Introduction
Kalix’s built-in Managed Clearinghouse supports over 3000 insurers. It offers seamless claim submission, real-time status updates, integrated error checking to reduce denials, auto-posting of remittances for effortless payment matching, and easy claim resubmission—all handled entirely within Kalix; no third-party clearinghouse account is needed.
For $15/month (per Billing Provider Tax ID), you get unlimited claims, billing provider NPIs, insurers, and rendering providers.
This guide provides a step-by-step walkthrough for enabling and setting up Kalix's Managed Clearinghouse and enrolling for claim submission and ERA with insurers. Please follow these instructions to ensure a smooth transition to electronic claims submission with the Kalix Clearinghouse.
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 their 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. Bill items contain:
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.
Administrative users cannot enable the Kalix Clearinghouse, but they can complete enrollment via the Insurer page (see "Alternative Enrollment Setup" section below).
Step 2: Enroll Your Tax ID/s & Subscribe
The enrollment window will appear after clicking Subscribe.
Select the Billing Provider Tax ID/s you'd like to enroll.
Ensure your Billing Provider NPI & Tax ID are saved under Mailing & Billing Details in Account Settings.
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).
Double-check your NPI and Tax ID details before enrolling. Errors here can delay processing!
4. Kalix will calculate your total subscription cost.
5. Press Pay Now to subscribe to the clearinghouse. The cost is $15/month (or $180/year on an annual subscription) per Billing Provider Tax ID (unlimited Billing Provider NPIs). You will be immediately charged the pro-rata amount for the current billing period.
Clearinghouse Charges
When you subscribe, you will be immediately charged a pro-rata amount based on the time remaining until your next Kalix billing cycle. If you are on an annual Kalix subscription, the charge may cover up to a full year. After this initial charge, the clearinghouse fee of $15/month or $180/year per Billing Provider Tax ID will be added to your regular Kalix subscription billing cycle.
6. Following this, the clearinghouse subscription will be charged at the same time as your regular Kalix subscription.
Step 3: Claim (EDI) & ERA Enrollment
After you click Pay Now, Kalix will take you to the Claim (or EDI) and ERA (Electronic Remittance Advice) Enrollment page.
Important Note!
Even if you have completed enrollment previously for another clearinghouse, it must be redone for Kalix. Enrollment is clearinghouse-specific.
The enrollment process consists of two parts: Claim (EDI) Enrollment and ERA (Electronic Remittance Advice) Enrollment.
Claim (EDI) Enrollment: enables Kalix to submit electronic insurance claims on your behalf. This enrollment is only necessary for certain insurers, particularly government ones such as Medicare, Medicaid, and Tricare. If EDI enrollment is required, your request will need to be processed before the insurer will accept claims from a new clearinghouse, i.e., the Kalix Clearinghouse.
ERA Enrollment: enables Kalix to receive electronic remittance advice from the insurer, which allows easier rejection and denial tracking, faster claim processing, and reduced manual data entry. You do not need to wait for these to be processed before submitting claims.
Understanding EDI & ERA Enrollment Requirements & Processing Times
Enrollment requirements and processing times for claim submission (EDI) and Electronic Remittance Advice (ERA) vary by insurer. Kalix aims to streamline this process as much as possible; however, certain insurers require providers to complete enrollment directly through their own portals, and this step cannot be skipped.
Processing timeframes are set by each insurer and remain consistent across all clearinghouses. Activation may be immediate or could take several days, typically averaging around two weeks, but it may occasionally extend up to a month or more.
If an insurer only requires ERA enrollment (and not claim enrollment), you can start submitting claims for that insurer through Kalix immediately, even if the ERA enrollment is still pending. However, if an insurer requires EDI enrollment for claim submissions, you must wait until that specific insurer completes the enrollment before you can submit claims through Kalix.
