Electronic Claims (Office Ally/TriZetto)
TRIZETTO: This article primarily mentions Office Ally as this is our claims processor. You can alternatively use TriZetto, you'd simply need to follow the same setup steps, except access the TriZetto integration option when starting.
Integrating IntakeQ with Office Ally will allow you to submit claims to insurance without leaving your IntakeQ account. Additionally, IntakeQ will capture the EOB (Explanation of Benefits) from your payers as they become available and automatically allocate insurance payments to claims and appointments. Office Ally has a very extensive payers list and it's quite likely that all your electronic claims can be submitted through them.
Note: At the time of this writing, IntakeQ does not offer support for secondary or institutional claims.
Before starting the integration process, we encourage you to become familiar with our Claims module. The following article will give you a thorough overview of how to create claims: How to Create a Claim
Preparing Your Office Ally Account
Before connecting IntakeQ to Office Ally, Secure FTP access needs to be enabled in your Office Ally account. Currently, this is done by contacting their support. Additionally, in order for IntakeQ to receive insurance payment information and keep the claim status up-to-date, you will need to ask them to enable ERA and 277CA reports.
Here's a template email you can send to Office Ally.
It typically takes 24-48 hours for Office Ally to enable SFTP access, and they will likely give you instructions on how have ERA reports enabled for each payer. Some payers require pre-enrollment, which will require you to submit a form. We recommend doing that as soon as possible because some payers take 30+ days to enable ERA reports.
IMPORTANT: Without an ERA setup between each of your insurance payers and Office Ally, claims will not be updated in the IntakeQ system as they have no way to send us back the ERA. Contact Office Ally or the insurance payer for more info on setting those up.
Regardless of how long ERA reports take to be enabled, you can connect your IntakeQ to Office Ally as soon as SFTP access has enabled. This will allow you to start submitting claims from your IntakeQ account.
Connecting IntakeQ to Office Ally
If you followed the instructions in the section above, you will receive an email from Office Ally containing your SFTP user name and password. Log into your IntakeQ account and follow the steps below:
- Navigate to "More > Settings > Integrations".
- Select "Office Ally".
- Enter the SFTP user name and password provided by Office Ally, and adjust the FTP Address if the one they provided is different than the default one. Then click on "Connect to Office Ally".
Once the accounts have been connected, you will be ready to submit your claims via IntakeQ.
Submitting Claims Electronically
Once your claims are created by following the instructions in the article How to Create a Claim, the easiest way to submit them is by navigating to "Lists > Claims", selecting the desired claims, clicking on "Bulk Actions" and then on "Submit to Office Ally". It's a good idea to validate them first to make sure there were no obvious mistakes.
Once the claims are sent, their status will immediately change to Submitted. From then on, their status will be updated automatically as we receive updates from your payers. The possible statuses are:
- Acknowledged: the clearinghouse (Office Ally) or the payer has received the claim submission successfully.
- Processing: the claim has been scrubbed and the payer has started to process it.
- Information Requested: the claim is being reviewed by the payer. If the status doesn't change in 10 business days, please call the payer directly.
- Pending: the claim is being reviewed by the payer. If the status doesn't change in a few days, please call the payer directly.
- Rejected: the claim has been rejected by the clearinghouse or by the payer. You can update the claim and resubmit it just like you did the first time.
- Denied: this indicated that the payer has processed the claim and denied payment. You will typically see the reason of denial when you open the claim. Contact the payer directly if the reason is not provided.
- Paid: the claim has been adjudicated and the payment has been sent.
Keeping Track of Payments
When IntakeQ receives remittance reports from your payers, it automatically closes the associated claims and creates a payment record containing the EOB details. In order to find the payments, navigate to "Lists > Claims > Payments". Notice in the image below how you can see the amounts for each claim, including the amount paid and the patient responsibility. We also show the line items for each claim and their respective amounts.
This page also allows you to enter payments manually, in case you work with a payer that doesn't provide ERA reports.