The first step in creating a claim is creating the insurer. To do this, ensure you are logged into an account with Full Access permissions.
*Please note, this is for accounts subscribed to the Insurance Plan.
Create an Insurer
In Settings on the left hand side, scroll down to the Billing section - Insurers
Select New Insurer from the top right:
The next step is to select the Insurer Type:
Important:You’ll need to select the US Insurer option if you need to generate CMS-1500/HCFA forms for clients covered by the insurer you’re creating.
After selecting the Insurer Type, you’ll need to enter in the insurer name (required) and contact information (optional).
Currently, US Insurers (whose claims are to be submitted to Office Ally) require both a Payer ID and full address information
You may also enter a portal is appropriate. This could be a clearinghouse billing portal such as Office Ally.This will allow you to launch the portal directly for claim submissions.
You can view some more information about managing claims and portals on this guide: Working with Claim Submissions - Online Insurer Portals
Determine Patient’s Fee
Next you’ll need to set how the patient is going to be billed.
To bill the full amount of an appointment and charge nothing to the patient, leave both the “user fee” and the “pay remaining” blank:
To bill a set user fee to a patient (say, $30 for an MVA patient), it would look like this:
Commonly though, a patient pays the balance not covered by their insurance (For example, if the insurer pays $24.15 of a $100 appointment, the patient would need to pay the remaining $75.85.) To do that, here’s what it would look like:
You don’t need to worry about setting an exact amount here. The amount billed to the patient is based on the coverage set on the claim you’ll create following this guide: Creating a Patient Claim (US)
If you have any questions along the way, please email us at firstname.lastname@example.org to discuss your options.