Kalix offers a seamless process for submitting insurance claims, whether you're using the Kalix Managed Clearinghouse, a third-party clearinghouse integration, or even generating CMS 1500 forms for manual submission.
Kalix’s Managed Clearinghouse
For $15/month (per Billing Provider Tax ID), Kalix’s Managed Clearinghouse offers unlimited claims, insurers, and rendering providers. With built-in electronic claim submission, there's no need for third-party services—reducing administrative workload, improving accuracy, and speeding up reimbursements. The platform also includes seamless claim and EDI enrollments, automated tracking, and real-time status updates for a smoother billing process.
Third-Party Clearinghouse Integrations
If you prefer another clearinghouse, Kalix integrates with four third-party clearinghouses—Availity, Claim MD, Office Ally, and TriZetto—via Secure FTP (SFTP) for batch claim processing. With a single click, you can submit claims directly from Kalix to your preferred clearinghouse.
Manual Submission via CMS 1500 Forms
For providers who manually submit claims, Kalix generates CMS 1500 forms that can be printed or downloaded for submission to insurers. This option ensures flexibility for practices that need to handle insurance claims outside of an integrated clearinghouse.
Follow the steps below to submit insurance claims efficiently within Kalix.
Step 1: Ensure Billing Setup is Complete
Before submitting claims, ensure your Kalix account is correctly configured for billing:
Setting Up Your Practice Details: In the 'My Details' and' Account Settings' sections, enter clinician information, billing details (such as NPI and tax ID), and service location details.
Setting Up Your Clearinghouse: Kalix simplifies insurance billing with a fully integrated billing solution and managed clearinghouse, with no third-party clearinghouses to deal with. For set-up instructions, click here.
Billing Items: Bill items in Kalix are essential for submitting claims and can be linked to specific appointment types. Each bill item includes CPT codes, place of service codes, modifiers, default units, and price per unit. To set up bill items, navigate to the Bill Items page under the Billing tab, click Add Bill Item, complete the fields, and save. Learn More
Appointment Types (Optional): Set up appointment types and link them to corresponding billing items. This configuration enables quick generation of appointment-specific bills, with Kalix automatically adding the appropriate bill item.help.kalixhealth.com
By completing these steps, you'll streamline your billing process within Kalix.
Step 2: Getting Your Client Details Ready
Before you create an insurance bill, you should set up your client's file by saving their demographic, appointment, referral, and insurance details. Kalix will auto-fill your insurance claims with this information.
Clients Can Complete Their Own Demographic Information
Kalix allows clients to complete all of their demographic information (including insurance details) for you via online documents Learn More or online scheduling Learn More
Please note: You only need to set up these demographics and referral details for a specific client once. These details will automatically be used for all future bills for your client.
Step 3: Creating Insurance Claims
Kalix allows you to create insurance claims quickly and easily. If you set up your Kalix account and client's details correctly, Kalix should autocomplete insurance bills for you.
For step-by-step instructions on creating insurance claims, please click on the button below.
Submitting Insurance Claims
Kalix's batching feature allows you to submit unlimited insurance claims simultaneously, even to different clearinghouses. There is no limit to the number of insurance bills in a batch—they can include different clients, insurers, and clearinghouses.
Note: All insurance bills marked "Ready to Batch" on the Billing Payments screen will be included in the batch. Kalix automatically assigns this status to all new insurance bills that have yet to be batched.
Creating a Claim Batch
Batching enables you to submit multiple insurance claims simultaneously, which streamlines the billing process and saves time. Kalix automatically marks all newly created insurance bills as "Ready to Batch," allowing you to submit them with just a few clicks. Follow these steps to efficiently create and send a batch.
1. Navigate to Billing: Click Billing → New → Batch on the top menu. All insurance bills with the "Ready to Batch" status will be listed.
2. Create a New Batch: Click Create New Batch at the bottom of the page.
3. Confirm the Batch: A confirmation alert will appear. Click Create if you are sure.
4. Review the Batch: Once created, the batch will display the insurance bills that are included.
5. Submit the Claims: Click Send, and Kalix will forward the claims to the appropriate clearinghouses, including the Kalix Clearinghouse.
Note: All insurance bills with the status - Ready to Batch (as shown below) selected on the Billing payments screen will be added to the batch. Kalix automatically assigns this status to all new insurance bills that have yet to be added to a batch.
Error Notification
When creating a batch, Kalix checks each claim for missing or incorrect information (data scrubbing). Errors are also displayed on the respective bill.
Types of Errors
Critical Errors – Claims with critical errors will not be included in the batch. An alert will appear at the top of the New Batch page. Click to expand and review.
Reasons for critical errors:
No insurer is associated with the bill.
A payment is already associated with the insurer being billed.
You have not commenced claim or EDI enrollment for the insurer (Kalix clearinghouse only).
Non-Critical Errors – These errors are listed below each bill in the batch. Claims with non-critical errors can still be submitted, but the clearinghouse id likely to reject them.
Fixing Errors
Click on the bill with errors and make the necessary corrections.
If the error stems from incorrect client details (e.g., insurance information), update the information on the Client Details page. This will ensure the accuracy of future claims.
After updating, return to the bill and use the Refresh icon to reload updated information.
Once all errors are resolved, recreate the batch and submit the claims.
For detailed, step-by-step error correction instructions, click the button below.
Please click on the button below to read step-by-step instructions about error correction.
Important Note - Error Correction
Instead of just fixing the errors on the specific bill, you should edit (and correct) the source of the error rather than just the mistake in the bill itself.
For example, if the client's insurance details are incorrect, go to the client's details page and edit the insurance details there. This way, the next time an insurance bill is created for the client, their details will be correct.
Refresh
You then need to edit the details of the specific bill. Use the Refresh icon to update (or reload) a bill section after changes are made to the page from which its info was auto-filled.
Printing Insurance Claims (Optional)
If you'd like to print the CMS 1500 form for an insurance claim, you can do this via the specific claim's Payment screen.
Open the claim's Payment screen.
Under the Insurance subsection, click the menu (three dots).
Select "Print Only Data" to print on official CMS 1500 paper (without formatting) or PDF to print with formatting.
