How do I prepare and send electronic billing claims?

Once the claims for a payor have been finalized, you can change their status to prepared. The next time you select send 837 for that payor, any prepared claims will be sent to the clearinghouse.

Preparing claims

Once all visits on the claim have been approved, you can prepare the claims for sending. You can prepare all the claims from the funder from the claims list by selecting prepare claims.

You will then be able to select which draft claims you wish to prepare for sending by checking the box next to the claim or at the top of the list to select all claims.

Once you have made your selection, click prepare selected claims.

In the dialogue, select the prepare claims button to continue.

The status of the claim will be changed to prepared.

Unpreparing claims 

If you wish to set the prepared claims for the payor back to draft status so they are not sent the next time you select send 837, you can select the unprepare claims button.

After selecting unprepare claims, you will be able to select which claims you wish to set back to draft status. Once you have chosen which claims you wish to set to draft, select unprepare selected claims.

Sending the 837

Once a claim has been prepared, the 837 can be sent to the funder. Select the send 837 button from the funder’s claims list to send all claims in prepared status.

Selecting send will change the status of prepared claims to sent. While the claim is in sent status, you will not be able to edit the claim by voiding it, revising it, adding transactions, or editing the claim summary.

Sending the claim will create the sales transactions and calculate the bank adjustments. You will then be able to view the sub-total, bank adjustment, and unit adjustment on the claim.

You can view the transactions created for each service line upon sending the claim from the accounting tab of the service lines section.

In the transaction history for each service line, you will see the sale transaction as well as any credits or debits to the bank that were logged when sending the claim.

Hover over the   icon to view the name of the employee who created the transaction (sent the claim) and on which date.

You can review the invoices created for each service line by going to Accounting>Billing>Invoices.

Once the claim has been received by the clearinghouse, the status of the claim will change to acknowledged. Like a sent claim, an acknowledged claim cannot be edited in any way.

If the claim is received and approved to be sent to the funder, the status will change to accepted.

If the claim is rejected by the clearinghouse due to an error, the status will change to rejected.

If the claim is accepted and paid by the funder, the status will change to paid once the file is received by AlayaCare.

 If the claim is denied by the funder, the status will change to denied once the file is received by AlayaCare.