Insurance Billing - Workflow Overview (US only)

An outline of the entire insurance billing process - from account set-up for insurance billing, to claim submission & payment posting.

Updated over a week ago

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

Exporting 837P Files For Availity

While Kalix does not directly integrate with Availity, Kalix creates insurance claims (837P files) for Availity Clearinghouse. These can be uploaded to the Availity Essentials portal & submitted to hundreds of insurers for free.

Kalix creates 837P files for both individual bills and batch claims. For instructions, please take a look at the sections below.

Downloading a Single Insurance Bill for Availity

1) Once an insurance bill is created, on the bill's Payment screen (as shown below), under the subsection Insurance, click on the menu icon (3 dots) and then select Availity (837P).

2) The file will be saved to your download folder.

3) For instructions on submitting 837P files to Availity, see the Creating a New Batch section.

Downloading a Batch for Availity

Create a batch using Kalix's Batching feature to save multiple CMS 1500 forms in a single file.

Uploading batches to Availity Essential takes much less time than uploading each bill individually. There is no limit to the number of insurance bills that can be added to a batch. Bills can be for different clients and different insurance companies.

Kalix allows you to select which claims to add to a particular batch through the use of two different methods:

  1. Filter of which bills are included in a batch through several factors, including specific insurers, providers, and locations.

  2. Kalix also allows you to remove specific bills from batches via the cross icon. When the next batch is created, any bills you may have removed will be readded.

Navigating to the New Batch Page

Click on Billing on the top header, followed by New, and then Batches.

Kalix will list all insurance bills with the status Ready to Batch.

Kalix Batch Claim Selection

Kalix allows you to select which claims to add to a particular batch. Here are two ways to do this:

Filtering Claims

At the top of the new batches page is a filter option allowing you to choose which insurers, providers, and/or locations you wish to export claims for.

Removing Claims Individually

Kalix also allows you to remove specific bills from batches via the cross icon. When the next batch is created, any bills you may have removed will be readded.

Creating a New Batch

When you are ready to create a batch, click on the Create a new batch button.

The notification message will appear. Click Create. Kalix will begin to build the batch file.

When Kalix finishes creating the batch, click on the Download button at the bottom right of the screen. Choose the option Availity (837P).

The file will appear in your downloads.

Upload this file to Availity.

How to Include Insurance Bills in a Batch

For insurance bills to be included in batches, their status must be set to "Ready to Batch." Kalix automatically assigns this status to all new insurance bills that haven't been added to a batch yet.

Uploading Your 837P Files to Availity

Once you have downloaded the 837P file from Kalix, whether it is a batch or a single claim, it is time to submit it to Availity.

While Kalix does not have a direct integration with Availity, the Availity (837P) files from Kalix can be uploaded to the Availity Essentials portal & submitted to hundreds of insurers for free. Also, remittance files from Availity can be quickly uploaded back into Kalix.

Please take a look at the video below for the entire workflow or the step-by-step instructions that follow.

  1. Select the Claims & Payments tab

  2. Under the EDI Clearinghouse section, select Send and Receive EDI Files

4. The Send and Receive EDI Files page will appear. First, select the organization you are billing for, followed by Submit.

5. On the next screen, select Send Files.

6. Select the Choose Files button (as shown below) and then locate the downloaded 837P File from Kalix. It should be saved in your computer's download folder.

7. Once the file is selected, click Upload File.

8. The uploaded file will be listed within the table of this page. When the file has been accepted, "Success" will be added to the file name (see below).

9. Availity will send the claims to the applicable insurance companies.

Uploading Electronic Remittance Advice (835) For Availity to Kalix

Electronic Remittance Advice (or payment information) is sent back from billed insurers to your Availity Essential account.

While Kalix does not have a direct integration with Availity, you can upload received files ERA 835 files) from Availity into your Kalix account. Kalix will automatically save payment details, adjustments & error codes to the applicable bills.

1) To upload remittance, navigate to the Remittance section of your Created Batch page in Kalix.

2) Click on the Upload 835 button (see below) and select the 835 file from Availity.

3) Kalix will save all remittance information to their applicable bills.

Errors Notification

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.

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