Office Ally OA Processing Application User Guide

OA Processing Application
User Guide

OA Processing Application

DISCLOSURE STATEMENT
Disclosure, distribution and copying of this guide is permitted, however, changes to items found in this guide may occur at any time without notice. The intended purpose and use of this guide is to provide information in reference to the Health Care Claim: Institutional (837I).
Office Ally, Inc. will be referred to as OA throughout this guide.
PREFACE
This Companion Document to the ASC X12N Implementation Guides and associated errata adopted under HIPAA clarifies and specifies the data content when exchanging electronic health data with OA. Transmissions based on this companion document, used in tandem with the X12N Implementation Guides, are compliant with both X12 syntax and those guides.
This Companion Guide is intended to convey information that is within the framework of the ASC X12N Implementation Guides adopted for use under HIPAA. The Companion Guide is not intended to convey information that in any way exceeds the requirements or usages of data expressed in the Implementation Guides.
Companion Guides (CG) may contain two types of data, instructions for electronic communications with the publishing entity (Communications/Connectivity Instructions) and supplemental information for creating transactions for the publishing entity while ensuring compliance with the associated ASC X12 IG (Transaction Instructions). Either the Communications/Connectivity component or the Transaction Instruction component must be included in every CG. The components may be published as separate documents or as a single document.
The Communications/Connectivity component is included in the CG when the publishing entity wants to convey the information needed to commence and maintain communication exchange.
The Transaction Instruction component is included in the CG when the publishing entity wants to clarify the IG instructions for submission of specific electronic transactions. The Transaction Instruction component content is limited by ASCX12’s copyrights and Fair Use statement.

INTRODUCTION

1.1 Scope
This Companion document supports the implementation of a batch processing application.
OA will accept inbound submissions that are formatted correctly in X12 terms. The files must comply with the specifications outlined in this companion document as well as the corresponding HIPAA implementation guide.
OA EDI applications will edit for these conditions and reject files that are out of compliance.
This companion document will specify everything that is necessary to conduct EDI for this standard transaction. This includes:

• Specifications on the communications link
• Specifications on the submission methods
• Specifications on the transactions

1.2 Overview
This companion guide compliments the ASC X12N implementation guide currently adopted from HIPAA.
This companion guide will be the vehicle that OA uses with its trading partners to further qualify the HIPAA adopted implementation guide. This companion guide is compliant with the corresponding HIPAA implementation guide in terms of data element and code sets standards and requirements.
Data elements that require mutual agreement and understanding will be specified in this companion guide. Types of information that will be clarified within this companion are:

• Qualifiers that will be used from the HIPAA implementation guides to describe certain data elements
• Situational segments and data elements that will be utilized to satisfy business conditions
• Tracing partner profile information for purpose of establishing who we are trading with for the transmissions exchanged

1.3 References
ASC X12 publishes implementation guides, known as Type 3 Technical Reports (TR3’s), which define the data contents and compliance requirements for the health care implementation of the ASC X12N/005010 transaction sets. The following TR3 is referenced in this guide:

• Health Care Claim: Institutional – 8371 (005010X223A2)

The TR3 may be purchased through Washington Publishing Company (WPC) at http://www.wpc:-edi.com
1.4 Additional Information
Electronic Data Interchange (EDI) is the computer-to-computer exchange of formatted business data between trading partners. The computer system generating the transactions must supply complete and accurate information while the system receiving the transactions must be capable of interpreting and utilizing the information in ASC X12N format, without human intervention.
The transactions must be sent in a specific format that will allow our computer application to translate the data. OA supports the standard transactions adopted from HIPAA. OA maintains a dedicated staff for the purpose of enabling and processing X12 EDI transmissions with its trading partners.
It is the goal of OA to establish trading partner relationships and to conduct EDI as opposed to paper information flows whenever and wherever possible.

GETTING STARTED

At Office Ally, we understand how important it is to have an easy-to-use, efficient, and streamlined claim process for your practice. You’ll receive payments up to 4 times faster when you submit electronically and know within hours if an issue occurs with one of your claims.
Office Ally Benefits:

• Submit Claims Electronically to thousands of Payers for FREE
• No Contracts to sign
• FREE Set up and Training
• FREE 24/7 Customer Support
• No more paper EOB’s! Electronic Remittance Advice (ERA) available for select payers
• Use your existing Practice Management Software to submit claims electronically
• Detailed Summary Reports
• Online Claim Correction
• Inventory Reporting (historical claims inventory)

A video introduction to Office Ally’s Service Center is available here: Service Center Introduction
2.1 Submitter Registration
Submitters (Provider/Biller/etc.) must enroll with Office Ally in order to submit claims electronically. You can enroll by contacting OA’s Enrollment Department at 360-975-7000 Option 3, or by initiating online registration HERE.
A registration checklist can be found on the next page.

