specification: FinOps Framework
specificationVersion: '1.0'
schema: https://www.finops.org/framework/
provider: Claim.MD
providerId: claim-md
created: '2026-06-21'
modified: '2026-06-21'
reconciled: false
tags:
- Healthcare
- Medical Claims
- Clearinghouse
- EDI
- X12
- FinOps
- Cost Management
- FOCUS
description: >-
  FinOps view of Claim.MD spend. Claim.MD is a medical-claims clearinghouse
  billed per provider via sales-led agreements rather than transparent public
  usage rates, so unit costs are not published. The natural cost and usage
  dimensions for tracking are claims submitted, ERA processed, and eligibility
  checks performed, allocated by billing provider / NPI and payer.
notes: >-
  Per-provider rates are negotiated and not public; confirm contract terms with
  Claim.MD and instrument usage counts (claims, ERA, eligibility) for internal
  allocation. Meters below describe usage to track, not published prices.
sources:
- https://www.claim.md/services-providers
- https://www.claim.md/services-software-vendors
- https://focus.finops.org/focus-specification/v1-3/
alignedWith:
  framework: FinOps Foundation Framework
  frameworkUrl: https://www.finops.org/framework/
  dataSpec: FOCUS
  dataSpecVersion: '1.3'
  dataSpecUrl: https://focus.finops.org/focus-specification/v1-3/
publisherName: Claim.MD
serviceCategory: Healthcare Clearinghouse
billingModel:
  pricingCategory: Subscription
  billingFrequency: Monthly
  billingCurrency: USD
  chargeCategories:
  - Usage
  - Purchase
focusColumns:
  ServiceName: Claim.MD Clearinghouse
  ServiceCategory: Healthcare Clearinghouse
  ProviderName: Claim.MD
  PublisherName: Claim.MD
  InvoiceIssuerName: Claim.MD
  BillingCurrency: USD
  ChargeCategory: Usage
  PricingCategory: Subscription
meters:
- name: claims_submitted
  description: Claims submitted through the clearinghouse (837P/837I and other formats).
  unit: claims
  aggregation: sum
  dimensions:
  - account
  - provider
  - payer
- name: era_processed
  description: Electronic remittance advice (835) retrieved and processed.
  unit: era
  aggregation: sum
  dimensions:
  - account
  - provider
  - payer
- name: eligibility_checks
  description: Real-time eligibility (270/271) requests performed.
  unit: requests
  aggregation: sum
  dimensions:
  - account
  - provider
  - payer
- name: enrollments
  description: Provider enrollment requests initiated through the API.
  unit: enrollments
  aggregation: sum
  dimensions:
  - account
  - provider
  - payer
principles:
- name: Visibility
  description: Track claim, ERA, and eligibility counts per provider and payer against invoices.
- name: Allocation
  description: Map AccountKey usage and billing-provider/NPI to internal cost centers.
- name: Optimization
  description: Batch up to 2000 claims per upload and use incremental polling to minimize redundant API calls.
- name: Accountability
  description: Assign owners per provider account; review monthly clearinghouse spend against claim volume.
maintainers:
- FN: Kin Lane
  email: kin@apievangelist.com