Availity - Kalix Integration
Availity is a comprehensive revenue cycle management solution that provides a range of services.
Kalix now directly integrates with Availity's clearinghouse solution via Secure FTP (or SFTP) for batch claim processing. By using the Kalix-Availity integration, you can submit claims to Availity 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.
The Kalix - Availity integration currently supports:
Professional Claims (837P)
Claim Status (276/277)
Claim Payment/Advice - Remittance (835)
Availity Essentials
Among its solutions is Availity Essentials, is completely free to use. Availity Essentials supports many of the largest health insurers, including many Aetna, Anthem, and BCBS plans.
Participating Insurers
To view Availity's participating insurers - those free to bill via Availity Essentials, you can 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.
Another option for insurer look up is to search Availity's Payer List via their website. Again, search for your insurers by name.
Make sure you select the Submission Type: Batch SFTP and the Transmission Type: Professional Claims (837P). If Availity lists an insurer as "Available" under the Batch column, it is free to submit claims to that insurer via the Kalix-Availity integration (with a free Availity Essentials account).
Non-Participating Insurers
Availity still allows you to submit claims to their non-participating insurer, but a paid account is required. Their paid plan is called Availity Essentials Plus and offers more insurers (compared to the Essential plan) for $35/month. Essentials Plus plan includes unlimited transactions with participating payers and 250 transactions/month with their non-participating insurers.
Once you set up an Availity Essentials account, you can update to an Essentials Plus plan from within your account settings.
Billing Using Multiple Clearinghouses
Alternatively, Kalix supports submitting different insurance bills within a batch via a range of clearinghouses.
When setting up a client's insurance details, you can assign which clearinghouse you will submit their insurance claims using.
Setting up Availity
The remainder of this article will specifically detail how to set up an Availity Essentials account and connect it to Kalix for claim submission via our integration. The process is broken down into 5 stages:
Stage 1: Create an Availity Account & Register Your Business
In order to use the integration, you are required to create a free Availity Essentials account for your practice.
If you already have an Availity account, skip to Step 3.
Please use the button below to commence this process:
Follow the wizard to create your account, set up 2-factor authentication, register your business, set yourself up as a provider, and verify your identity.
For step-by-step instructions, please click on the button below:
Stage 2: Enrollment
Some insurance companies require pre-enrollment forms to be completed before Availity can submit electronic claims on your behalf.
Additionally, enrollment may be needed to receive automatic electronic claim payment/advice (remittance) and/or claim status updates (277 files).
Optional - Check Enrollment Requirement
To see whether any enrollment is required for your insurers, click here to view the Availity Payer List and search for your insurance companies.
Important Tips:
Use the Insurer list filters to find the correct information. The Submission Type you need to select is Batch (SFTP).
The transaction types to select are Claim Status (276/277), Claim Payment/Advice - Remittance (835), Professional Claims (837P) & Professional Encounters (837P)
If enrolment is required, you will see a green tick in the Enrollment Required column
You can also view whether submitting to the insurer and receiving remittance and claim status advice is free via the Batch column. If Availity lists "Available," the transaction is included as part of Availity Essentials (so it is free). If "Get EDI Plan" is displayed instead, you are required to purchase a paid Availity account (Availity Essentials Plus).
Completing Insurer Enrollment
If you are required to complete enrollment for any of your insurers, please complete the steps below:
1. Navigate to My Providers -> Enrollments Center -> Transaction Enrollment
2. Select the Enroll drop-down and click Enroll a Provider.
3. Enter your details and follow the on-screen instructions.
Note: You can select up to twenty payers at a time from the list in the Payers field, or you can click View All Payers and select your payers from the Select Payers window.
5. When you click Done on the confirmation page, an email will be sent to you.
Important Note
Make sure (if available) you select Electronic Remittance Advice
Note: this is a one-time set-up step.
Stage 3: Create Your FTP Availity SFTP (or FTP) Mailbox (or Account)
In order to link Kalix to Availity, you need to create an FTP (or SFTP) Mailbox (or Account) from within your Availity account settings. The steps to do this are outlined below:
Log into Availity Essentials
Navigate to Claims & Payments -> FTP and EDI Connection Services -> Manage Your FTP Mailbox.
Note: FTP administration is limited to certain roles within Availity Portal. If you can't navigate to the above location, you don't have the appropriate role. In that case, look up your account administrators by navigating to My Account Dashboard > My Administrators on the home page of the Availity Portal. Ask them to add the EDI Management role for you so that you can manage the FTP mailbox for your organization.
3. Once you're on the Manage Your FTP Mailbox page, follow the on-screen instructions to create a username and password for your FTP account.
Important Note: Make a note of these account credentials. You will need to input them into Kalix.
Stage 4: Set up your EDI Reporting Preferences
Below is a diagram displaying the data interaction between Kalix and Availity. Setting up your EDI Reporting Preferences correctly will ensure these interactions occur.
To receive claim status updates for submitted claims as well as payment and remittance information, please follow the steps below exactly.
1. Log in to the Availity Essentials Portal.
2. Navigate to Claims & Payments > EDI Reporting Preferences.
3. On the EDI Reporting Preferences page, select the organization for which you're setting preferences.
4. On each of the EDI Reporting Preferences tabs, specify the preferences you want, and then click Save to save the preferences for that tab. Changes are saved on a per-tab basis.
Only some of the preferences are applicable to the Kalix-Availity integration. If an option is not described here, Kalix does not use it.
Setting up Interchange Acknowledgments
Under the Claims tab, select you wish to receive both positive and negative acknowledgments.
Select the format X12 (.999).
Choose to include TA1 with this acknowledgment.
Important: When you're done making any changes on this tab, click Save before moving on to another tab. Changes are saved on a per-tab basis.
Immediate Batch Responses (IBR)
Please have all of these settings disabled.
Immediate Batch Responses Plus (IBRP)
Have the 277CA enabled only; do not select any of the other format options.
Electronic Batch Reports (EBR)
Select the Text Report (.EBT) with the option Detail Report (.DPT) to receive detailed information that includes acknowledgment of all claims in the payer's response and important messages from the health plan.
The .277CA (.277EBR) must also be selected.
Delayed Payer Reports (DPR)
Select the Text Report (.EBT) and the Detail Report (.EBT). Also, choose to receive the 277CA (.277DPR).
Setting up 835 Delivery Advice
This section is located on the Claim Payment/Advice tab.
Select the Version 5010A1 (this is the default selected).
For Grouped by - select by organization.
Include Customer ID - make sure this option is selected.
Is it up to you if you would like to schedule multiple deliveries of electronic remittance advice files throughout the day.
Claim Status Responses
Claim Status Responses settings are located under the Non-Claim Transaction tab.
For the question - Grouped By: choose not to group the response files.
Under Delivery, choose Immediate.
Mail Box Options
On the Mail Box Options tab, under X12 Files, select Start for each segment in X12 files on a new line. Do not select use compression.
Step 5: Connect Your Availity SFTP Account to Kalix
Now, it is time to link up your Availity account to Kalix.
Navigate to the Integrations page of Account Settings in Kalix.
Scroll down to the Clearinghouses section and turn on the Enabled switch.
3. Click the Connect associated with Availity. A pop-up window will appear.
4. Enter the SFTP Mailbox User Name and Password you set up in Stage 3.
5. Click Connect.