Once you have generated and reviewed your claims, you are ready to prepare them for sending. On AlayaCare Cloud, this means updating the claim status from Draft to Prepared, and then Sent.
Prepare claims
1. Go to Accounting > Billing > Electronic Billing Summary v2.
2. Select View on the electronic billing payor that you would like to prepare claims for.
3. On the claims list view, select Prepare claims.
4. Choose the claims in draft status you would like to prepare or select all.
5. Select Prepare selected claims.
6. On the Prepare Claims dialog, review the information and validate that you want to proceed by selecting Prepare claims.
The claims will now be in Prepared status. The next time you go to send claims for this specific payor, all prepared claims will be sent to the clearinghouse.
Unprepare claims
If needed, you can revert Prepared claims back to Draft status.
1. Go to Accounting > Billing > Electronic Billing Summary v2.
2. Select View on the electronic billing payor that you would like to unprepare claims for.
3. Select More actions, then Unprepare claims.
4. Choose the claims you want to move back to Draft status.
5. Select Unprepare selected claims.
6. On the dialog that appears, confirm you want to proceed by selecting Unprepare claims.
These unprepared claims will not be sent to the clearinghouse next time you go to send claims for this specific payor.
Send the 837
Once you have prepared the claims, the 837 file containing the claim data is ready to be sent to the payor.
⚠ You will need an integration with Waystar to have the claim sent automatically to the clearinghouse. Otherwise, the claim will need to be exported manually; in that case, taking the steps explained below will only change the status within AlayaCare Cloud. ⚠
1. Go to Accounting > Billing > Electronic Billing Summary v2.
2. Select View on the electronic billing payor you want to send claims for.
3. Select Send 837.
4. On the dialog, confirm you want to proceed by selecting Send 837. (Choosing "Apply Date of Service as the Posting Date for selected claims" sets the posting date per service line to the date of service of the visits on that line.)
The status of each claim item will change to Sent. You may need to refresh the page to see the change.
If there are any sending issues, an indicator beside the claim status will explain why if you hover over the ⚠ icon. (For example, it would say "Unable to get client diagnosis" if there was no client primary diagnosis input on the client's profile.)
For agencies using the Waystar integration:
- Once the clearinghouse has received the claim, the status will change to Acknowledged. At that point, the claim cannot be edited.
- Once the claim is received and approved to be sent to the funder, the status will change to Accepted.
- If the clearinghouse rejects the claim due to an error, the status will change to Rejected.
For agencies using either the Waystar integration or manual exports:
- Once the funder has accepted and paid the claim—or when you manually upload the 835 file for those not using a clearinghouse—the status will change to Paid.
- If the funder denies the claim, or the 835 has been uploaded, the status will change to Denied. (The 835 is a payment file that can contain both payments and denials. For example, a single 835 file could update 10 claims to Paid status and 10 other claims to Denied status.)
- The acknowledged/accepted/rejected statuses can be ignored if your agency does not use the Waystar integration.
View transaction details
Once the claim is sent, the sales transactions will be created, and bank adjustments will be calculated.
1. Go to Accounting > Billing > Electronic Billing Summary v2.
2. Select View on the electronic billing payor you want to send claims for.
3. On the claim details page, go to the Service lines section and select the Accounting tab.
4. Select Transactions on the service line ID you want to view.
This will bring you a detailed view of the banking adjustments alongside the original sales transaction.
To view which employee created the transaction and on which date, hover over the ⓘ icon.
Bulk sending claims
The option to send claims to multiple payors simultaneously will be useful for agencies with numerous payors. With the bulk sending workflow, it is possible to send claims with either Draft or Prepared status.
1. Go to Accounting > Billing > Invoice Management.
2. From the More Actions dropdown, select Send.
3. Select the claims you want to send or select all.
4. Select Send.
5. In the Send Claims dialog, review the details and adjust the Posting Date, if necessary. Choosing "Apply Date of Service as the Posting Date for selected claims" sets the posting date per service line to the date of service of the visits on that line.
6. To confirm, select Send.
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