In some cases, a Funder may choose to respond to a claim directly to your organization instead of through the clearinghouse. In these instances, AlayaCare will not receive the 835 file and thus cannot automatically update the claim's status to Paid or Denied.
If you wish to ensure that the claim record in AlayaCare accurately reflects the status of a claim, you can manually change the status of an Accepted claim to either Paid or Denied or the status of a Denied claim to Paid.
To begin, open a claim and click the icon next to Accepted.
In the dialogue box, you will see the following warning: You should only manually update the status of a claim if you know you will not receive an 835 file for this claim.
To proceed, select either Paid or Denied as the New Status and enter the Internal Control Number (the adjudication number). You also have the option to check Allow Internal Control Number to Remain Empty.
If you select Paid as the New Status, a new Transaction Details section will open below with Payment selected and locked as the Transaction Type. The Amount field will be populated with the claim amount but can be edited as necessary. You can also change the Posting Date from today's date.
If you select Denied as the New Status, the Transaction Details section will appear with Writeoff selected and locked as the Transaction Type. The Amount field will be populated with the claim amount but can be edited if necessary. Note, however, that you cannot write off more than the amount of the claim. Select an Expense Account and adjust the Posting Date as necessary.
When you have finished, click Save to update the status.