Service and Claim Management

How to submit claims, make edits, re-submit, and transfer claims to secondary payers.

Jump to:

• Submitting a claim
• Editing and re-submitting
• Transferring to another payer

Submitting a Claim - How to submit encounters/services to our clearinghouse partner, Waystar:

1. Once services are provided and submitted from the Encounter Transmission Table to Alleva Billing, they will be available in the Service Management tab. Check the Service Management tab to find the encounters you're submitting.

2. Click on the encounter to review all details and make any edits to claim fields, service fields, or client information that are necessary before submitting.

3. Select "Submit" at the top of the edit screen, or back on the Service Management list view select multiple encounters and click Actions > Submit.

4. A claim will be automatically generated and sent to Waystar for further processing. The claim will be accessible in the "Claim Management" tab with the status "Submitted". 

How to edit and re-submit a claim that is rejected:

1. The claim status will provide some indication for why the claim was rejected. For instance, if it says "Claim Rejected by First Edits", this means that Waystar rejected the claim based on preliminary information like your facility's NPI being invalid, for example. In order to get more insight into the reason for the rejection, click on the claim and navigate to "Submission History."

2. In Submission History, click the dropdown for the recent submission and you will see a list of fields that were either missing or invalid.

3. To edit claim fields, go to the "Claim Details" tab and you can access all available fields. Once you enter new information, select "Update Fields". 



4. To re-submit a claim, navigate back to the list view of all claims, select the claim and click "Actions" > "Submit". The claim is now re-submitted to Waystar, and the Clearinghouse Status will clear and reflect the new response from Waystar/Insurance.

How to transfer a claim to another payer

NOTE: If you receive a payment from the primary payer and it does not cover the full balance, that outstanding balance can be transferred to the secondary payer in Payment Management. 

1. On Claim Management, select the claim and navigate up to Actions. Select "Transfer".

2. You will receive a pop-up message stating that the claim will be transferred to the next responsible party. This is found on the insurance payment (if you received one from the primary payer) or it is the secondary payer on the patient account. 

3. Once you acknowledge this message, a new claim will be generated on Claim Management with the status "Pending Submission". It does not automatically submit to Waystar.

4. Select the claim and navigate to "Claim Details" to make any edits before submitting it to Waystar.