One crucial aspect of insurance billing is creating secondary insurance claims for patients with multiple insurance providers.
This support article will guide you through the step-by-step process of creating secondary insurance claims in Kalix.
There are 3 possible ways to add secondary insurance claims to batches:
Option 3 Via Manual Upload Your Clearinghouse
Setup
1. Please save the primary and secondary insurance against the client's details page before creating the initial insurance bill.
2. Create the insurance bill for the client in Kalix as usual. For information about doing this, click here.
3. Download the claim for the primary insurance or add it to a batch using Kalix's Batching feature as usual, for further information about this click here.
You may also download the file and upload it to your clearinghouse.
5. Wait to receive partial payment or denial from the primary insurance.
Option 1 - Direct Clearinghouse Integration + ERA received directly into Kalix
Once you have either received the denial / partial payment from the primary insurance, open up the created bill again.
The bill will have the payment posted and the ERA information below, as shown in the image below.
This is an example of an ERA that came directly from Office Ally into Kalix with a partial payment of $50 vs the full payment of what was billed, which was $100.
This claim will now have the status as processed.
Change the status to Ready to Batch.
Create a new Batch and send it to your clearinghouse.
Option 2 - Via Clearinghouse Integration + manual EOB entry
1. Once you have either received the denial /partial payment from the primary insurance, open up the created bill again.
2. Enter the payment details into the Payments section of the created bill. For details about entering payments, click here.
Note: If payment was denied, you must still create a payment for the primary insurance but enter $0 as the payment amount.
3. If you received a paper remittance, please enter it by clicking the Add Remittance button.
4. Enter the remittance details.
5. Still on the payment screen, set the payment status to Ready to Batch (as shown below).
6. Create a new batch as per usual. The claim for the secondary insurance will be available on your list of available bills to batch. You will notice that Is Primary will not be selected.
7. When you send the batch to your clearinghouse, the system will detect it is a secondary claim.
Option 3 - Via Manual Upload to Office Ally
After creating your bill for the primary insurance and receiving payment or either denial for the claim:
1. Open up the created bill again.
2. Enter the payment details into the Payments section of the created bill. For details about entering payments, click here.
Note: If payment was denied, you must still create a payment for the primary insurance but enter $0 as the payment amount.
3. Change the status of the bill to ready to batch.
4. Download the claim by clicking on the 3 dots and choosing the (837P) option for your clearinghouse.
5. Log on to your clearinghouse and upload the claim as usual.
Manual Upload to Office Ally
When uploading a secondary claim to Office Ally, it will recognize that it is a secondary claim. The claim will be sent to the Claim Fix section of Office Ally. It may take between 1 minute to 3 hours for claims to appear in the claims fix section. From this page, you can enter the primary EOB or ERA details.