====== SharpRCM with Healthie ====== If your practice runs on Healthie, ClaimRev connects to it directly. You can submit the claims you build in Healthie, check eligibility straight from your appointment schedule, and have payments posted back onto your claims in Healthie automatically. This guide covers the Healthie screens in ClaimRev. For the rest of SharpRCM, see [[guides:sharp-rcm|SharpRCM: Billing and Practice Management]]. ---- ===== Connecting Your Healthie Account ===== The connection is set up once on the **Healthie setup** screen, using API credentials from your Healthie account. Your ClaimRev account team will walk you through this during onboarding. The same screen holds the options that control how claims and appointments are handled. These are covered at the bottom of this page. ---- ===== Bringing Your Healthie Data Across ===== So that claims are built from the same codes and people you use in Healthie, you can import: * **Providers** and **facilities**, brought over in bulk * **CPT codes** and **diagnosis codes**, searched in Healthie and imported as you need them * **Patients**, brought over individually * **Appointments**, either to review or to turn into encounters You normally do the bulk imports once at onboarding, then pull in individual records as new providers, codes, or patients appear. ---- ===== Submitting Claims from Healthie ===== If you build your CMS-1500 claims in Healthie, ClaimRev takes them from there. - Open the **Healthie claims** screen. It lists the CMS-1500 claims available in your Healthie account. - Select the claims you want to submit. You can pick a single claim or a batch. - Submit. ClaimRev converts each claim into a compliant 837 and sends it to the payer. There is no separate export step and no file to hand off. Once submitted, the claim is tracked in [[guides:claim-search|Claim Search]] like any other, and anything needing attention appears on your [[guides:work-board|Work Board]]. If a claim will not convert, ClaimRev tells you what is missing so it can be corrected in Healthie and resubmitted. ---- ===== Eligibility from Your Appointment Schedule ===== Rather than checking coverage claim by claim after the fact, you can run eligibility directly against your Healthie appointments. * Search your upcoming appointments and run eligibility on them * Add a payer to a patient straight from an appointment when coverage is found * Choose which appointment types are included by default, so routine visits are checked without anyone remembering to This is the difference between finding a coverage problem **before the visit** and finding it after the claim comes back denied. Eligibility requests draw from your monthly eligibility package. See your pricing sheet for package sizes. ---- ===== Posting Payments Back to Healthie ===== When a payer's 835 comes back, ClaimRev can write the payment onto the claim in Healthie itself, so your team does not key it in twice. ==== What gets written ==== * Amount reimbursed * Total adjustments * Payment received date * Payment status * Optionally, the full adjustment and remark code detail as notes on the claim ==== How the status is decided ==== The status comes from the payer's own adjustment reason codes, not a guess: ^ Status ^ When ^ | **Fully Paid** | The payer paid and left no patient responsibility | | **Partially Paid** | The payer paid and left some patient responsibility | | **Denied by Insurance** | The payer denied it, or paid nothing with no patient responsibility | ==== Posting ==== Nothing posts on its own. On the **payment advice** screen you review the matched payments, then post: * A single claim * A batch you have selected * Everything matching your current search Before writing anything, ClaimRev confirms the claim still exists in Healthie. Anything that cannot be posted is flagged with the reason rather than skipped quietly, and posted items are marked as worked so they are not handled twice. ---- ===== Options You Can Set ===== These are configured on the Healthie setup screen. Your account team will usually set them during onboarding, but it is worth knowing what they do. ^ Option ^ What it does ^ | Use actual appointment duration | Service units are calculated from the real length of the appointment rather than the scheduled length | | Fix missing pointers | Repairs missing diagnosis pointers on a claim rather than failing it | | Override claim filing indicator | Sets the filing indicator, useful when Healthie's value does not match what the payer expects | | Override insurance type code | Same, for the insurance type code | | Save additional text on posting | Writes the full adjustment and remark detail onto the claim when a payment is posted | | Auto-create claim from encounter | An imported appointment becomes a claim automatically | | Roll over appointment on import | Carries encounters forward for recurring appointments | | Default eligibility appointment types | Which appointment types are picked up automatically for eligibility | ---- ===== Getting Help ===== If a claim does not appear in Healthie, a payment has not posted, or an appointment looks wrong, contact support with the claim or appointment and we can trace exactly what was sent and what came back. //Contact ClaimRev support at [[mailto:help@claimrev.com|help@claimrev.com]] or call 918-842-9564.//