This article explains how pharmacists create and submit a medical claim in MedMe. It covers the three places a claim can be started, how claim templates prefill the codes for a service, saving a draft, submitting for billing, and the 24-hour window to undo a submission.
Table of Contents
Overview
A claim in MedMe is a professional medical claim (CMS-1500 / 837P format) sent to the patient's medical insurer through MedMe. Pharmacists create the claim after the encounter is documented, review the prefilled codes, and submit it.
Before You Start
The pharmacy's EDI enrolment with the patient's payer must be complete. See Medical Billing 101: What to Know Before Submitting Claims in MedMe.
The patient must have at least one active medical insurance on the profile. See How to Add and Manage a Patient's Insurance in MedMe.
Complete the encounter documentation for the appointment first. The claim is linked to the appointment, and the documentation supports the codes billed.
Know who administered the service; the Rendering Provider (the pharmacist's name and NPI) should be added to every claim.
Check that the patient's profile has a sex, date of birth, and complete address. A claim cannot be submitted without them.
Warning: Do not submit claims to a payer until the MedMe RCM team confirms that the pharmacy's EDI enrolment with that payer is complete. Claims sent to a payer without a completed enrolment are rejected.
Tip: Verifying insurance eligibility before the visit prevents most rejections. See How to Check Insurance Eligibility in MedMe.
Step 1: Open the Create Claim Modal
A claim can be created from three places.
From the appointment (recommended)
Open the Patient Profile and select the appointment's tab.
Locate the Claims card, between Documentation and Attachments.
Select + (Add Claim). The Create Claim modal opens with the Patient and Linked Entity already set to this patient and appointment, and the service lines prefilled from the claim template.
From the Billing tab
Open the Patient Profile and select the Billing tab.
In the Claims card, select +. The patient is prefilled; choose the Linked Entity to prefill the service lines.
From the Claims page
Select Claims in the left navigation bar.
Select Add Claim. Search for the patient by name; the rest of the form stays disabled until a patient and a payer are selected. Then select the appointment in Linked Entity to prefill the service lines.
Please Note: The Claims card on the appointment tab lists every claim linked to that appointment. If a claim already exists, review it before creating another one to avoid duplicate submissions.
Step 2: Review the Prefilled Claim (Claim Templates)
MedMe sets up claim templates for each pharmacy's billable services and payers. When an appointment whose service has a template is linked, the modal adds one service line per template line with the suggested CPT / HCPCS code, modifiers, diagnosis (ICD) codes, and units. Charge amounts are filled separately from the pharmacy's fee schedule (see Step 4).
Every prefilled value can be changed. The CPT, modifier, and diagnosis fields become searchable pickers that show the template's suggested options; a code outside the list can still be typed.
Warning: Templates are a starting point, not a guarantee. Always confirm the codes match what was actually done, and that the product code matches the vaccine or product administered.
When there is no template
If a linked service has no claim template, the banner No claim template found for service name appears under Linked Entity with two options. When several appointments are linked, one banner names every service that has no template.
Contact MedMe — ask the MedMe team to set up a template for this service and payer.
Continue Manually — add the service lines and codes yourself.
Billing Several Same-Day Appointments on One Claim
When a patient has more than one appointment on the same day, for example a flu shot and a COVID-19 vaccine, the appointments can be billed together on one claim.
Open the Create Claim modal from one of the appointments.
Under Linked Entity, MedMe lists the patient's other appointments on the same day after Include same-day appointment:. Select an appointment to add it, or open the Linked Entity dropdown and select it there.
Each linked appointment appears as a chip in Linked Entity and adds the service lines from its own claim template below the lines already on the claim. Each appointment's lines use that appointment's service date.
To remove an appointment, select the x on its chip. The service lines it added are removed, unless they were edited; edited lines are kept and a notice asks to review them.
Please Note:
Cancelled and no-show appointments are never suggested. On a claim that was already saved as a draft, removing an appointment that was saved with it does not remove its service lines automatically.
The same-day suggestion does not check whether an appointment is already on another claim. Before linking an appointment, check its Claims card so the same service is not billed twice.
Warning: Each claim template adds its lines on its own, and MedMe does not adjust the codes for services billed together. For example, when flu and COVID-19 vaccines are billed on the same claim, add modifier 59 to the second administration line. Review every service line before submitting.
Step 3: Complete the General Information
The General Information section holds the claim-level fields:
Patient — locked when the modal is opened from a patient profile.
Payer — lists the patient's insurances in policy order and defaults to the primary (order 1). One payer per claim. The payer cannot be changed after the claim is saved, so confirm it before saving.
