Billing Overview

Billing Overview




Getting Ready to Bill

It is vital to have the correct information in the system to submit for billing.  Make sure you have the correct Payer ID (double check the clearinghouse) and have completed eligibility checks for your clients to ensure that you are sending your claims to the right place.

Before you bill

  1. Clearinghouse connected (ensure your CSM has connected your clearinghouse and the clearinghouse is selected in the payer profile
  2. Double-check that you have the correct payer ID
  3. Ensure any required EDIs were completed
  4. Complete eligibility checks for clients to ensure that you are sending claims to the right place.

Check and make sure that your appointments are ready to bill. 

  1. Go to Reports > Appointment Billing Info
  2. It is recommended to bill one payer at a time (e.g, BCBS CA)
  3. Set your parameters with your payer and date range
  4. Hit Generate and all the appointments from that payer in that date range will populate
  5. Scroll to the right and view the Completed column.  If you see a "Yes", this appointment is ready to bill.  If it is blank, the appointment has not been completed/verified.  Go back to the schedule and go to the Verification Tab and check the box that says "Completed".
Alert
All appointments, whether completed or not, will appear in this report.  If you skip this step and go straight to the Billing Manager, uncompleted appointments will not appear.  

Once all of the appointments for your desired date range have been completed, you are ready to bill.  To access any of the features below simply click the  icon on the left navigation menu.

Billing Manager

Processing Billing

  1. Select a date range and payer to find your billable appointments and click Generate.
  2. Sort and filter the appointments using the Search field at the top or sort at the top of each column.
  3. All appointments with a GREEN box are ready to bill.
  4. All appointments with an ORANGE box contain a validation error.
    1. You can view the validation error by hovering over the  icon.  
    2. In most cases you can simply fix the error on the same screen by locating the column which has the missing or incorrect information. After fixing the validation warning the orange checkbox will change to green and your all set!
    3. If multiple appointments have the same fix, you can select them all and perform a "bulk update" to fix them all at the same time.
  5. Scan across your appointments to ensure there is no important information missing (e.g., modifiers)
  6. Select the appointments you would like to bill. 
  7. After confirming that you have selected all ready to bill appointments click Process Billing at the top right of your screen.
  8. For insurance appointments, this will create a CMS 1500 form that will go to the clearinghouse (if connected).  Review this form and click Process Billing again to send to the clearing house.
    1. If your clearing house is not connected to the Payer, your claim will not go anywhere and just be considered "billed" in Aloha.

Customizing Billing Manager Columns

  1. Click   on the top right of the screen.
  2. Settings
    1. Freeze Columns - Freezes the # of columns on the left. These columns will always be view-able.
    2. Max Appointments per page - How many appointments to show on the same page.
    3. Managing Columns - Customize what columns to see on the Billing Manager screen.

Accounts Receivable

AR Manager
Once a claim is billed out, it moves from the Billing Manager to AR manager.  All transactions related to billing (post payment, adjustments, re-bill, denials, rejections etc.) will be processed through AR Manager. Toggle between Payers or Clients by using the drop down on top of the filter section. 


Claim View

To view a detailed breakdown by claim, double click the payer. Aging and status will be displayed under the State column.

Smart Actions
Smart Actions will be available after selecting one or more claims.
  1. Transfer
    1. Will automatically transfer the claim to the secondary insurance indicated when setting up authorizations. If the secondary insurance is not available the Transfer option will not be available. 
  2. More:  You will be able classify the claim to the following with the More option.
    1. Rejected:  A rejection means there is a clerical error on the claim and it was not able to be viewed because of this (e.g, wrong payer ID).  Most often in this scenario you will use the release option.
    2. Denied:  Mark a claim as denied when the insurance company has refused to pay a claim and given you a remit with a reason code. This is different than a rejection.  A reason code will be required and can be found on the ERA/remit.
    3. Release:  Complete this option when you need to make changes to an appointment or claim.  This will make the Aloha system think the claim has not yet been billed.  An example might be if you need to change the number of units billed.  When you are ready to bill it again, go back to the Billing Manager.  Releasing a claim only releases it in Aloha, not in a clearing house.
    4. Settle:  The payer has not paid you the amount that was contracted, but you are not going to continue to engage in negotiations.  This will mark the balance as zero.
    5. View invoice/claims:  View your CMS 1500 form again

277/999 Statuses 
The various statuses display acceptances or rejections at the clearinghouse level or at the payer level. The O indicates Clearinghouse, and P indicates the Payer.

To receive these 277/999 statuses from Office Ally, please follow instructions here. 
To receive these 277/999 statuses from Availity, please follow instructions here.
  1. Accepted (O): The claim was accepted by Clearinghouse.
  2. Accepted (O/P): The claim was accepted by both Clearinghouse and the Payer.  
  3. Accepted (Error-P): The claim was accepted by Clearinghouse, but rejected by the payer
  4. Rejected (O): The claim was rejected by Clearinghouse needs to be corrected before submitting again. 



Chargeline View

To view the chargelines (i.e., specific appointments) in a claim double click the claim.

Generate Invoice 

For non-insurance payers (school districts, regional centers, private payers), invoices will need to be generated AFTER appointments have been processed for billing.  This will also apply to client responsibility (i.e., deductibles copays and coinsurance).  Instructions can be found here: Generating Invoices

Secondary Billing

Please click this link for instructions on Secondary Billing

Fix Claim

Claims that have been marked as Rejected or Denied will need to be fixed.  Please click this link for instructions on completing a Claim Fix in Aloha.

Verification Forms

If a payer requires a verification form (not common), these can be generated by going to Billing > Verification forms
  1. Payer:  Select a payer to generate a verification form.
  2. Verification Format: Select which verification form to generate (DDS Parental Verification/DDS with Service type/ Parental Verification).
  3. From / To Date: Date range for appointments.
  4. Client(s): Select the clients to show on the verification form.
  5. Appointment State: What type of appointments to display (All/Signed/Completed) on the verification form.
  6. Click Generate and download if desired.















FAQ Billing




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