Submitting Insurance Claims

Kalix supports the submission of insurance claims via 5 clearinghouses Assertus, Availity, Claim MD, Office Ally & TriZetto

Updated over a week ago

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 gives you the flexibility to choose the most suitable clearinghouse for each claim. It can save you money by only 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:

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 are searching for an insurer, Kalix displays the associated clearinghouse and whether they are participating. (see example below).

Alternatively, you can select your chosen clearinghouse in the Clearinghouse field.

Please note: the payer ID for insurers can vary between clearinghouses. If changing clearinghouses, you should double-check check the payer ID remains the same.

Submitting Insurance Claims

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 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.

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