Home Forums Discussions General Discussion Billing electronically/Texas/Pediatrics/me dicaid

Hi Everyone
I am new to AC , just got it last month , I am a Pediatrician in Texas and mainly see Medicaid population ( Medicaid HMO -Community health choice and Texas children health plan are the main players) , its a new practice and for now i am averaging 2 patients a day ,i have a few questions regarding billing electronically .
1. For electronic billing they need the ANSI X12 format, the CMS 1500 that AZ generates , is that in ANSI format and can i electronically export that 1500 directly to a billing clearing house like Availity
2. since I have a few patients right now , do I need to get Medisoft / ? someone other clearing house for electronic billing ? Ally /PM etc
3. or should I stick with paper submission

You have used the abbreviation AZ which I suspect is Amazing Charts. We usually use AC for that. AZ means your neighboring state to me.

You may need to talk to AC central about whether the X12 format is adequate for your state.

Most people here use a clearinghouse that will convert into the format you need. Office Ally is free but I for one had problems with them connecting to IL Medicaid. A fair amount of people here use it without problems.

I would not go with Medisoft until you have more volume. AC is working on a PM module(?maybe this summer, but maybe not). You can always go with a billing service for a percentage (4-6%) if Office Ally or another direct clearinghouse does not work.

Medisoft costs thousands, connectivity with AC has been an issue (not sure if it still is), do a search here for more info. For the few patients you have now, do not put out lot of money, especially since there may be less costly options out there and you are taking Medicaid.

You are right , it should be AC not AZ.When you say AC central , do you mean the tech support ? I asked one of the people from tech support, he did not have any knowledge about the format.So when I use Offce Ally, even if AC generates a CMS 1500 form automatically, I have still mechanically enter the ICD/CPT codes into Office Ally or is there a way to tranfer the data automatically into Office ally and then bill it.

Yes, I meant tech support.

You should be able to download a file (don't hold me to which format, as there are several available and it has been about 2 years since I worked with Office Ally) that they can extract all the data. Once downloaded, you should not have to add any more information. There was a problem with modifiers, if memory hold me correctly, but I think that was fixed. Search the board for office ally.

You have to call Office Ally and they will help you set it up. I am a Office Ally user who purchased AC last month. So I called Office Ally and they are working with me to set up to recieve my claims from AC. That is, I now export my claims from AC to my hard drive and then up load them into the Office Ally wesite/clearing house. The export out of AC and upload to OA is easy. But I am still working out kinks on the OA side. OA has not accepted all my uploads and we are trying to figure out why.

Office Ally says they have a lot of AC customers and that it works fine. But I have been working with them two weeks now and we find that some uploads are accepted and some are not. We have another appointment for phone help with OA on Tuesday. I am hoping we get this going early this week. If it is not resolved by Tuesday then we will use OA Practice Mate and just enter the patient demographics and billing codes directly into PM until we get OA to accept all our uploaded claims from AC.

Steve Lovato MD
Oakland, CA Internal Medicine

Thanks for the feedback , so the office Ally issues of rejecting some of your claims , is this happening with other customers also or its a rare issue. And to confirm for OA , one does not need to pay but for OA practice mate one has to pay( and is it worth it for solo provider with start up practice with mainly medicaid)
thanks again