OA Registration Check I ist.

1. Complete Online Registration (or call OA’s Enrollment Dept @ 360-975-7000 Option 3)
2. Sign OA’s Authorization Sheet 
3. Review, sign, and store OA’s Office-Ally-BAA-4893-3763-3822-6-Final.pdf (officeally.com) for your records
4. Receive OA assigned User Name and Password activation link
5. Schedule FREE training session (if needed)
6. Review OA’s companion guide
7. Review OA’s Office Ally Available Payers to determine Pager ID as well as EDI enrollment requirements
8. Complete testing and review response reports (only required for 3rd party software submitters)
9. Start submitting production claims!

FILE SUBMISSION GUIDELINES

3.1 Accepted File Formats
Office Ally can accept and process the following file types:

• HCFA, CMS1500, UB92, and UB04 Image Files
• ANSI X12 8371, 837P, and 837D files
• HCFA NSF Files HCFA Tab Delimited Files (Format must strictly adhere to OA specifications. Contact Support for details.)

3.2 Accepted File Extensions
Similarly, Office Ally can accept files which have any of the below file name extensions:

3.3 File Format Changes
It’s important that you continue to send the same file format when sending claim files to Office Ally. If your file format changes due to system updates, new computers, or different form selections, the file could fail.
Should you need to update the file format being sent to Office Ally, please contact OA at 360-975-7000 Option 1 and let the Customer Service Representative know that you need to have your file format updated.

TESTING WITH OFFICE ALLY

To ensure a smooth transition to submitting electronically via Office Ally, it’s recommended that testing be completed for all third-party software submitters.
End-to-End testing is not available for all payers (and it’s completed only at the payer’s request); however, you can test as often as you’d like with OA directly.
It’s recommended that a test file containing 5-100 claims be submitted for testing. Test claims should include a variety of claims, accounting for different types of situations or scenarios that you deal with most frequently (Ambulance, NDC, Inpatient, Outpatient, etc.).
After your test file has been submitted and processed, Office Ally return a report identifying the claims that passed testing and those that may have failed.
4.1 Test File Naming Requirements
The word OATEST (all one word) must be included the test file name in order for Office Ally to recognize it as a test file. If the file does not have the required keyword (OATEST), the file will be processed in our production environment regardless of whether ISA15 is set to ‘T’. Below are examples of acceptable and nonacceptable test file names:
ACCEPTABLE: XXXXXX.OATEST.XXXXXX.837
ACCEPTABLE: OATEST XXXXXX_XXXXX.txt
UNACCEPTABLE: 0A_TESTXXXX>C<X.837
UNACCEPTABLE: TEST XXXXXX_XXXXX.837
Test files may be submitted via file upload or SFTP transmission. When submitting test files via SFTP, the claim type keyword must also be included in the file name (ie 837P/8371/837D).

CONNECTIVITY INFORMATION

Office Ally offers two file exchange methods for batch submitters:

• SFTP (Secure File Transfer Protocol)
• Office Ally’s Secure Website

5.1 SFTP — Secure File Transfer Protocol
Setup Instruction
To request an SFTP connection, send the following information via email to Sipporteofficeallu.com:

• Office Ally Username
• Contact Name
• Contact Email
• Software Name (if available)
• Claim Types Submitted (HCFA/UB/ADA)
• Receive 999/277CA reports? (Yes or No)

Note: If you select ‘No’, only the Office Ally proprietary text reports will be returned.
Connectivity Details
URL Address: ftp10officeally.com
Port 22
SSH/SFTP Enabled (If asked to Cache SSH during logon, click ‘Yes’)
Files uploaded to Office Ally via SFTP must be placed in the “inbound” folder for processing. All SFTP outbound files (including 835’s) from Office Ally will be available for retrieval in the “outbound” folder.
SFTP File Naming Requirements
All inbound claim files submitted via SFTP must contain one of the following keywords in the file name to identify the type of claims being submitted: 837P, 8371, or 837D
For example, when submitting a production claim file containing institutional claims: drsmith_8371_claimfile_10222022.837
5.2 Office Ally Secure Website
Follow the below steps to upload a claim file using Office Ally’s secure website.

1. Log into www.officeally.com
2. Hover over “Upload Claims”
3. Click to upload the file based on your claim type (ie. “Upload Professional (UB/8371) File”)
4. Click “Select File”
5. Browse for your file and click “Open”
6. Click “Upload”

Upon upload, you’ll receive an upload confirmation page with your FilelD number.
Response reports will be available within 6 to 12 hours in the “Download File Summary” section of the website.