Enrollment Type | Required? | Can I Submit Claims Before Enrollment is Processed? |
Claim/EDI Enrollment | Yes | ❌ No, wait until EDI enrollment is approved |
ERA Enrollment | Yes | ✅ Yes, submit claims immediately after submitting the ERA enrollment form |
Reach Out If You Have Issues
If you have any issues with enrollment, please contact Kalix Support ([email protected]). You can also schedule a training session with a trainer who can complete enrollment with you. Click here to book.
Claim (EDI) Enrollment (Electronic Claims Submission)
Some insurers, particularly government payers such as Medicare and Tricare, require providers to complete Claim (EDI) Enrollment before accepting electronic claims submitted through a new clearinghouse.
🚨 Important: Claims submitted to an insurer before your EDI enrollment with them is approved will be automatically denied by that insurer, returning the following error:
"Submitter not approved for electronic claim submissions on behalf of this entity."
You may continue submitting claims to other insurers who do not require EDI enrollment or have already approved your submission through the clearinghouse.
Note: Insurers usually do not send notifications when enrollment is approved, though you will be notified if your enrollment is denied.
Checking Claim Enrollment Status
You may not be notified by the insurer when your EDI enrollment is approved (and Kalix isn't, either).
Check the insurers' online enrollment portals (if available) for status updates.
If there is no online enrollment portal, send a "test" claim after 2 weeks to verify approval. If the claim is accepted, then your EDI enrollment has been approved.
Special Note: Regarding Tricare East Only
In January 2025, Tricare East transitioned its claims processing to a new vendor, Palmetto GBA. Due to a high volume of enrollment requests, Tricare East is currently experiencing delays, taking approximately 60-90 days to approve Claim (EDI) enrollments. We anticipate this processing time will improve as they manage the backlog.
Please note that until your EDI enrollment is fully approved by Tricare East, you will not be able to submit insurance claims to Tricare East electronically via Kalix Clearinghouse. Kalix has no control over Tricare East's processing timelines, which affect all clearinghouses equally. No other insurers are affected.
We appreciate your patience and understanding during this transition period. This issue is specific to Tricare East only.
Medicare-Specific Tips (Please Read)
Medicare is extremely strict with EDI enrollment and has some unique requirements compared to other insurers. Enrollments often get denied for minor discrepancies, and Medicare does not provide leniency when it comes to exact information matching.
Enrollment is denied if provider details don’t exactly match PECOS (Provider Enrollment, Chain, and Ownership System). PECOS is Medicare's official online system for managing and verifying provider enrollment, ownership, and practice details.
Even minor differences in punctuation, capitalization, abbreviations, spacing, or the way your name or address is formatted can result in denials.
How to Prevent Issues:
Log into PECOS (Provider Enrollment, Chain, and Ownership System):
Verify the following details:
Legal Provider Name (first name, middle name/initial if listed, last name)
NPI Number (whether you are enrolled under your individual vs. group NPI)
Tax ID
PTAN (Provider Transaction Access Number) — a unique identifier assigned to Medicare providers, used to authenticate and track claim submissions and enrollment status. There are two types of PTANs: Individual PTANs, assigned to individual providers, and Group PTANs, assigned to practices or billing groups. It is important to use the correct PTAN (individual or group) when completing the EDI enrollment form to match how you are credentialed with Medicare.
Practice Address and Billing Address
Contact information
Ensure every single detail exactly matches what's listed in PECOS, including punctuation like commas, periods, dashes, as well as capitalization and spacing. Even a missing period or extra space can cause rejections.
💡 Tip: Double-check each field carefully and copy-paste directly from PECOS where possible to minimize manual errors.
2. Line of Business Field:
Always select "Part B" when prompted during the Medicare enrollment process. This indicates outpatient and provider services.
3. Check Enrollment Status Regularly:
Use Palmetto GBA's EDI tools to monitor the status of your EDI enrollment: 🔗 Palmetto GBA EDI Tools
4. Wait to Submit Claims:
Do not submit Medicare claims until you are certain the EDI enrollment has been processed. Submitting prematurely will result in the rejection error: "Submitter not approved for electronic claim submissions on behalf of this entity."
Consider Saving a PECOS Screenshot:
Keeping a screenshot of your PECOS enrollment details can serve as a handy reference when completing the EDI enrollment form.
