The Claims section allows clinicians to generate, submit, and track insurance claims for patients.
Top Section
Patient Overview (Top Section)
The top section acts as your "quick check" to ensure you are billing for the right person and under the correct payment model.
Profile Data: View the patient's Name, DOB, and Contact Info.
Payment Method: Toggle between Insurance or Private Pay.
Insurance Snapshots: For insurance patients, this displays their Member ID and Payer Name. Use "Edit Patient Details" to update their address or insurance plan before submitting a claim.
Bottom Section (Four Tabs)
Unbilled Services
This is your "billing to-do list." It contains all services that have been documented but not yet sent to insurance.
How services get here:
The "Auto" Flow: If you create a Billable Note in Allia, it automatically generates an unbilled service once you save the note.
The "Manual" Flow: If you saw a patient outside the platform, click "+ Create New Service" to manually enter the session details.
Before clicking "Initiate Claim," double-check these three items:
Diagnosis: This pulls automatically from the patient's profile. Verify it is accurate for this specific session.
Modifiers: Ensure telehealth modifiers (like Modifier 95) are added for virtual appointments.
Service Charges: Fees are pulled from your Enrollment Fee Schedule. If you haven't set your rates yet, the charge will appear as $0.
Submitted Claims
Once you click submit, the service moves here.
Track Claim: Use this action to see real-time updates from the payer.
Status Indicators: Monitor whether a claim is "Accepted," "Pending," or "Rejected" by the insurance company.
Superbills
Use this tab for Out-of-Network patients who pay you directly and then seek reimbursement from their own insurance.
Generate: Select a service and click "+ Create Superbill."
Distribute: Download the PDF to provide to your patient.
Shows services where a note with a CPT code exists but no claim has been submitted.
Columns of table: Date of Service, Primary Service, Payer Name, Service Charges, Actions (Initiate Claim / Edit Draft / Delete)
Payments
This tab acts as your financial ledger, tracking every dollar collected from both payers and patients.
Reconciliation: Compare the Service Charge against the Insurance Paid and Patient Paid amounts.
Write-Offs: The system automatically calculates "Write-Offs" based on your contracted rates.
Sending Invoices: If a patient has an outstanding balance, click "Send Invoice." * Invoices are sent via Stripe.
The patient will receive the invoice in their Allia Messaging tab and via email.
You can track the payment status (Sent, Paid, Overdue) directly within this tab.
