Correcting Claims in Office Ally

Correcting Claims in Office Ally

After you’ve processed claims through Aloha to get sent to Office Ally, you may encounter a situation where you need to fix or correct a claim. Before we get started, let’s define these words:  


Rejection: When a claim is rejected, the claim must be fixed so that it goes through to the payer. A rejected claim means that it got stuck in the clearinghouse (OA) due to a clerical or demographic error, and has to be addressed before the payer receives it.  Sometimes a claim is accepted by the clearinghouse and then rejected by the payer before a claim number is created for it.  This should still be treated as a rejection rather than a denial.


Denial: When a claim is denied, needs to be edited after submitting and has been received already, or voided, then it needs to be corrected. A denied claim has been received by the payer and denied for whatever reason, and needs to be addressed before resubmitting for reconsideration.

Claim Correction due to a Mistake:  If you realize you made a mistake on a claim that wasn't denied or rejected by the payer, it's still important to do a claim correction.


Info

Office Ally Definitions:  

Passed = the claim was successfully submitted through Office Ally and has been sent to the payer. 

Rejected = the claim has been rejected by Office Ally and is correctable. It needs to be fixed before the payer receives the claim.  

Rejected+ = the claim has been fixed and has been processed to be sent to the payer. It is now sitting in “Awaiting Batch” until OA sends them off. 

Awaiting Batch = claims that have been fixed and are in a “queue” to be sent off by Office Ally and sent to your payer. You have one more opportunity to fix/edit your claims before Office Ally sends them off in a batch to be reprocessed.  


Claim Fixes in Office Ally

Rejections


Office Ally has two views you can toggle between depending on your preference—new view or classic view. 

Alert
Fixing a claim in Office Ally will result in the claims looking different in OA than in Aloha.  Fix the claim in Aloha if you want accounting to match. 

New View

1.  Under Claims, click “Review Correctable Claims” or “Manage Claims”  


 

2. Look for anything that shows a status of “Rejected”.  
3. Click the "view" (it looks like an eye) button to the right of the claim (you may need to scroll) next to the claim that was rejected. 
4. This will lead you to the CMS1500 form in an editable format. The top will display the rejection reason code and description so that you can fix it.  
5. Fix the necessary information/fields and click Send at the top. This will resubmit your claim so it can get reprocessed and sent to your payer.  
There is no need to update Box 19 and 22 as you would for a denial.  

6.  The claim status should be updated to  This indicates the claim has been fixed.


Classic View


 

On the left hand side navigation bar, select Claim Fix > Repairable Claims.  A calendar will be displayed to show you which dates have claims that can be fixed. The pink box on a date indicates there are DOS there that need addressing.  
  1. Click the pink box on the calendar to view claims.  
  2. Rejected claims will appear in the list below. Correct the claim according to it's rejection reason. 
  3. Press update. Your claim has been reprocessed and will get sent to the payer now.  

 

Denials (or if you realize you made an error):  

You will know if a claim is denied based on what your EOB/ERA says, Office Ally will not automatically display your claims that were denied, so you need to identify it on the ERA and then search for it to make any corrections. 


Idea
This method will also work if you realize that you made a mistake on a claim before the ERA comes back.


New View

  1. You can search for your denied claims by clicking “Manage Claims”. 
  1. Select the checkbox next to the claim that was denied and click “View Claim”. You will see the CMS1500 form in an editable format.  
  1. Fix the necessary information/fields.  
  1. Boxes to update on CMS1500 form: 
  1. Box 19—Enter the note/reason the claim was changed (e.g. corrected claim – HO modifier added)  
  1. Box 22 – original reference no. (the original claim number assigned by the insurance company, can be found on payer portal or on ERA listed as “Payer claim control No” or at the top of the claim in Office Ally
  1. Change resubmission code from 1 to 7 (next to Box 22)  
  1. Make the necessary changes to the claim based on the denial reason 
  1. Click “Send” at the top. This will resubmit your claim so it can get reprocessed.  

Classic View

  1. On the left hand side under Reports, click on “Inventory Reporting”  
  2. In the next screen, you will enter your search parameters to find your claim. This includes selecting the payers, the date range, DOS as your data type, then click “search”.  
  3. Click the pencil icon next to the claim to edit.  
  4. Boxes to update on the CMS1500 form: 
    1. Box 19—Enter the note/reason the claim was changed (e.g. corrected claim – HO modifier added)  
    2. Box 22 – original reference no. (the original claim number assigned by the insurance company, can be found on payer portal or on ERA listed as “Payer claim control No” 
    3. Change resubmission code from 1 to 7 (next to Box 22)  
    4. Make the necessary changes to the claim based on the denial reason 
  5. Click Update, and this will resend the claim over to get reprocessed.