Introduction
Kalix's Managed Clearinghouse is designed to simplify the insurance claim submission process, providing an efficient and cost-effective solution for healthcare providers. Using Kalix's built-in clearinghouse, you can electronically submit insurance claims directly from your account without needing third-party clearinghouse services. This reduces administrative overhead, improves claim accuracy, and speeds up reimbursements.
With Kalix’s Managed Clearinghouse, you can access an integrated platform that allows seamless claim and EDI enrollments, automated claim tracking, and real-time claim status updates.
For $15/month (per Billing Provider Tax ID), you get unlimited claims, insurers, and rendering providers.
This guide provides a step-by-step walkthrough for enabling and setting up Kalix's Managed Clearinghouse & enrolling for claim submission and ERA with insurers. Follow these instructions to ensure a smooth transition to electronic claims submission with Kalix.
Setup Kalix for Insurance Billing
If you are new to Kalix, ensure that your account is correctly set up for insurance billing before enabling the clearinghouse.
First, set up your practice details. These include:
Clinicians: (individuals who provide the billed services). Enter these details via the My Details page.
Billing details: Set up your billing provider details, e.g., NPI, tax ID, and billing address. Please enter these into the Account Settings page's Mailing and Billing Details section.
When you enter your billing provider NPI, please make sure that you enter the NPI type. If your NPI is a Type 1 for Individual, you will see the section to enter the first and last name of the NPI holder.
Location of service details: (the locations where billed services are conducted). Enter location details under the Location section of the Account Settings page.
Bill Items: Bill items are essential for submitting claims in Kalix. Many users create separate bill items for each appointment type they offer. Each bill item includes:
CPT Codes – The procedure codes used for billing insurance.
Place of Service Codes – Identifies where services were provided (e.g., office, telehealth, home visits).
Modifiers – Additional information about the procedure or service performed.
Default Number of Units – Specifies the typical number of units billed for this service.
Price Per Unit – The standard charge per unit of service.
To set up your bill items, navigate to the Bill Items page (under the Billing tab on the top header). Click on the Add Bill Item button. The Bill item fields will appear. Complete the applicable fields and click Save.
Please click on the button below for detailed instructions on setting up your practice's details for insurance details.
Step 1: Enable Kalix's Managed Clearinghouse
Now that your account is set up, you can enable Kalix’s Managed Clearinghouse.
On the top menu bar, navigate to Settings (your practice name) > Account Settings > Integrations.
Under the Insurance Clearinghouses selection, select the Subscribe button associated with Kalix.
Please Note: only users with Director access can enable the Kalix Clearinghouse.
Step 2: Enroll Your Tax ID/s & Subscribe
1) The enrollment form below will appear once you have clicked subscribe. Select the Billing Provider Tax ID/s you would like to enroll in the Kalix Clearinghouse.
Before you complete this step, it is essential to save your Billing Provider NPI and Tax ID under Mailing & Billing Details on the Account Settings page (found under Settings).
2) Kalix will calculate your total subscription cost.
3) Press Pay Now to subscribe to the clearinghouse. The cost is $15/month per Billing Provider Tax ID. You will be immediately charged the pro-rata amount for the current billing period.
4) Following this, the clearinghouse subscription will be charged at the same time as your regular Kalix subscription.
Step 3: Claim & ERA Enrollment
After you click Pay Now, Kalix will take you to the Claim (or EDI) and ERA (Electronic Remittance Advice) Enrollment page.
Insurers often require enrollment to submit electronic claims and receive Electronic Remittance Advice (ERA) before you can use a new clearinghouse. This process is also a prerequisite for using the Kalix Clearinghouse, enabling automatic remittance posting, easier rejection tracking, faster claim processing, and reduced manual data entry.
Even if you have completed enrollment previously for another clearinghouse, it must be redone for Kalix.
1) To check the enrollment requirements of an insurer and start the enrollment process if applicable, click on the Add Insurer button as shown below.
2) The Search Available Insurers window will appear (displayed below).
3) Use the search bar to find your insurer. You can search by name or payer ID.
4) Click to select the insurer and then select Continue.
5) The enrollment requirements for the selected insurer will then be displayed.
If you see a green tick ✅ - no enrollment is required, or enrollment is already complete.
If you see a red cross ❌ - enrollment is required.
6) If enrollment is required, select the edit icon (pencil) to commence the enrollment process.
7) After selecting the pencil icon, the below window will appear.
8) When you click to enroll, the enrollment form will open in a new browser window. Please complete the form in the new window.
Frequently Asked Questions
What is the cost of Kalix's Managed Clearinghouse?
Kalix’s Managed Clearinghouse is available for a flat fee of $15 per month per billing provider Tax ID, regardless of the number of claims submitted, payers, or the number of rendering providers.
Can I use Kalix's Managed Clearinghouse for all payers?
Kalix Clearinghouse supports over 3000 payers across all states and Puerto Rico.
What if my claim is rejected?
Claims may be rejected due to missing or incorrect information. Review the rejection message, correct any errors, and resubmit the claim. You can also contact Kalix Support for help.
Can I switch back to using my own clearinghouse?
Yes, you can disable Kalix's Managed Clearinghouse at any time.
By following these steps, you can seamlessly set up and use Kalix's Managed Clearinghouse to streamline your insurance billing process. If you have any questions or need assistance, please contact Kalix Support.