Kalix allows you to create CMS 1500 forms (the standard insurance claim form) quickly and easily. If you set up your Kalix account and client's details correctly, Kalix should autocomplete insurance bills for you.
Contents of this article:
When first using Kalix, you must set up your Kalix account. Once everything is set up, you will not need to modify these settings again.
Before you create a bill, you should set up your client's file and save their demographic details against their Details page—Kalix auto-fills insurance bills with information from the client's details page, appointment, and Referral.
Navigating to Billing
There are two different navigation pathways to create a CMS 1500 form (insurance bill). Choose a path that makes the most sense to you.
Pathway 1 - Via the Client's File
Click on the search icon on the purple bar to the far left of the screen. A side menu will appear. Using the search field, search for the applicable client as shown below. Once selected, click on the New Bill link.
Pathway 2 - Via the Appointment Screen
Navigate to your appointment calendar, locate the appointment you are billing for and click on the appointment slot. The Edit Appointment screen will appear. Click on New and select bill.
Selecting a Template
You will be asked to select a template for your bill, select the option CMS 1500 (as shown below), or a template you have created that supports CMS 1500 forms.
Link up records on the Quick Set-up page to autocomplete your insurance bill. Kalix may (depending on your workflow) auto-link up the relevant records for you. If this is the case, all you need to do is click Start Bill at the bottom of the page.
Alternatively, start typing the client's name into the client field and then click to select (as shown below).
Next, select the appointment you are billing for.
If the selected appointment is linked to a referral, Kalix will automatically link this next.
Alternatively, you can manually link the Referral by clicking and selecting an option in the referral field.
Likewise, Kalix may link up with the referring provider. You can also complete this step manually by searching by name. If a referring provider is not required, leave this field blank.
Now click Start Bill.
The Billing Page
Kalix will now auto-complete the insurance bill for you. You can go through the page and edit any incorrect information.
At the bottom of each bill section, several options exist for modifying the contained details.
Edit Linked Records
Clicking on this icon will take you back to the Quick Step-up page, where you can modify the bill's linked records.
Edit (Pencil icon)
The pencil icon (only supported for Client, Referring Provider, ICD-10 Diagnosis Codes & Bill Items) allows you to change or correct the entered information on a specific bill section.
After clicking on the pencil icon, a pop-up window will appear. Make your changes and then click Update.
Note: Changes are made to the bill's information only. They do not flow back to the pulled record.
Edit permits you to modify the selected options on a specific bill section, e.g., select a different rendering provider. After clicking on the edit icon, a pop-up window will appear. Make your changes and then click Update.
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.
Using the Rendering Provider section as an example, if you update the My Details page (for example, change the Other ID) by clicking Refresh, this section will get the most up-to-date details (i.e., the corrected Other ID).
Fixing the Source of Errors
If there are errors on the bill, it will alert you to what the errors are.
Instead of just fixing the errors on the specific bill, you also have the option of editing (and fixing) their source. To do this, select the button at the bottom right of the page.
This will take you to the Details page, where the information was initially pulled.
If you edit the info source instead, e.g., the My Details page, and then navigate back to the bill (just press back on the browser), use the Refresh feature to update the bill.
The Sections of the Insurance Bill
The Insurance bill in Kalix is broken down into nine sections:
Section 1 - Bill Details
Section 2 - Client (and the Insured)
Section 3 - Referring Provider
Section 4 - Rendering Provider
Section 5 - Service Facility
Section 6 - Billing Provider
Section 7 - ICD 10 Diagnosis
Section 8 - Miscellaneous
Section 9 - Billing Items
Section 1 Bill Details
This section contains the date the bill was generated and identification details.
1) Bill ID: this is a unique identification number for this specific bill. You can let Kalix auto-generate the bill ID or enter your own. Kalix can automatically increment the ID on your next bill if you input your ID number. This field is used for internal identification purposes, not insurance billing.
2) Date: the date the insurance bill was generated. This is used for internal identification purposes only, not for insurance billing.
3) Due date: the date by which the payment is expected. This is used for internal tracking purposes only, not for insurance billing (optional).
4) Prior Authorization Number: a number authorizing the services being billed. It could be the prior authorization number issued by the insurance or the referral number. Kalix pulls this number from the linked Referral Learn more (CMS 1500 Field 23). -Optional
Section 2: Client (and the Insured)
This section refers to the client you are generating the bill for. Client information is auto-pulled from the client's details page.
Section 3: Referring Provider (Optional)
A referring provider is required for Medicare and Medicaid insurance claims. Private pay insurance often does not require a referring provider. Check with the insurance company to confirm this.
Kalix inputs the referring provider's details from the linked Contact's Details page in Kalix. Contacts are saved under Clients on the top header, subtab Contacts.
If there is no referring provider, these details can be left blank.
Section 4: Rendering Provider
This section contains details relating to the individual healthcare professional who provided the service/s. The rendering provider could be you or another member of your account.
Kalix can automatically link the clinician who conducted the appointment to the bill.
Kalix auto inputs the rendering provider details from the My Details page (shown below). Click here for more information about the My Details page.
Section 5: Service Facility
The details of the location where the service (that is being billed for) was rendered.
Kalix auto inputs this information from the location details. Kalix will automatically select the correct option based on the chosen location on the linked appointment. Click here for more details.
The required information for the Service Facility section includes the location name, address, city, state, and ZIP code of the location where the service was rendered (CMS 1500 item number 32).
Section 6: Billing Provider
The Billing provider identifies the entity that is requesting payment for the services. This will be your practice or yourself if you are a sole proprietor. The billing provider cannot be a billing service or clearinghouse. This section should always be completed.
Note: You must choose the NPI type. If your NPI is a type 1 for an individual, you must enter the name of the NPI holder below it.
Kalix auto inputs this information from your account's details; select settings (your organization name) on the top header and then Account Details. The mailing and billing address field is used here. Click here for more information.
If you only have one billing provider saved, Kalix automatically adds its details into the Billing Provider section. If you have more than one billing provider, click on the Name field and select your location from the drop-down list.
Section 7: ICD 10 Diagnosis
Kalix auto inputs information from the client's linked Referral. Click here for additional information about referrals.
Section 8: Miscellaneous
These are additionally CMS 1500 Fields that are completed less often.
Resubmission Code and Original Reference Number
One of the most commonly completed miscellaneous fields is the Resubmission code. If the claim was rejected by the insurance company (not just Office Ally) and you are required to use a resubmission code and reference number, they can be entered into the appropriate fields under the Miscellaneous section.
Section 9: Bill Item
Billing items contain the service/s or procedure/s being billed for (also referred to as service line). Kalix will auto-create your billing item from the information entered into the linked appointment.
For this process to work correctly, we recommend setting up your own Billing Items and Appointment Types. Also, when setting up your Appointment Types, associate their related Billing Item. Click here for details.
Edit Bill Item
If Kalix has created your billing item incorrectly, you can click on the pencil icon to edit.
Adding Bill Items
Click on the Add Bill Item button to add additional bill items, e.g., to bill for additional services.
When you are happy with the insurance bill, click, Save to create. Kalix will save and close to the insurance bill's Payment screen.