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 might potentially 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."
While Availity offers their 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:
Claim MD (Article Coming Soon)
TriZetto (Article Coming Soon)
Creating Insurance Claims
Kalix allows you to create insurance claims quickly and easily. If you set up your Kalix account and client's details correctly, Kalix should autocomplete insurance bills for you.
For step-by-step instructions on creating insurance claims, please click on the button below.
Assigning Preferred Clearinghouses
Important Note: When setting up your client's insurance details (in the insurance section of the client's details page), you need to assign the clearinghouse (if you are billing through multiple clearinghouses) you will be using to submit their claims.
When you search for an insurer, Kalix displays the associated clearinghouse and whether the insurer is participating (see example below).
Alternatively, you can select your chosen clearinghouse in the Clearinghouse field.
Please note: insurers' payer IDs can vary between clearinghouses. If you change clearinghouses, you should double-check that the payer ID remains the same.
Submitting Insurance Claims Via Kalix's Clearinghouse Integrations
Kalix's batching feature allows you to submit multiple insurance claims at one time, even to different clearinghouses.
There is no limit to the number of insurance bills that can be added to a batch. Bills can be for different clients, different insurance companies, and different clearinghouses.
Note: All insurance bills with the status - Ready to Batch (as shown below) selected on the Billing payments screen will be added to the batch. Kalix automatically assigns this status to all new insurance bills that have yet to be added to a batch.
1. To create a batch, click Billing -> New -> Batch on the top header. All insurance bills with the status - Ready to Batch will be listed.
2. Click on the button Create New Batch at the bottom of the page.
3. When you click on Create a new batch, this alert will appear. If you are sure, click on Create.
4. Once the batch is created, you will see the list of bills included in the batch.
5. Click the Send Button, and Kalix will send the claims to the appropriate clearinghouses.
Error 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.
There are two types of errors: Critical Errors and Non-critical Errors.
Critical Errors
If any insurance bill has a critical error, Kalix will not include it in the new batch. Instead, a notification will appear at the top of the New Batch page. Click to expand.
There are two reasons for critical errors:
No insurer is associated with the bill.
There is already a payment associated with the insurer being billed.
Non-Critical Errors
When there are non-critical errors, Kalix lists these below each listed bill in the batch (see example below).
Kalix checks that all required fields in a claim form are filled out correctly. This includes ensuring that client information, provider details, diagnosis codes, procedure codes, and other relevant data are accurate and conform to the necessary standards.
When there are non-critical errors, Kalix will still allow you to submit the claim to the clearinghouse. The clearinghouse is likely to reject the claim without forwarding it on the the relevant insurer.
Fixing Errors
To fix the errors (whether critical or non-critical), click on the bill that has the mistakes listed and make your changes.
Once the errors are fixed, create your batch.
Please click on the button below to read step-by-step instructions about error correction.
Important Note - Error Correction
Instead of just fixing the errors on the specific bill, you should edit (and correct) the source of the error rather than just the mistake in the bill itself.
For example, if the client's insurance details are incorrect, go to the client's details page and edit the insurance details there. This way, the next time an insurance bill is created for the client, their details will be correct.
Refresh
You then need to edit the details of the specific bill. 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.
Printing Insurance Claims (Optional)
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.
