Secondary Billing in AlohaABA

Secondary Billing in AlohaABA

Secondary Billing in Aloha ABA

Step by step guide to setting up and billing secondary claims in Aloha 

FYI: As of 7/3/24, our Secondary Billing feature will exclusively support Office Ally as the selected clearinghouse at this time. Our team is working on Availity EDI Clearinghouse and we will keep our users posted.

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 the Settings tab on the left hand side and select "System Settings"
  2. Under the "Billing Settings", enable the "Auto Transfer to Secondary" option to activate automatic transfer functionality.  
    1. This means that when ERAs that have come back automatically from Office Ally are posted, the system will automatically transfer balances from primary to secondary. 
    2. If you do not have this selected but still wish to bill to secondary, you will need to manually transfer your balance from primary to secondary upon manual payment posting. 

 

 


Step 2:  

Make sure that all clients with secondary insurance are configured for auto transfer. For each client with secondary insurance, access their profile, navigate to the authorization tab, and click the edit button for their secondary insurance details.  



 

  1. After opening it, please verify that "Secondary" is chosen under the Coordination of Benefits section. If you prefer not to enable auto transfer to the secondary for this specific client, select "Do not Auto Transfer to Secondary." After making your selections, click on "Save."   

 

 

Part 2: Transferring Claims from Primary to Secondary 

The primary billing process remains unchanged. It will continue as usual until the primary has processed the claim.  

 

 

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. Ensure all necessary posting is completed for the specific claim you intend to transfer. For assistance with manual payment posting, please consult the following article in our knowledge base.  

 

https://support.alohaaba.com/portal/en/kb/articles/how-do-i-add-and-manage-my-payments 

 

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, you will click the “Transfer” button at the top. If there is a listed secondary for that client, it will appear. You will then select the secondary insurance and click on it. This will transfer the claim to secondary insurance. 

**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  

In this section, we will cover how to review and modify the claims and primary EOB information before submission. This allows you to make any necessary adjustments specific to the secondary payer.  
Examples of situations where you may need to edit the claim include:  
  1. The primary used CPT codes (97153, 97155, 97156) but your secondary is using HCPCS codes (H2019, H0032, etc...) 
  2. Primary does not require taxonomy codes, but the secondary does. 
  3. Service Location needs to be added for the secondary 

Step 1: Open the secondary billing section of Aloha 

 

Select the billing icon on the left side of the screen, then select “Secondary Billing.” 

 

 

 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.

 

Step 2: Assessing the claim options in the secondary billing section.  

 

Please see below the color-coded list of available options along with a description of what the buttons do.  

 

Select Icon - This feature enables you to perform the same action on multiple claims simultaneously by selecting them together. (Applies only to releasing and submitting claims.)  

 

View all Transactions- This option opens the claim history, allowing you to view the events and actions that have occurred so far for this claim. 

 

               Edit Claim- Clicking this button in Aloha opens the secondary claim, allowing you to review and edit both the claim and primary EOB information before submission. We will provide further details on this button in the next step. 

 

Release- To utilize this feature, you must first select a claim. Selecting this option will 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 you mistakenly transferred a claim to secondary but have not yet billed the secondary payer. 

 

Submit Claim- To use this option, you must first select a claim. Clicking this button will 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 3: Editing the claim. 

 

Select the "Edit Claim" button as outlined in the previous step for the claim you intend 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, you can 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 

Below, you will find the upper section of the secondary claim form. The areas highlighted in yellow are editable. 

**NOTE: If 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.
**Billing Tip: If you need to correct information in this top section, consider reviewing your client and payer setup to prevent similar issues in future claims. 

 

 



Below, you will find the lower section of the secondary claim form. The areas highlighted in yellow can be edited. The screenshot below has redacted areas to ensure privacy. Despite this, the highlighted boxes remain editable.  

 

  

 

Primary Remittance View 

Below, you will see the Primary Remittance information that was pulled based on the posting in Aloha for the primary payment.  The areas outlined in yellow below are editable fields.



 

 

Part 4: Validating and Submitting Claims 

In this section, we will discuss the final verification of claims and submitting the claims.  We will also review the remaining buttons at the bottom of the page.  

 

Please see below a color-coded key to the buttons that corresponds with the colors highlighted buttons at the bottom  

 

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 you accidentally transferred a claim to secondary but haven't yet billed the secondary payer.   

 

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 for you to select how to submit the claims.  

 

Save- Use this button to save all entered work for future submission.   

 

Discard- Clicking Discard closes the window in Aloha and returns you to the previous screen, discarding any manual changes made to the claim.   

 


 

Step 1: Validate the claim.  

After making all necessary changes to the claim and primary remittance information, click the Validate button at the bottom. 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, you must correct them on the claim form or primary remittance information before proceeding. 

 

 

 

 

If no errors are found, you will see the following message in the top right of the screen. This indicates that the claim is now ready for submission to the secondary insurance.  

 

 

 

 Step 2: Submitting the claim 

 Once you have validated the claim, it is ready to go out to the insurance. This can be achieved in 2 ways, electronically, or via paper submission.  


When you click on the Submit Claims button, 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. 

  • 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 you have preprinted CMS-1500 forms for mailing claims. 


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

 

  



 

Once you choose the submission method, 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 completed. For paper mail submission, you will need to download and print the claim form.  


 

FYI: 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. 


Congratulations! You have successfully submitted your secondary claim. The claim should now appear in the secondary payer's aging report in the AR manager. 

Please remember to check in your payer portal for confirmation of the secondary claim submission. 


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