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AlayaCare’s Electronic Billing: Automatic Claim Submission and Adjustments


Billing for home care services is no easy task. Inaccurate home care billing documentation can generate hours of rework and, even worse, delay reimbursement.

It’s the biller’s responsibility to review and make sure all documentation is on file and accurate before transmitting the claim for payment. This is especially important when you are billing Medicaid because you need to make sure you have all the required documentation on file before you submit your claim for processing.

Without the help of technology, these processes can be daunting. Software has the ability to streamline manual billing processes and eliminate error. Experience AlayaCare’s fully integrated electronic billing solution to maximize reimbursement, increase efficiency and improve outcomes.

Introducing AlayaCare’s Electronic Billing Solution

AlayaCare introduced billing software for Medicaid that contains a foolproof, automated banking option for agencies submitting claims to a payer. With AlayaCare’s electronic billing solution, your agency can:

  • Auto-check eligibility of a client to ensure claims are not rejected after care has been delivered.
  • Trim time and resources that staff would otherwise devote to manual administrative billing work.
  • Easily identify any issues with a claim via software that automatically searches for potential errors before submission.
  • Simply resolve any issues online before processing claims, ensuring reimbursement is as quick as possible, and reducing the number of rejected claims.
  • Instantly upload claims to clearinghouses with one click.
  • Monitor a claim as it progresses through the system between intermediaries and a payer, unlike paper processes
  • Electronic reports can confirm that a payer has received an agency’s claim.
  • Adjudication, reconciliation and a “closed loop” billing data file that is returned from your clearinghouse partner directly into claim/visit data is another key area for efficiency.

Agency challenges and how AlayaCare Electronic Billing solve them:

Challenge #1

Some agencies are still in the process of filling claims by hand and then faxing, scanning or even mailing it to third party payers. This is not only high-scale inefficiency, it increases the risk for errors and other pitfalls that then need more time to be adjusted.


With AlayaCare, your agency can say goodbye to unnecessary postage and mailing expenses. You have the ability to record, edit, adjust and submit claims right within the software. For Medicaid billers, AlayaCare supports a number of electronic file formats including the 837i, 837p, 835, as well as 270 and 271 eligibility checks. The 270 can be sent out as a background job in AlayaCare on a frequency the client/agency determines because eligibility of a patient can change weekly. This can prevent your agency from getting denied claims because a client is all of a sudden ineligible and they weren’t aware.

All this happens and updates in real-time.

AlayaCare Medicaid Process

Challenge #2

Other systems let you send claims that have unapproved visits resulting in rejections.


AlayaCare does not let you send the claim unless the visit is approved which could save agencies from getting denied claim. Technology affords some important ingredients to make reconciliation easier and more accurate, including automated QA and error notifications.

Challenge #3

Some aspects of billing can result in lost revenue; receiving a rejected claim due to data entry errors causing lags in reimbursement and additional admin burden; missing out on reimbursements because agencies are unable to submit claims for half or quarter units, despite paying for that time.


Depending on where you’re located, regulators may permit agencies to bank units when submitting claims. While some agencies elect to manually bank units by rounding to the nearest whole number, AlayaCare enables your staff to option banked time for each bill code or client and assemble all fractional hours into whole unties with the click of a button. This can save agencies thousands, and also eliminates inefficient workflows.

AlayaCare electronic billing

Check out the AlayaCare Electronic Billing feature

Whether your agency is currently operating on paper documentation or your working on a dated legacy solution, AlayaCare could be the solution you’ve been looking for.

Learn more about how AlayaCare’s Electronic Billing solution can drive your organization forward by clicking the link below.