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.
This support article will outline the entire insurance billing functionality. The workflow is broken into 9 stages:
For each stage, please click on the Learn More button that's needed for detailed instructions.
Stage 1 - Setting up Your Kalix Account for Insurance Billing
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, billing address. Please put these into the Account Settings page's Mailing and Billing Details section.
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.
Stage 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 CMS 1500 forms with this information.
Clients can complete all of their demographic information for you via online documents. Learn More
Please note: you only need to set up these demographics and referral details for a specific client once. All future bills for your client will automatically use these details.
Stage 3 - Navigating to Billing
It is time to start producing your bill now. There are two different navigation pathways. You can choose the pathway that makes the most sense to you.
Pathway 1 - Via the Client's File
Click on the search icon located on the purple bar to the far left of the screen. A side menu will appear. Using the search field, you can go ahead and search for the right client, as shown below. Once selected, click on the New Bill link.
Pathway 2 - Via the Appointment Screen
You can just navigate to your appointment calendar, locate the appointment you are billing and click on the appointment slot. The Edit Appointment screen will appear.
Then click on New, followed by Bill.
Stage 4- Creating the Insurance Bill
When creating the bill, you will first be asked to select a template. You can choose the CMS 1500 or a template you have made that supports CMS 1500 forms.
Kalix should auto-complete the insurance bill for you. You can go through the bill and edit any incorrect information.
Click Save to create. Kalix will save and close to the insurance bill's Payment screen.
For step-by-step instructions on creating and editing the insurance bill page, click on the link below:
Stage 5 - Adding Co-Payments
Once you have created your client's insurance bill, Kalix will save and close to the insurance bill's Payment screen. From this page, you can record (i.e., if paying cash or check) or charge the co-payment to the client's credit card.
1) On the bill's Payment screen (click here for further information on payments).
2) Click the New button and choose Manual Copay or Credit Card Copay.
Stage 6 - Submitting Insurance Claims
The next step is to submit the insurance claim. To do this, create a new batch. Kalix's batching feature allows you to submit unlimited insurance claims at the same time.
Batches can be for different clients and different insurance companies.
For insurance bills to be included in batches, their status needs to be set to "Ready to Batch."
To create a batch, click Billing -> New -> Batch on the top header. All insurance bills with the status - Ready to Batch will be listed.
Click on the button Create New Batch at the bottom of the page.
When you click on create a new batch, this alert will appear. If you are sure, click on Create.
Once the batch is created, you will see the list of bills included in the batch.
Click the Send Button
You need an Office Ally account to submit claims using Office Ally. Click here to register for one.
When you create a Batch, Kalix will display an error message against each claim if certain information is missing. This error will also appear on the created bill.
To fix the errors, click on the bill that has the mistakes listed and make your changes.
Once the errors are fixed, create your batch.
Printing Insurance Claims
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 (as shown below).
Under the subsection Insurance, click on the menu (the three dots) and select the "Print Only Data" option to print on the official paper (print without formatting). Choose PDF to print with formatting.
Stage 8 - Adding Insurance Payments
If you are using Kalix's Office Ally integration and you have electronic remittance advice (ERA) set up, payment information will automatically save into your Kalix account against each associated bill. The status of claims in Kalix will automatically update.
Kalix receives ERA only once a day from Office Ally in batches (payment details about multiple claims in one file).
The claims included in a remittance batch maybe not be the same claims that are sent together to Office Ally.
Incoming payment information can be viewed in the Remittance tab of the Batch page.
As a default, you will receive an email notification when a new remittance is received.
Click on a row to view the claims in the batch.
Next, click on a particular bill to view additional remittance information.
On the payment page, scroll down to the Payment section to see a summary. Click on menu (three dots, followed by edit, to view additional information.
Note: To receive payment information automatically in Kalix, ERA must be set up by completing paperwork for each insurance company you bill.
Stage 9 - Submitting Secondary Insurance
Kalix supports the creation of CMS 1500 forms for secondary payers.
Stage 10 - Closing the Bill
You can close a bill at any time in the Payments section. Just click on the Close button as shown below. When payments have been assigned against insurance, and Total Paid is equal to or greater than the amount Outstanding, the bill will automatically close.
Note: bills can still be closed if money is still outstanding on the claim, e.g., insurance pays less than the service cost. After the claim is closed, Kalix will remove any outstanding amount.