Ready to Bill Claims

In this guide we will be reviewing the features available and the general process for submitting claims through Theralytics. Topics covered: claim information, areas within the software relevant to submitting claims, and the process of submitting claims.

Submitting Electronically vs Non EDI

There are two ways to submit claims in Theralytics, either as an electronic submission (that is sent to the clearinghouse Office Ally) or as an internal submission (for self pay or private pay claims that are not submitted to a payer).

1. For Non EDI payers, please make sure that the EDI checkbox is unchecked on the payer profile under Manage Payers. A Non-EDI payer is any payer that you are not submitting claims to electronically.

2. Both electronic and Non EDI claims will appear in the Ready to Bill Area once rendered. For EDI claims, you will still be using the Batch EDI Generation button to submit.

3. For Non EDI claims, once you select the claim you will use the Submit Claim for Non EDI Payer button. This will mark the claim as submitted and move it into the Submitted Claims area, but will not send it to the clearinghouse or payer.

4. Once Submitted, the Non-EDI claim will appear as an outstanding claim on your reports. You can now apply payment to the claim manually. Please click here for more information about applying payments.

Locating Ready to Bill Claims 

Claims that have been successfully rendered will automatically be moved to the Ready To Bill area. Please follow the instructions below for more information on how to verify if claims are ready to bill.

1. First you will need to go to Billing > Claims and choose the Ready to Bill tab. From here you can filter out your claims and review the claim information.

2. Once you have filtered out your claims, there are a few options for editing, viewing and changing the claim information. Review options on ready to bill page

   1. Submit Claim for Non EDI Payers - Used to submit claims internally so that a payment can be applied manually, without sending the claim to the clearinghouse or payer.

2. Batch EDI Generation - Used to submit claims electronically to the clearinghouse and payer.

3. Batch Form 1500 Generation - This option prints out a paper CMS 1500 form for the selected claims. Choose Normal to have the system print out the entire red form for you, or choose Pre-Printed to if you are printing onto your own form.

4. Add Bulk Note - Used to add internal notes to multiple claims at the same time.

5. Batch change Rendering Provider - Used to update the rendering provider for multiple claims at the same time. 

6. Download Batch EDI - This option allows for you to download the 837 file and upload the file into another clearinghouse aside from Office Ally.

7. Batch Update Rates - Update the billing rates for more than one claim at the same time.

3. Under the Action Column there are also additional ways to edit claim information.

   1. Add an additional service code - Used to add additional service codes that can be billed on the same claim. Services added this way will not appear on the session note within the scheduling area, only in the billing area.

2. View the claim history - View a list of actions performed on a claim. 

3. Add/Edit Claim notes - Allows for adding, viewing, editing, and deleting the internal notes that have been added for a claim.

4. Edit Service code - Allows for editing the service code that is being billed. 

How to Check and Edit Claim Information

Before you submit claims, we recommend understanding where some of the claim information is pulled from within your database. In case you need to edit claim information before submitting please review the information below.

1. Client Information

   1. Rendering Provider for Therapy - This is the provider NPI (Box 24J on the 1500 form) that you will be billing under for this client. The rendering provider can be found by going to Manage Client > Edit > Rendering Providers for Therapy. The rendering provider can also be changed from the Ready to Bill area by editing the claim directly. 

      1. If Practitioner is Rendering Provider is selected for the payer you are billing (under Manage Payer > Edit > Payer Info) then the NPI of the person performing the service will be applied to box 24J instead of the rendering provider. The rendering provider will still appear on the session notes as the Supervising Clinician regardless of the payer settings.

2. Address - If the service location is Home (12) this will be the client’s primary address. The primary address can be changed by going to Manage Client > Edit > Address. You also have the option of adding additional service locations directly on the client’s profile. 

3. Insurance - This is the payer that the claim will be submitted to. The insurer information for a client can be changed by going to Manage Client > Edit > Insurance. Theralytics gives the option of assigning multiple primary payers to the same client, and also adding in a Secondary Payer. This is also where the client’s Insurance ID is entered.

2. Payer Information

   1. Payer ID - The payer ID lets the clearinghouse know which payers you are submitting to. The payer ID can be found under Office Ally’s Resource’s tab in the Payer area click here. 

   2. Payer Address - The payer address can be found either on the client’s insurance card or usually at the payer’s website. 

3. Location Information

   1. Tax ID - This can be found under Masters > Location > Edit 

   2. Group NPI - This can be found under Masters > Location > Edit 

   3. Facility Service Location Information (Box 32) - Located under Masters > Location > Edit.

   4. Billing Provider Information (Box 33) - Located under Masters > Location > Edit

4. Rendering Provider Information

   1. NPI - This can be found under Manage User > Edit 

Submitting Ready to Bill Claims

Once you have selected your claims and verified the claim information, you’re ready to submit.

1. From the Ready to Bill area, you can use the filtering options to locate the claims you would like to submit.

2. Select the checkbox next to the claims that you would like to submit and then use the Batch EDI Generation button to submit the claims. You can also select all claims by clicking the checkbox at the top.

3. Once the claims have been submitted, you will receive a notification to your email address from Office Ally confirming claims have been received.

4. If you have requested the 999, 277, and 277CA files from Office Ally, you can also click Sync Office Ally to download the acknowledgement files and view the confirmation that Office Ally received your claims in the OA Acknowledgement tab.

5. Any Office Ally denials will appear on the dashboard under the OA rejections area as long as the file has been synced previously.

6. Denial and Acceptance information from the clearinghouse can also be viewed from the OA and Payer Response area under Billing > Claims.