Correcting Claims in Office Ally/Aloha

Correcting Claims in Office Ally/Aloha

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.

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 rejections and denials can be handled in two ways:
  1. Directly through Office Ally
  2. Release and Rebill in Aloha (only necessary if it will change the amount outstanding in your AR)





Fixing Claim (for Rejections) through Office Ally: 


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

FYI: Fixing a claim in Office Ally is the quickest way to fix a claim. However, in Aloha the original claim you processed will still appear the way it was originally billed out even though you’ve changed it in Office Ally. For quick fixes where you don’t mind it looking different in OA than in Aloha, this is the preferred method to correct it. If you want AR Manager/Reports to accurately reflect what you’ve changed, you need to release the claim, make your corrections, and fake “rebill” it so that it matches what you just changed in OA.  


Fake Rebill:  

Go to your Payer list > Select the payer > Under “Clearinghouse” change it to “None”. Make your corrections in Aloha, then Process Billing for the claim in Billing Manager. Lastly, go back to your Payer List and turn the clearinghouse back on so that your claims you bill actually get sent out to Office Ally.  


In the new view: Click “Review Correctable Claims” or “Manage Claims”  


 

  1. You can search for claims that need to be fixed through clicking “Review Correctable Claims” or “Manage Claims” and looking for anything that shows a status of “Rejected”.  

  1. Select the checkbox next to the claim that was rejected and click “View Claim”. 

  1. You will see the CMS1500 form in an editable format. The top will display the rejection reason code and description so that you can fix it.  

  1. 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.  

  1. The claim status should be updated to This indicates the claim has been fixed and is good to go.  

In 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.  

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.  


 

Fixing claim (for Rejections) through Aloha: 

This method takes a little bit longer than doing the fix directly through Office Ally, but ensures that your AR manager/reports will match what you’re correcting in Office Ally.  

Because the payer never received the claim to begin with and it’s “stuck” in Office Ally as rejected, you will release the claim out of Aloha, make your corrections, and rebill it as if it were a new claim. 

  1. Release the claim  

    1. Click the Billing icon > AR Manager > double click the payer name > select the claim > “More” in the top right corner > Release

  1. After releasing the claim, the claim will return back to the Billing Manager as if it were never billed in the first place.  

  1. Update the appointment by going back to the Schedule or Billing Manager to make your changes according to your rejection reason.  

  1. Return to the Billing Manager > Process Billing just as you did the first time

  1. Your claim has been sent off to Office Ally and reprocessed.  

 

Correcting a Claim (for Denials) through Office Ally:  

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.  


FYI: Fixing a claim in Office Ally is the quickest way to fix a claim. However, in Aloha the original claim you processed will still appear the way it was originally billed out even though you’ve changed it in Office Ally. For quick fixes where you don’t mind it looking different in OA than in Aloha, this is the preferred method to correct it. If you want AR Manager/Reports to accurately reflect what you’ve changed, you need to release the claim, make your corrections, and fake “rebill” it so that it matches what you just changed in OA.  


Fake Rebill:  

Go to your Payer list > Select the payer > Under “Clearinghouse” change it to “None”. Make your corrections in Aloha, then Process Billing for the claim in Billing Manager. Lastly, go back to your Payer List and turn the clearinghouse back on so that your claims you bill actually get sent out to Office Ally. 


In the new view:  Click “Manage Claims” 

  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” 
  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.  

In Classic view:  Navigate to “Inventory Reporting”  

  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.  


Correcting a Claim (for Denials) through Aloha:  

If you choose to fix the claim in Aloha, it will send automatically back to the clearinghouse.  


  1. Claims need to be denied in AR Manager. Go to Billing > AR Manager > double click the payer name and select the corresponding claim that needs to be marked denied.  
  2. In the top right corner, click “More” and select “Denied”  
  3. In the pop up, enter the denial date, reason code, and any note you'd like to make about the denial. Click “apply” when done. 
  4. Denied claims will now appear under Billing > Fix Claim  
  5. Select the claim you want to correct and click “Fix Claim” in the top right.     
  6. Complete the necessary fields to update, just like how you would on the CMS1500 form.  
    1. In the Submission information window: 
      1. Resubmission code is equivalent to box 22 (7 for replacement of claim, 8 for voiding a claim)
      2. Original reference no (the claim number assigned by the payer) is equivalent to box 22  
      3. Additional claim information is equivalent to box 19  
    2. Update the changes you need to the claim itself for the denial reason (e.g. update units, auth number, etc.)  
  7. Click “Ready to Bill” when done.  
  8. On the left hand side in Billing, go to “Rebill” 
  9. Any claims that were ready to bill are now sitting in Rebill. Select the claim and process billing just like how you would in the Billing Manager.  
  10. Your claim has now been sent off to the clearing house and resubmitted.

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