Linked Entity — the appointment the claim is for. Every claim should be linked to an appointment. Several appointments from the same day can be linked; see Billing Several Same-Day Appointments on One Claim.
Place of Service — defaults to 01 - Pharmacy; any CMS place-of-service code can be selected.
Rendering Provider — the pharmacist who performed the service. Add it to every claim so the payer knows who provided the service.
Billing Provider — the pharmacy (organization) that is paid. Required.
Referring Provider (Optional) and CLIA number (Optional, offered only if the pharmacy has a CLIA number on file).
Prior Authorization Code (Optional) — the authorization number the payer issued before the service, for payers that require prior authorization.
Providers are saved for the pharmacy and reused on later claims. See How to Manage Providers on Claims in MedMe.
Step 4: Review the Service Lines
Each Service section is one billable line: Service Date, CPT / HCPCS Code, Modifiers, Units, Charge Amount, Diagnosis (ICD), and optional NDC, NDC Units, Unit Qualifier, Ordering Provider, and Additional Information.
Charge Amount is prefilled from the pharmacy's fee schedule when MedMe has a rate on file for the line's CPT / HCPCS code and the selected payer. This works whether the code came from a template or was entered manually. If no rate is on file, the field stays empty and the charge amount must be entered.
Changing the CPT / HCPCS code, or the payer on a new claim, updates a prefilled charge amount. A charge amount entered by hand is never overwritten.
To reuse diagnosis codes from another line, select Copy ICD Codes from Service N at the top right of the line's Diagnosis (ICD) field. When several lines have codes, the link reads Copy ICD Codes from Another Service and opens a list to choose from. Copied codes are added after the line's existing codes, duplicates are skipped, and the copied codes stay editable.
Select Add Another Service Line to add a line, or Remove on a line to delete it.
Use the bookmarks on the left (General Information, Service 1, Service 2…) to jump between sections.
For field-by-field guidance and limits, see Understanding the Claim Form in MedMe.
Step 5: Save as Draft or Submit for Billing
Save as Draft stores the claim without submitting it. Required fields can be left empty, and the claim appears with a Draft status on the Claims card, the Billing tab, and the Claims page. Reopen it later with Edit, or select Delete Draft Claim from the claim's more menu (three dots) to permanently delete a draft that is no longer needed.
Submit for Billing validates the claim and queues it:
Select Submit for Billing.
If a required field is missing, an inline error appears on the field. Fix the errors and submit again.
When the claim is valid, the modal closes, the claim shows Ready for Submission, and a confirmation message appears: Claim … has been queued for submission. Undo within 24 hours.
After MedMe has sent the claim to the payer, the status changes to Submitted, and the Submitted On date and Submitted By user are recorded on the claim.
Reminder: A claim in Ready for Submission has not left MedMe yet. Once it moves to Submitted, it can no longer be edited or undone. It can be cancelled once the payer accepts it, or corrected and resubmitted if the payer rejects or denies it.
Undoing a Submission
Within 24 hours of submitting, before the claim is sent:
Select Undo on the confirmation message, or
Open the claim's more menu (three dots) on any claims list and select Undo Submission.
The claim returns to Draft (or to its previous status if it was a resubmission) with the message Claim moved to Draft. Select Edit to make changes and submit again.
Troubleshooting
The form is disabled and says "No insurance on file for this patient". Select Go to patient profile, add an active medical insurance, then create the claim again.
The banner says no claim template was found. Select Contact MedMe to have a template added, or Continue Manually and enter the codes.
The Charge Amount is empty. No fee-schedule rate is on file for that code and payer. Enter the amount, or contact the MedMe RCM team to have a rate added.
Submit for Billing does nothing. Look for red inline errors; every required field must be valid. Save as Draft does not have this restriction.
Submitting shows an error about the patient's sex, date of birth, or address. Update the patient's details on the patient profile, then submit the claim again.
The Payer field cannot be changed. A claim's insurance is fixed once the claim is saved. To bill a different insurance, create a new claim.
The claim shows Ready for Submission but no Submitted On date. This is expected; the date is filled once the claim is sent overnight.
The claim was rejected. See How to Fix and Resubmit a Rejected or Denied Claim in MedMe.
Conclusion
To submit a claim in MedMe: document the encounter, open the appointment's Claims card and select +, review the template-prefilled codes and providers, and select Submit for Billing. The claim is queued as Ready for Submission with a 24-hour window to Undo, then sent to the clearinghouse and tracked on the Claims page.