ERA Enrollment (Electronic Remittance Advice)
Most insurers require ERA Enrollment to receive electronic remittance advice through 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.
📢 Important: You can only receive ERA through one clearinghouse at a time.
Once ERA enrollment for Kalix is processed:
You will stop receiving ERA in your previous clearinghouse.
ERA/EOBs already received will remain visible in your old clearinghouse and insurer portal.
New ERAs will appear in 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).
🔍 Tips for Searching Insurers
When searching for an insurer in the Search Available Insurers window, use these tips to improve your results:
✔️ Search by Payer ID – Even if the Kalix clearinghouse uses a different payer ID for an insurer, the correct results may still appear when searching by payer ID.
✔️ Use State Abbreviations – Some insurers are listed with their state abbreviation first. Try searching in the format:
[State Code] [Insurer Name]
Example: CA Medicaid (for California Medicaid)
✔️ Look for Common Abbreviations – Certain insurers are often listed using common abbreviations:
Blue Cross Blue Shield (BCBS) is usually abbreviated as BCBS instead of the full name.
If you’re having trouble finding your insurer, try different variations of the name or payer ID for the best results!
✔️ Still Can’t Find Your Insurer? – Reach out to Kalix Support for assistance. We support over 3,000 payers, so we likely support your insurer even if it doesn’t appear in the initial search.
Alternative Setup - Insurer List
Alternatively, if you have previously used Kalix for insurance billing, you may find it more efficient to complete your enrollment through your Insurers List (Billing > Insurers) instead.
The Insurers List automatically stores a record of each insurer you have billed through Kalix. By reviewing and updating each insurer’s entry directly in this list, you can enroll with them more efficiently—eliminating the need to search for each insurer manually in the Enrollment window.
1. On the Isurers page, click on each insurer to view their details window.
2. In the Clearinghouse field, select Kalix.
3. The Check Enrollment Status button will appear, click this.
5. Select the Tax ID and NPI combination under which you wish to check enrollment.
4. Kalix will verify whether claim and ERA enrollment is required for that insurer.
Understanding Claim & ERA Enrollment Status
Once Kalix verifies enrollment, you will see one of the following statuses:
✅ Green Checkmark – No enrollment required, or enrollment is already complete.
❌ Red Cross – Enrollment is required. Click the pencil (✏️) icon to start the enrollment process.
🟠 Orange Tick – Enrollment is being processed. However, this status may not change to green because we do not always receive updates from insurers. If your enrollment has been pending for an extended period, reach out to Kalix support.
❔ Green Question Mark – Enrollment status is unknown. This often happens if the insurer's payer ID does not exist in our system. In this case:
Try searching for and re-adding the insurer.
Keep in mind that the payer ID may differ between clearinghouses.
Completing Enrollment
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.
Bulk Updating Insurers to Kalix Clearinghouse
If you have previously used Kalix for insurance billing with a different clearinghouse and are switching to the Kalix Clearinghouse, you may find that multiple insurers need to be updated. To save time, you can use the Bulk Reassign Clearinghouse feature.
Why is this necessary?
When you first set up insurance billing in Kalix, each insurer and client's insurance details were assigned to the original clearinghouse you were using at that time.
If you are switching to the Kalix Clearinghouse, these existing insurers and client records will remain assigned to the previous clearinghouse by default.
To submit claims through the Kalix Clearinghouse, you must update the assigned clearinghouse with both insurers' and clients' insurance details.
How to Bulk Update Insurers:
Navigate to Billing > Insurers.
Click the Bulk Reassign Clearinghouse button.
Select Kalix Managed Clearinghouse as the new clearinghouse.
Confirm your selection.
Once completed, Kalix will automatically update all insurers in your insurer list and all client insurance details to use the Kalix Clearinghouse.
🔹 Note: If an insurer requires claim or ERA enrollment, you will still need to check their enrollment status and complete the process as needed (see the "Understanding Your Enrollment Status" section).
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 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.