Practice Management on Embodia - Part 3: Billing - Submitting claims to Office Ally

Superbills (US)

Important: If you would like to enable Submitting claims to Office Ally to your account, please reach out to our support team at support@embodiaapp.com

Overview

Embodia's Clearinghouse integration allows you to submit electronic healthcare claims (EDI 837P format) directly to insurance payers through Office Ally. This streamlines your billing workflow by eliminating manual claim submissions and providing real-time status tracking.

Key Features:

Direct SFTP submission to Office Ally clearinghouse
Batch claim submissions from existing superbills
Comprehensive validation before submission
Support for multiple billing providers per clinic
Automatic EDI 837P format generation

Prerequisites

Important: The actions described in this tutorial require Manager-level permissions and the following clinic configurations.

Before you can submit claims to the clearinghouse, ensure your clinic has:

A valid Practice Management subscription
Superbill functionality enabled
Clearinghouse Credentials (Obtained from Office Ally)
The 3 required patient properties setup:
1. Date of birth: this needs to be a patient property of type Birth date
2. Gender: this needs to be a patient property of type Gender (with options of Male and Female added)
3. Address: this needs to be a patient property of type Address

Setting up your Clearinghouse credentials

To connect Embodia to the Office Ally clearinghouse, you must first add your credentials. To do so:

Navigate to Billing > Settings > Clearinghouse settings > Credentials
Enter your Office Ally Username in the username field
Enter your Office Ally Password in the password field

Important: Your credentials should be obtained from Office Ally, and might be different from the credentials you use to sign in to your regular Office Ally account.

Managing billing providers

Billing Providers represent the entities submitting claims on behalf of your clinic. You can configure multiple billing providers and associate them with specific practitioners.

Adding a billing provider

Navigate to Billing > Settings > Clearinghouse settings > Billing providers
Click Add a provider
Select the Entity Type:
- Person - For individual practitioners
- Organization - For clinic or practice entities
Complete the required fields based on your selection:
For Person:
- First name and Last name
- NPI (10-digit National Provider Identifier)
For Organization:
- Organization name
- NPI (10-digit National Provider Identifier)
Enter the Tax identifier type:
- EI - Employer Identification Number
- SY - Social Security Number
Enter the Tax identifier
Complete the Address fields:
- Street address
- City
- State
- Zip code
Enter Contact information:
- Contact name
- Contact phone
(Optional) Associate the billing provider with a specific Practitioner, or leave as "Any Practitioner" for clinic-wide use

Editing a billing provider

Navigate to Billing > Settings > Clearinghouse settings > Billing providers
Locate the billing provider you wish to edit
Click the Edit icon
Make your changes

Deactivating a billing provider

To deactivate a billing provider without deleting it:

Navigate to Billing > Settings > Clearinghouse settings > Billing providers
Locate the billing provider you wish to deactivate
Click the Edit icon
Uncheck the Active checkbox

Important: You cannot delete a billing provider that has existing submissions. Deactivate it instead to prevent future use.

Managing Clearinghouse payers

Clearinghouse Payers represent the insurance companies to which you submit claims. Each payer requires a unique Payer ID that corresponds to Office Ally's payer identification system.

Adding a payer

Navigate to Billing > Settings > Clearinghouse settings > Payers
Click Add payer
Enter the Payer name (e.g., "Blue Cross Blue Shield")
Enter the Payer ID (obtain this from Office Ally's payer list)
Ensure Active is checked

Editing a Payer

Navigate to Billing > Settings > Clearinghouse settings > Payers
Locate the payer you wish to edit
Click the Edit icon
Make your changes

Important: You cannot delete a payer that is associated with existing patient policies. Deactivate it instead by unchecking the Active checkbox.

