Secondary Billing in AlohaABA

Secondary Billing in AlohaABA

Alert

FYI: As of 7/3/24, our Secondary Billing feature will exclusively support Office Ally as the selected clearinghouse at this time. Secondary Billing cannot be completed with an Availity integration.

As this feature is newly released, we recommend submitting one secondary claim to each payer initially to ensure its acceptance in the payer portal before proceeding with mass billing of all secondary claims. Once confirmed, feel free to submit additional claims confidently. 

Part 1: System Setup 

Step 1: Turning On Auto Transfer in Settings 

  1. In Aloha, navigate to Settings > System Settings
  2. Under the "Billing Settings", toggle on "Auto Transfer to Secondary"  
    1. When ERAs are auto-posted, the system will automatically transfer balances from primary to secondary. 
    2. Not toggling this on will require manually transferring the balance from primary to secondary upon manual payment posting. 




 


 


Step 2:  Customizing Secondary Transfers by Client

It is now possible to customize when balances are transferred to secondary payers based on payer requirements.

1.  Navigate to Client Profile> Authorization > Payer.

2.  Click  and verify that "Secondary" is chosen under the Coordination of Benefits section. 


 

3.  Under "Transfer to Secondary", select one of the following options:

  • Do NOT transfer to secondary to disable auto-transfers for one particular client. 
  • Transfer to secondary if Patient Responsibility is present is the default option.  Most secondary payers only pay patient responsibility.
  • Transfer to secondary if there is a Contractual Obligation but no Patient Responsibility is the option to choose when the secondary pays at a higher rate than the primary and will reimburse even when no patient responsibility is present.

 

 

Part 2: Transferring Claims from Primary to Secondary 

Once the primary payment is received, secondary can be billed.  The ERA or EOB must be received in order to accurately complete secondary claims.  If a claim still needs to be fixed for primary (e.g., there is a denial on one chargelines), do not bill out secondary. 

Option 1: Auto Transfer 

If Auto Transfer is turned on, when an electronic remittance advice is posted and the client has a secondary identified as in the previous part, Aloha will transfer the claim to secondary and will be taken up in the next step.  

 

Option 2:  Manual Transfer 

If the payment needs manual entry or the claim doesn't auto-post from an electronic remittance advice, manual transfer of the claim will be necessary.   

Manual Transfer 

Step 1: Post the payments 

To initiate manual transfer, begin by manually posting the payment as usual (Adding and Managing Payments). Ensure all necessary posting is completed for the entire claim.

 

Step 2:  Manually transfer the claim to the secondary payer 

Once the payment information has been posted for all charge lines for the claim in the payment details section, click the “Transfer” button at the top. If there is a listed secondary for that client, it will appear after a second. Select the secondary insurance.


Alert**NOTE** If clicking the "Transfer" button doesn't display a secondary, it indicates that the selected client doesn't have a secondary identified in their profile's authorizations tab. Please refer to Part 1 for instructions on how to identify the secondary in the Aloha System. After transferring the claim to the secondary payer, the system will consolidate all balances and adjustments into the payer balance. The claim status will then be updated to "Ready to Bill." This action will remove the charge lines from the client's statement and the patient view in AR Manager.  

 



 


  

Part 3:  Reviewing and Editing Claims  

Examples of situations where you may need to edit the claim include:  
  1. The primary uses CPT codes (97153, 97155, 97156) from secondary (H2019, H0032, etc...) 
  2. Secondary uses modifiers
  3. Chargelines are not adding correctly

Step 1: Navigate to Billing > Secondary Billing



 


 


Info
 If you do not see "Secondary Billing", please check your User Role permissions for visibility. This can be found under Settings > Security > User Roles. Under your specific User Role (assuming Admin), make sure you have "Secondary Billing" selected as "Full Access" and hit save at the bottom.




  Selecting multiple claims enables you to perform the same action on simultaneously by selecting them together. (Applies only to releasing and submitting claims.)  

 Opens the claim history to view the transactions that have occurred so far for this claim. 

Allows review and edit both the claim and primary EOB information before submission. 

Select a claim and release to reverse or "undo" the transfer to the secondary payer in Aloha. This action will restore the patient responsibility entered from the ERA and reapply any adjustments made before the transfer. Use this option if claim was mistakenly transferred to secondary.

 Select a claim and click to reveal three options used for submitting claims if no further edits are required. We will explore these options in more detail in Part 4: Validating and Submitting Claims. 

Step 2: Edit the claim. 

 Select as outlined in the previous step for the claim to modify.  


 



 


 

Once selected, Aloha will open the "Edit Claim" screen, which is divided into two parts: "Secondary Claim" and "Primary Remittance." 

  • Secondary Claim: This section serves as a digital representation of the CMS-1500 form. Here, make edits to the secondary claim form before submitting it to the secondary payer. Upon submission, Aloha converts the information from this section into the 837P file sent to the clearinghouse. 

