In some cases, a payor configured to send claims electronically may send a response 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 the status you wish to change.
In the edit claim status dialogue, select the new status. For accepted claims, you can select either paid or denied. For denied claims, you can only select paid.
Enter the internal control number you received on the 835 file or check the box to allow internal control number field to remain empty.
Finally, check whether you wish to add the transactions after changing the status. If you check this box, you will be prompted to enter the transactions for the service lines after saving the new status. If you leave the box unchecked, the status will be updated without adding a payment or write-off transaction to any service lines on the claim.
When you are ready, click save.
If chose to add transactions to the service lines, second dialogue will open to allow you to choose how you wish to apply transactions associated with the status change. When changing the status to denied, the transaction type selected will be write-off. When changing the status to paid, the transaction type selected will be payment.
Adjust the posting date if necessary and choose whether you wish to apply the transaction to all service lines or individual service lines.
Once you select all service lines, the visit details for all service lines on the claim will appear below.
For write-off transactions applied to all service lines, you must select an expense account and have the option to add a comment.
For payment transactions applied to all service lines, you must select a payment method and have the option to add a comment.
When applying transactions to individual service lines, check the boxes next to the service lines you wish to apply transactions to. For payment transactions for individual service lines, you can enter a payment amount and comment.
For write-off transactions for individual service lines, you can enter a write-off amount, select an expense account, and add an optional comment.
Before adding the payment transactions, you will also need to select a payment method.
Before adding individual write-off transactions, you can also select a default expense account. Note the selecting a default expense account will override the expense accounts selected at the service line level.
When you are ready, click add transaction. The transactions will be added for each service line. Go to the transaction history for each service line to review the changes.