Configuring patient policies for claims

Before submitting claims for a patient, their insurance policy must be configured with clearinghouse-specific information. On Embodia, you can use the patient policy feature to store this information. When adding or editing a policy, ensure the following have been added:

Payer - Select the appropriate payer from the dropdown
Policy number - The patient's policy number
Member number - The patient's member ID
Relationship to Policy Holder - Select from:
- Self
- Spouse
- Child
- Domestic Partner
- Full-time Student
- Part-time Student
- Handicapped Dependent
- Other
If the patient is NOT the policy holder (relationship is not "Self"), complete the Policy holder Information:
- First name and Last name
- Date of birth
- Street address
- City
- State (US states only)
- Zip code

Required patient information

For successful claim submission, ensure the patient's profile includes the following information added via patient properties :

Date of birth: this will use the patient property of type Birth date
Gender: this will use the patient property of type Gender
Address: this will use the patient property of type Address. Ensure that the State entered is a valid US State.

Creating and submitting claims

Claims are created from existing superbills and grouped into submissions for batch processing.

Creating a new submission

Navigate to Billing > My patient Invoices > Insurance submissions
Click New submission
Select the Billing provider from the dropdown and check Billing provider is rendering provider if the billing provider is also the practitioner who rendered services
Click Next

Adding claims to a submission

After creating a submission, you'll see two panels:

Left Panel: Claims already added to this submission
Right Panel: Available superbills that can be added

To add a claim:

In the right panel, locate the superbill you wish to submit
Review the superbill details:
- Invoice number
- Patient name
- Procedures and charges
- Diagnosis codes
Click Add icon to include it in the submission

The claim will move to the left panel and be auto-populated with data from the superbill.

Editing a claim

If a claim requires adjustment before submission:

In the left panel, locate the claim
Click the Edit icon
In the popup form, you can update:
- Practitioner license (to change the rendering provider's NPI)
- Patient policy (to select a different insurance policy)

Removing a claim

To remove a claim from a submission:

Locate the claim in the left panel
Click the Delete icon

Submitting claims to the Clearinghouse

Once you've added all desired claims:

Click Next to proceed to the review screen
Review the submission summary:
- Number of claims
- Billing provider
- Rendering provider status
Review any validation errors displayed in red
If all claims are valid, click Submit

Your claims will be transmitted to the Office Ally clearinghouse via secure SFTP connection.

Understanding claim validation

Before submission, Embodia validates each claim to ensure it meets EDI 837P requirements. Claims with errors cannot be submitted until resolved.

Required information for valid claims

Each claim must include:

From the Superbill:

At least one procedure with CPT code
At least one diagnosis code
Place of service code
Service date(s)

From the Patient policy:

Clearinghouse payer selected
Policy number
Member number
Subscriber information (name, DOB if dependent)
Subscriber address (if patient is a dependent)

From the Patient profile:

Patient date of birth
Patient gender
Patient address (street, city, state, zip code)

From the Practitioner:

Valid NPI from practitioner license

Common Validation Errors

Error	Resolution
Missing patient date of birth	Update the patient's profile with their date of birth using the date of birth patient property
Missing patient address	Add complete address to patient profile using the date of address property (ensure that the State is spelled correctly)
Missing payer ID	Select a clearinghouse payer on the patient's policy
Missing member number	Add member number to patient's policy
Missing NPI	Ensure the practitioner has a valid license with NPI
Missing diagnosis codes	Add diagnosis codes to the superbill
Missing procedures	Add at least one procedure to the superbill

Tracking Submission Status

After submitting claims, you can track their status from the Clearinghouse Submissions list.

Submission Statuses

Status	Description
Draft	Submission is being prepared. Claims can be added, edited, or removed.
Being Submitted	Submission is in progress. The system is transmitting data to the clearinghouse.
Submitted Successfully	Claims were successfully transmitted to Office Ally.
Error	An error occurred during transmission. Review the error details and retry.

Viewing submission history

Navigate to Billing > My patient Invoices > Insurance submissions
There you can view the list of all submissions with their:
- Billing provider
- Status
- Number of claims
Click on a submission to view its details

Important: Once a submission has been transmitted (status is "Submitted Successfully"), it cannot be modified. To resubmit claims, create a new submission.

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