  • Primary Remittance: In this section, you will find details of the primary remittance, including Allowed Amount, Paid Amount, Adjudication Date (date of payment by the primary insurance), and adjustments.     


Secondary Claim View 
The areas highlighted in yellow are editable. 

NotesIf the "Patient Relationship to Insured" is "Self," Boxes 4 and 7 (Insured’s Name and Address) will not be editable. The screenshot below has redacted areas to comply with HIPAA regulations; however, these boxes remain editable.
IdeaTo correct information in this top section, consider reviewing client and payer setup to prevent similar issues in future claims. 

 



 


 



  


 

Primary Remittance View 

The Primary Remittance information that is pulled based on the primary posting information in Aloha.  The areas outlined in yellow below are editable fields.



 


WarningOne common error is that chargelines are not adding correctly.  The Charge (Box 24F) (in secondary claim) must equal the paid + any adjustments (in the primary remittance section).  If this error pops up; double check the primary ERA to ensure all information properly transferred over. 

Part 4: Validating and Submitting Claims 

Once in the edit screen, the following icons are available: 



 

Release:  As previously described, the Release button reverses or "undoes" the transfer to the secondary payer. Aloha will restore the patient responsibility and reapply any adjustments made before the transfer. Use this option if the claim was mistakenly transferred to secondary.


Validate:  Upon clicking, Aloha will verify the claim for errors to ensure all necessary information is included and to prevent potential rejections.

Submit Claim:  This button will open a drop-down menu to select how to submit the claims (see below).  
 
Save:  Save the claim to continue editing later. 

Discard:  Closes the edit screen and discards any changes made.

 

Step 1: Validate the claim.  

After making all necessary changes to the claim and primary remittance information, click the Validate button at the bottom of the screen. Aloha will then conduct checks to minimize the risk of rejection. Upon completion of the validation, the system will display one of two outcomes: 

Errors: If errors are found, correct them on the claim form or primary remittance information before proceeding. 



 



 


 


 

If no errors are found, this indicates that the claim is now ready for submission to the secondary insurance.  



 


Alert
 No errors does not guarantee a claim will accepted and paid; it simply minimizes the chance of rejection by double checking the claim.


 Step 2: Submit the claim 

Once the claim is validated with no errors, it is ready for submission. This can be achieved in 2 ways, electronically, or via paper submission.  


After clicking Submit Claims, three options will appear: 

  • Option 1: Submit to Clearing House. With this option, Aloha will convert all claim information into an electronic format and send it to your selected clearinghouse for the secondary payer.  This can only be completed with Office Ally as the clearinghouse.

  • Option 2: Paper Mail with Background. This option prints the claim with the CMS-1500 background visible to a PDF document for downloading and printing. Note: Some insurances require claims to be printed on pre-printed forms; this option may not be suitable and could lead to rejections. 

  • Option 3: Paper Mail without Background. Similar to Option 2, but the background is not visible. This is preferable if preprinted CMS-1500 forms for mailing claims are used. 




  • InfoFor Options 2 and 3, download a copy of the primary payer EOB and attach it to the claim form. 



 

  



 

Once the submission level is selected, Aloha will generate the corresponding file for electronic submission or paper mailing and show the "Process Billing" screen. 



 

For electronic submission (Clearing house) the process is complete. For paper mail submission, download and print the claim form to submit directly into the portal.  


 

Warning
As of 7/3/24, only ONE claim can be selected at a time to submit to secondary. We are working on this and will address this ASAP so that users can select multiple claims at once for submission. 
Alert
Please remember to check in your payer portal for confirmation of the secondary claim submission. 


    • Related Articles

    • Secondary Billing Instructions in Office Ally

      Aloha Secondary Billing: Secondary billing within Aloha is now available. The steps in this current article below are to show you how to bill to secondary within Office Ally's site. You can access the instructions to complete your Secondary Billing ...

    • Release Summary 2.6.7 Secondary Billing

      The Aloha ABA team is excited to share our latest update regarding Secondary Billing. On Tuesday, July 2 2024 at 11:30PM PST Secondary Billing features will be deployed to all customer sites. During this time, your site may be temporarily unavailable ...

    • 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 in Office Ally Payer List) and have completed eligibility checks for your clients to ensure ...

    • FAQ: Billing

      These frequently asked questions will help provide guidance as you troubleshoot through the billing section of Aloha. I settled a claim, but then ended up getting paid for it. How can I unsettle? Start by going to AR manager and double clicking on ...

    • Preparing for Aloha's Insurance Billing Services

      Welcome to the Aloha family! We're super excited for you to move forward with using Aloha's billing services. Before you meet your assigned RCM manager from the Aloha Billing team, please complete the following steps: Required Steps to ensure ...