Skip to main content
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.

Kalix directly integrates with five clearinghouses, allowing users to submit claims with a click of a button. Users can also set up electronic remittance advice to receive back payment information, adjustments, and final claim statuses without ever leaving Kalix.

This support article will outline the entire insurance billing functionality. The workflow is broken into nine 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, and billing address. Please enter 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.

Please click on the button below for detailed instructions on setting up your practice's details for insurance details.

Clearinghouse Set-up

Kalix directly integrates with five different clearinghouses: Assertus, Availity, Claim MD, Office Ally & TriZetto via Secure FTP (or SFTP) for batch claim processing.

By using Kalix's clearinghouse integrations, you can submit claims to your chosen clearinghouses from within Kalix with a click of a button. You can receive back claim status updates, remittance advice, payment information, adjustments, and patient responsibility amounts without ever leaving Kalix.

Kalix insurance billing offers a unique feature that allows you to submit different bills within the same batch to various clearinghouses at the same time.

Kalix's insurance billing allows you to choose the most suitable clearinghouse for each claim. It can save you money by submitting claims to insurers via participating clearinghouses only.

Many practices use the combination of two clearinghouses, e.g., Availity and Office Ally. By doing this, you can complete all your insurance billing for FREE!

Office Ally is free to use if greater than 50% of your claims per month are from "Participating insurers."

Availity offers its Essentials plan, which is completely free to use. Availity Essentials supports many of the largest health insurers, including Anthem and BCBS plans.

Pro-tip Clearinghouse Lookup

To view each clearinghouse's participating insurer, navigate to the Integrations section of Account Settings in Kalix and use the Clearinghouse Lookup.

Use the search field to find each insurer you bill by name (usually, including your state in the search terms gives a more exact match). Kalix will list the supporting clearinghouses and their participating status.

Clearinghouse Integration Setup

For instructions on setting up Kalix's integration with each clearinghouse, please click on the links below:

Setting Up Your Insurer List

We highly recommend setting up your Insurer Page in Kalix if you choose to utilize two clearinghouses at the same time.

To navigate to your Insurer page, hover your cursor over Billing on the top header, followed by Insurers.

Your Insurer page (even if you have never visited it before) will contain a list of all the insurers you have billed.

If you haven't created any insurance bills yet, click on the Plus button to add a new option. Search for and select each insurer you plan to bill for. Kalix should list each clearinghouse's participating status.

If you are already using Kalix's insurance billing for all insurers you bill, click on each insurer's row to edit. Their details will open up in a new window.

Delete insurers that are entered incorrectly or not used. To do this, click on an entry to edit. Then select the Delete button at the bottom left of the pop-up window.

Turn on to limit the selection of insurance companies to only what is listed on this page.

For complete instructions on setting up your account for insurance billing, please click on the button below.

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 Their Own Demographic Information

Kalix allows clients to complete all of their demographic information for you via online documents Learn More or online scheduling Learn More

Please note: You only need to set up these demographics and referral details for a specific client once. These details will automatically be used for all future bills for your client.

Stage 3 - Navigating to Billing

It is time to start producing your bill now. There are two different navigation pathways. 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 navigate to your appointment calendar, locate the appointment you are billing, and click on the appointment slot. The Edit Appointment screen will then 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 (Optional)

Once you have created your client's insurance bill, Kalix will save it and close it on 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.

Important Note

As part of the electronic remittance (ERA), you will receive back the Patient Responsibility amount. This will become the copayment amount, and you will be able to charge this quickly during stage 8.

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 (including for different clients and different insurers) at the same time, even via different clearinghouses.

Insurance bills must be set to "Ready to Batch" so that they can be included in batches.


Click Billing -> New -> Batch on the top header to create a batch. 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.

This alert will appear when you click on Create a new batch. 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. Kalix will send your claims to your chosen clearinghouses.

Select the button below for more detailed instructions on submitting insurance claims.

Errors Notification

When you create a batch, Kalix will display an error message for 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.

Stage 8 - Adding Insurance Payments

If you are using Kalix's clearinghouse integrations and you have electronic remittance advice (ERA) set up, payment information will automatically be saved into your Kalix account against each associated bill. The status of claims in Kalix will also automatically update.

Kalix may receive ERA only once a day from your selected clearinghouses. They can be received in batches (payment details about multiple claims in one file).

The claims included in a remittance batch may not be the same claims that are sent together to the clearinghouse.

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 the menu (three dots, followed by edit, to view additional information.

Note: To receive payment information automatically in Kalix, you must set up ERA 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 the Total Paid is equal to or greater than the outstanding amount, 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.

Did this answer your question?