With Kalix EMR, users can now easily create insurance claims (837P files) for Availity Clearinghouse. Availity Essentials provides a convenient and free portal for healthcare providers to upload and submit insurance claims to hundreds of insurers. View insurer list
Availity
Availity offers several plans, including Availity Essentials, which is completely free. Availity Essentials supports many of the largest health plans, including Aetna, Anthem, and BCBS. Features include eligibility and claim status, pre-authorizations, claim submission, and notification features.
The Availity Essentials Plus plan offers more insurers (compared to the Essential plan) for $25/month. Availity Essentials Plus could be more affordable for your business even with this plan, as they don't charge for each provider you have (unlike Office Ally). Essentials Plus plan includes unlimited transactions with participating payers and 250 transactions/month with their non-participating insurers.
To create a free Availity account, please use the button below:
Office Ally + Availity = Free Insurance BillingMany practices use Availity alongside Office Ally rather than as a replacement. 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. Check out the Office Ally payer list to see which insurers are participating and non-participating 👉
If an insurer is listed as non-participating, then may well be able to submit claims directly to them via Availity Essentials for free 🤑 . See Availity's payer list below.
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Creating Insurance Claims
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. Availity insurance claims are created just the same as other bills. Click on the button below for instructions.
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:
Filter of which bills are included in a batch through several factors, including specific insurers, providers, and locations.
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.
Select the Claims & Payments tab
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.
