliation
• Recording External Payments
• Tracking Outstanding Client Payments
  • Invoicing Clients for Open Balances
  • Updating Client Responsibility
• Viewing ERAs
• Duplicating a Claim

Before You Begin

This article covers claim management for practitioners with an active Claim.MD integration.  

Learn more about Setting Up Your Claim.MD Integration →

For more details on creating claims, see Creating and Updating Insurance Claims → 

Viewing Claims

To view all claims in your practice, go to My Practice > Insurance Claims. This page lists all claims created for your clients.

📍 Note: The claims manager only displays claims owned by Claim.MD integrated practitioners. Admin users with the appropriate permissions can view and manage claims on behalf of practitioners.

Understanding Claim Statuses

Each claim in your claims manager displays a status. Here's what each status means and what action, if any, is required.

📍 Note: Practice Better uses "Denied" as a catch-all status when insurance pays $0, which includes deductible scenarios. Always check the ERA for the specific reason before taking action. 

Resyncing Claims

Claims sync automatically every 12 hours. To manually refresh your claims at any time:

1. Go to My Practice > Insurance Claims.
    
2. Open the More Options menu (3 dots) in the top right of the claims manager.
   
    
3. Select Update Claims.

📍 Note: Manual syncing is limited to once per hour.

Submitting Claims

When a claim is first created, its status is set to Draft. Once you've completed the required fields, update the status to Ready to submit before sending it to the payer.

Updating a Claim to Ready to Submit

1. Open the More Options menu (3 dots) to the right of the claim.
    
2. Select Update Status.
   
    
3. Choose Ready to submit from the dropdown.
   
    
4. Add any optional private notes and click the Update button.

Submitting a Single Claim

1. Open the More Options menu (3 dots) to the right of the claim with Ready to submit status.
    
2. Select Submit.
   

Submitting Multiple Claims at Once

1. Click the Select multiple button above your claims list.
   
    
2. Select the claims you want to submit.
    
3. Click the Submit claims button.
   

Submitting Claims to Secondary Insurance

If a client has secondary insurance coverage, you can include that information in the initial claim submission.

1. In the claim editor, check the box beside Include a secondary benefit plan. Additional fields will appear below.
   
    
2. If your client has multiple saved insurance policies in their Practice Better client record, select the appropriate one from the dropdown. The fields will auto-populate. Otherwise, enter the policy details manually.
   
    
3. Click Save Changes.

Viewing and Tracking Claim Status and Reconciliation

Go to My Practice > Insurance Claims to review claim status and track payment reconciliation. Filter your claims by date issued, practitioner, claim status, or client responsibility status using the options on the left-hand side.

To ensure claims are automatically transmitted within Claim.MD without requiring manual approval each time, log into your Claim.MD account and go to Settings > Account Settings. Confirm that Transmit Approval Required is disabled. This ensures valid claims are marked for transmission immediately and updated in Practice Better.

📍 Note: Configuring this setting is recommended during the initial Claim.MD setup. Setting Up Your Claim.MD Integration →

Recording External Payments

If you receive a payment outside of Claim.MD (such as a physical check), you can record it manually so your claim reflects the correct balance.

1. Open the More Options menu (3 dots) to the right of the claim.
    
2. Select Record External Payment.
   
    
3. Enter the payment amount in the pop-up and click Update.
   

⚠️ Important: Recording an external payment will overwrite existing and future ERA payments for this claim. This action is reversible. You can view ERAs in the claim details panel.

Tracking Outstanding Client Payments

For paid claims, the Client Responsibility column shows the remaining balance your client still owes after insurance has paid.

If a claim is Denied and the ERA is coded with a client responsibility amount, it will appear automatically in the Client Responsibility column.

If the denied ERA is not coded with a client responsibility amount, you can configure Practice Better to default to the full claim balance. Go to All Settings & Preferences > Insurance Billing and enable: For denied claims, default client responsibility to full claim balance unless ERA patient responsibility is available.

Invoicing Clients for Open Balances

Once there's an amount in the Client Responsibility column, you can generate an invoice directly from the claim.

📍 Note: Invoices are not automatically sent to clients. You'll need to send the invoice manually to notify your client of the balance owing.

1. Open the More Options menu (3 dots) to the right of the claim.
    
2. Select Create/Edit Invoice. The client's responsibility amount will auto-populate into the invoice.
   
    
3. Send the invoice to your client for payment, or process their card on file immediately.

📍 Note: Payment from the invoice won’t automatically update the client responsibility column for the claim. Once the invoice is paid, the client responsibility column can be manually updated.

Learn more about Processing Payments with Practice Better Payments →  

Updating Client Responsibility

Once your client has paid their balance, update the Client Responsibility amount in your claims manager. Updating client responsibility is independent from claim status; both can be updated separately.

1. Go to My Practice > Insurance Claims.
    
2. Open the More Options menu (3 dots) next to the relevant claim and select Update Client Responsibility.
   
    
3. Enter the new balance and click Update.
   

Viewing ERAs

After a claim is paid, you can view its ERA status and payment history directly in Practice Better.

1. Go to My Practice > Insurance Claims.
    
2. Click View next to the paid claim.
    
3. The claim details panel on the right will show the ERA status. Scroll down to view the full ERA history, including payment amounts, check numbers, payer name, service provider, and adjustments.

📍 Note: If ERA data isn't appearing for a paid claim, try clicking Update Claims from the More Options menu (3 dots) to refresh. If the data still isn't showing as expected, contact Practice Better support → with details of the steps you've already tried. You can also review the claim directly in Claim.MD to cross-reference available information.

Duplicating a Claim

The Duplicate option creates a copy of a claim with all original details pre-filled. You can access it from the More Options menu (3 dots) next to any claim. 

This is useful in several situations:

• Maintaining a paper trail: If you need to delete a submitted claim (for example, to switch submission methods), duplicating first keeps a record of the original.
• Resubmitting through a different channel: Duplicate the claim to submit it externally while keeping the original in Practice Better for record-keeping.
• Creating a corrected claim: Start from the original data and edit only what needs to change, rather than building a new claim from scratch.

📍 Note: Claims can be deleted at any time from the More Options menu (3 dots).