A clearinghouse is like a middleman that checks and sends paperwork between providers and insurance payers. It makes sure everything is filled out right so you can get paid.  Think of it like a spell-checker and mailroom for medical bills.  The clearinghouse also enables you to send out your claims directly from Aloha to the payer and receive your ERAs (Electronic Remittance Advice or itemized payment receipt) directly into Aloha.  Using a clearinghouse will save a lot of time on billing and reconciling payments.

Step 1:  Check your Payers

Checking Payers in Office Ally

In the "Search Payers" box, you can type in a payer name or search by payer ID. 

1. Payer name: The name of the payer as identified in Office Ally. This name does not need to be identical (e.g., BCBS vs. Blue Cross) to what is entered in Aloha necessarily; what matters most is that the payer ID is the right one for the payer you are looking to bill. 
   
2. Payer ID: a unique 4-6 letter or numerical value that identifies this payer within Office Ally. Verifying your Payer ID will ensure that your claims are being sent to the correct place. 
   
3. Transaction: Look for the one next to your payer name labeled "Professional Claims - 837P". or "Remits - 835". These are the file types that are processed for sending CMS1500 claims out from Aloha and receiving EOBs/ERAs back into Aloha. 
   
4. Available: when the checkmark is checked for payer and available, this means this payer can be billed and processed through Office Ally. 
   
5. Non par: when this checkmark is checked, this means the payer is a non-participating payer and would require you to pay an additional fee in order to bill them through Office Ally. For a breakdown of Office Ally's pricing, visit this link: Office Ally Pricing 

Office Ally: In general, OA charges per tax ID + Rendering Provider NPI combination whose claim volume is 50% or more to Non-Par payers in a month. For tax ID + rendering provider NPI combinations where < 50% of claims are from Non-par payers, there is no additional cost.

1. Enrollment: This is only relevant for 835 transactions, meaning EDI enrollment for the selected payer. When this box displays an !, it means this payer requires enrollment EDI Enrollment. These forms are listed by State in Office Ally under Resources > Payer Claims/Eligibility/Claim Status Enrollment Instructions 
   
2. Secondary: This checkmark indicates that the payer allows electronic secondary billing submission through Office Ally. If it is not checked, it means that you'd have to bill this payer for secondary manually through paper submission or through the payer portal. 
   
3. Notes: This can be useful to check if there is anything additional you should know about the payer. This typically tells you if a payer needs you to fill out an ERA form, their customer service number, and sometimes if the payer goes by another name when you're searching for their EDI/ERA form.

Checking Payers in Availity

1. Portal: You may see "Available" or "Get Essentials Plus" here.
   
1. This means that this payer's portal is through Availity and is either free to use , or requires an upgraded plan to their Essentials Plus. 
2. 
   

1. Batch: Next to the 837P transaction type, you may see "Get EDI Plan" or "Available" here. 
   
1. Get EDI Plan means that you need to upgrade your Availity account to be able to bill this payer electronically through the clearinghouse. Clicking this link will prompt you to upgrade your account if you have not done so already. 
   
2. Available means that no further action is needed in order to bill this payer through the clearinghouse. 
   

Pricing: Contact Availity directly for pricing info for EDI plans.

1. Enrollment Required: If this box displays a checkmark, it means that this payer requires enrollment to receive 835 Claim Payment/Remittance Advice (ERAs) back electronically. The enrollment forms can be found within the Availity portal. 

Step 2:  Complete the Integration

Complete the Office Ally integration if you are using either Office Ally or Availity for claims.  Your ERAs will come back through Office Ally either way!

Office Ally Integration

Availity Integration Instructions

Step 3:  Complete Required Enrollments

EDI Enrollments 

EDI stands for Electronic Data Interchange.  Basically it gives the clearinghouse permission to process claims electronically.  Not all payers require it, but if they do, you cannot bill out until enrollment is complete.

Office Ally EDI Enrollment

If you are using Office Ally as a primary clearinghouse and not just for ERA enrollment, double check to make sure you don't need to complete any EDI enrollments.   Required enrollments are listed by State under Resources > Payer Claims/Eligibility/Claim Status Enrollment Instructions

Availity EDI Enrollments

In the Availity Payer List, next to the 837P transaction type, you may see "Get EDI Plan" or "Available".

1. Get EDI Plan means that you need to upgrade your Availity account to be able to bill this payer electronically through the clearinghouse. Clicking this link will prompt you to upgrade your account if you have not done so already. 
   
2. Available means that no further action is needed in order to bill this payer through the clearinghouse. 

ERA Enrollments

All ERA enrollments must be completed through Office Ally, even if you are using Availity as your clearinghouse.  ERAs can be found in Office Ally under Resources > Payer ERA Enrollment Forms and should be listed alphabetically.  You should complete an ERA enrollment for every insurance payer you work with.  Enrollment is not required, but highly suggested as it will save time on reconciling payments.

Availity ERA Delivery Change Form:  Please complete the ERA Delivery Change Form attached to this article if you are using Availity for billing.