Before you can successfully generate and send claims in AlayaCare, you must set up electronic billing funders and corresponding bill codes to attach to the services you wish to create claims for.
- Setting up electronic billing funders
- Creating bill codes for electronic billing funders
- Additional required fields for electronic billing
- Creating services
Setting up electronic billing payors
For visits to be included on electronic billing claims, the service must be funded by an electronic billing payor.
To learn how to set up an electronic billing payor, see how do I create an electronic billing payor?
Creating bill codes for electronic billing payors
A bill code must be linked to the electronic billing payors for which you wish to generate claims.
Bill codes for electronic billing should begin with the procedure code followed by a colon and 4 digits (for example, ER:2020). The available procedure codes are:
- JURISDICTION_SPECIFIC_PROCEDURE_AND_SUPPLIES_CODES = ER
- HEALTH_CARE_FINANCING_ADMINISTRATION_COMMON_PROCEDURAL_CODING_SYSTEM = HC
- HOME_INFUSION_EDI_COALITION_PRODUCT_SERVICE_CODE = IV
- ADVANCED_BILLING_CONCEPTS_ABC_CODES = WK
After selecting an electronic billing payor as the funder on a bill code, additional fields will appear for you to complete. These fields will vary according to whether the claim type is professional or institutional.
For bill codes for professional claims, make sure to select a billing increment and place of service code in addition to filling out other required fields.
The billing increment represents the amount of time that constitutes a billable unit when generating claims for the bill code. Available options are 60 minutes, 30 minutes, or 30 minutes.
The place of service code represents a code that indicates where a service occurred. Start typing to select a configured option.
For bill codes for institutional claims, enter a billing increment, facility code, revenue code, and revenue code description.
For the facility code, start typing to select one of the predefined codes for indicating the location of the visit. Note that a maximum of 48 alphanumeric characters will be accepted in the revenue code field and a maximum of 80 alphanumeric characters will be accepted for the revenue code description (no special characters permitted).
When you have completed all required fields for the bill codes, click save.
Additional required fields for electronic billing
In addition to setting up electronic billing payors and bill codes, a few additional fields at the agency, client, and client contact level must be correctly filled out to be able to send claims successfully from AlayaCare.
In Settings>Agency Information>Address, the agency needs to have an address set. Note that the city name cannot contain any accents.
The client needs to have the following fields completed under Demographics on the client profile:
- External ID
Note that if you intend to send the claim through Waystar, the claim will be rejected unless the client has a valid U.S. address.
Clients also need to have their medical history filled out. In Care Documentation>Medical History on the client profile, add one or multiple rows in Current Medical History with the client’s relevant diagnoses.
If you have selected yes for send date of injury for electronic billing payors of professional claims, you can use the following form context fields to send injury-related information on claims:
- Medicaid accident type (tag: medicaid_eb_injury_type).
- Medicaid accident date (tag: medicaid_eb_injury_date).
- Medicaid accident state (tag: medicaid_eb_injury_state).
When creating contacts for clients, there are two fields available for clients whose services are billed to electronic billing payors: provider type and NPI.
In the add client contact dialogue, you can select referring provider, rendering provider, attending provider, supervising provider, operating provider, or ordering provider as the provider type for this client and enter the NPI (national provider identifier) that you wish to send on claims.
When creating services that are funded by electronic billing payors, you must select electronic billing as the funder methodology. You will then be able to select the correct electronic billing payor as the funder and service code.
You can also add a prior authorization number where applicable.