Troubleshooting: Insurance Claim Errors

Healthie's Insurance Billing / RCM feature gives you the strong foundation to create the billing process that you'd like, including leveraging in-house capabilities and/or partnering with 3rd party vendors. 

Within Healthie, you can create CMS 1500 claims and submit them (electronically or physically) to an insurance company for reimbursement for services, via a Clearinghouse or third-party RCM company. Information is pre-filled to save team member time from charting notes, patient information, and other relevant fields. 

This article covers troubleshooting for common errors users might experience when creating or submitting a CMS 1500 claim.

Claim Can't be Submitted or Exported

If you are unable to send your claim to Office Ally, export the claim as a PDF or TXT file, then this indicates that there is likely an error with your claim form. If you are attempting to batch-submit your claims, we recommend trying to submit one claim at a time to determine which claim in the batch is experiencing an issue. 

Common claim issues: 

• Check to see that there is at least one diagnosis added for the claim, and the diagnostic pointer points to it.

• Make sure there is no blank diagnosis field (ie. a new diagnosis field was added, but no diagnosis was selected)  

If you still cannot determine where the error with the claim is occurring, you can submit a ticket by using the HELP button when logged into your account. Our Support team can help you troubleshoot further.

Office Ally Direct Claims Submission Errors 

If a claim has been submitted to Office Ally, and it has returned to Healthie as Denied By Clearinghouse, there is some next-steps that can be helpful: 

• Look up the claim in Office Ally directly to determine what Office Ally is reporting as claim errors. Most commonly, required information was left off of the claim. 
• If unclear why the claim was denied by Office Ally, follow-up with Office Ally directly to determine the cause 
• Fix the claim errors (ie missing information) in Healthie, and resubmit the claim to Office Ally 
• If a claim field in Healthie is not populating in the correct field within Office Ally, then this is a claims mapping issue. 
  • As a next step, we recommend reaching out to your Office Ally Technician, as they can update the mapping on their end to resolve this for you. (https://cms.officeally.com/Pages/Support.aspx) 
• Invalid SFTP credentials. Your SFTP credentials are provided by Office Ally. If you receive a notification that they are invalid, or the connection has been lost, then you'll need to request new SFTP credentials (or a refresh of your credentials) by Office Ally. 
  • This error message comes from Office Ally, and likely the integration needs to be reset. As the next best step, we recommend reaching out to Office Ally to request new SFTP credentials. You can use these credentials to then reconnect your Office Ally account to Healthie (within Healthie). 
  • If you are attempting to use the Office Ally integration with Healthie, but have not requested SFTP credentials, you can find  step-by-step instruction on request SFTP credentials here: Office Ally & Healthie: Direct claim submission
• Claim statuses not automatically updating in Healthie. 
  • Confirm that you've enabled the Office Ally integration in Healthie. Settings > Integrations > Office Ally should show a status of "enabled" in green. 
  • Confirm that you have filled out a remittance report for EACH payer that requires it within Office Ally. This will allow the payer to send electronic data to Healthie. Office Ally Support can help you identify which forms need to be filled out in order for your claims to data to be electronically sent and received. 
  • Check the status of a claim directly in Office Ally. Verify that the status in Office Ally does not match Healthie. Only claims you have submitted through Healthie to Office Ally will automatically update within Healthie. 
  • Some additional resources that may be helpful:
    • Office Ally & Healthie
    • Office Ally Payer EDI Enrollment
• EDI Message Error:  
  • If this is happening, be sure to check over your claim submission within Healthie. Box #27 should default to select YES; if it is selected NO, you may receive this error message.