Sending Electronic Claims to Office Ally
Before sending claims, whether test or production, you'll need to setup your client's insurance billing information under Clients (button at top) > Details > Billing & Insurance (tab at top of page).
You also need to make sure that the client has a Progress Note for appointments and Diagnostic code(s) in their notes.
Claims are generated from invoices, so to send a claim, you'll need to create an invoice and then send the invoice to the clearinghouse as a claim.
The easiest way to create an invoice is to schedule a client.
1. Go to Calendar and schedule an appointment with a client:
2. After the session, go to the client's Ledger page and create a new invoice. (click Clients at top > click Ledger next to appropriate client). You can also use an existing invoice by clicking on an existing invoice in the Ledger page.
3. In the invoice, make sure you select the appropriate provider or leave blank if you're billing with the Organization or Facility NPI.
4. Click Save & Add to Claims Awaiting Submission at the top.
5. Make sure diagnostic codes exist for the client. You can click “Enter Notes” from the Dashboard, next to the appointment, or from the client’s Details page.
Go to the appropriate tabs in the notes section to enter codes and progress notes.
Enter Diagnostic codes as necessary under Initial Assessment and Diagnostic Codes.
Under Progress Notes, for each session, enter the notes for the Date and Time of each appointment
The diagnostic codes should show in the Progress Notes.
6. Once you’ve entered a diagnostic code and a progress note, then created an invoice and added it to Claims Awaiting Submission, click Billing on the left navigation menu, and click Claims Awaiting Submission.
7. Switch from Test Mode to Production Mode since you are using Office Ally. Office Ally does not require you to submit test claims first.
8. Select the invoices/claims you'd like to submit and click Check Selected Claims for Errors.
9. Once you fix any validation issues that pop up, click Send Selected Claims.
Your claims have now been submitted.
10. Click Submitted Claims under the Billing menu to see status.
11. You can mark a claim as Failed to Process and re-submit from here as needed. Or Mark as Paid once you receive an ERA.
ERAs are always on for users with Office Ally. When a user gets an SFTP account, if they have ERAs, they will be automatically pulled through to your TheraNest account. However, you may need to work with your Payers and Office Ally to link your ERAs to Office Ally. Office Ally's customer service is able to assist with that. You can process ERA files following this article.
12. You can process ERA's after they are received by clicking Billing > Process Claim Payments (ERA).
All paid claims will appear on the page.