CONTACT INFORMATION

6.1 Customer Service

6.2 Technical Support

6.3 Enrollment Assistance

6.4 Training

https://cms.officeally.com/Pages/ResourceCenter/Webinars.aspx

CONTROL SEGMENTS/ENVELOPES

This section describes OA’s use of the interchange (ISA) and functional group (GS control segments. Note that submissions to Office Ally are limited to one interchange (ISA) and one functional group (GS) per file. Files may contain up to 5000 transaction sets (ST).
7.1 ISA-IEA

For testing, send “OATEST” in the filename.

7.2 GS-GE

OFFICE ALLY SPECIFIC BUSINESS RULES AND LIMITATIONS

The following file specifications are taken from the 837 X12 Implementation Guide. The purpose is to provide guidance on specific loops and segments that are important to processing claims electronically. This is not a full guide; a full guide is available for purchase from Washington Publishing Company.

Submitter Information
Loop 1000A— NM1

The purpose of this segment is to supply the name of the individual or organization submitting the file
Position| Description| Min/Max| Value| Comments
NM101| Entity Identifier Code| 2/3| 41|
NM102| Entity Type Qualifier| 1/1| 1 or 2| 1 = Person
2 = Non-Person
NM103| Organization (or last) Name| 1/35| |
NM104| Submitter First Name| 1/35| | Situational; Only required if NM102 = 1
NM108| Identification Code Qualifier| 1/2| 46|
NM109| Identification Code| 2/80| | Submitter ID of your choosing (Tax ID is common)
Receiver Information
Loop 10008 — NM 1

The purpose of this segment is to supply the name of the organization you’re submitting to
Position| Description| Min/Max| Value| Comments
NM101| Entity Identifier Code| 2/3| 40|
NM102| Entity Type Qualifier| 1/1| 2|
NM103| Organization Name| 1/35| OFFICE ALLY|
NM108| Identification Code Qualifier| 1/2| 46|
NM109| Identification Code| 2/80| 330897513| OA Tax ID
Billing Provider Information
Loop 2010AA— NM1, N3, N4, REF

The purpose of this segment is to supply the name, address, NPI, and Tax ID for the billing provider
Position| Description| Min/Max| Value| Comments
NM101| Entity Identifier Code| 2/3| 85|
NM102| Entity Type Qualifier| 1/1| 2| 2 = Non-Person
NM103| Organization (or Last) Name| 1/60| |
NM108| Identification Code Qualifier| 1/2| XX|
NM109| Identification Code| 2/80| | 10-digit NPI Number
N301| Billing Provider Street Address| 1/55| | Physical Address required. Do not send PO Box.
N401| Billing Provider City| 2/30| |
N402| Billing Provider State| 2/2| |
N403| Billing Provider Zip| 3/15| |
REAM| Reference Identification Qualifier| 2/3| El| El= Tax ID
REF02| Reference Identification| 1/50| | 9-digit Tax ID
Subscriber (Insured) Information
Loop 2010BA – NM1, N3, N4, DMG

The purpose of this segment is to supp y the name, address, member ID, DOB, and gender of the subscriber (insured)
Position| Description| Min/Max| Value| Comments
NM101| Entity Identifier Code| 2/3| IL|
NM102| Entity Type Qualifier| 1/1| 1|
NM103| Subscriber Last Name| 1/60| |
NM104| Subscriber First Name| 1/35| |
NM108| Identification Code Qualifier| 1/2| MI|
NM109| Identification Code| 2/80| | Member ID Number
N301| Subscriber Street Address| 1/55| |
N401| Subscriber City| 2/30| |
N402| Subscriber State| 2/2| |
---|---|---|---|---
N403| Subscriber Zip| 3/15| |
DMG01| Date Time Period Format Qualifier| 2/3| 8|
DMG02| Subscriber Date of Birth| 1/35| | YYYYMMDD format
DMG03| Subscriber Gender| 1/1| F, M, or U
F = Female| M = Male
U = Unknown
Payer Information
Loop 201088 — NM1

The purpose of this segment is to supply the payer name and ID that the claim should be submitted to (destination payer)
Please use the payer ID os listed on the Office Ally Payer List to ensure proper routing.
Position| Description| Min/Max| Value| Comments
NM101| Entity Identifier Code| 2/3| PR|
NM102| Entity Type Qualifier| 1/1| 2|
NM103| Destination Payer Name| 1/35| |
Nm108| Identification CodeQualifier| 1/2| PI|
Nm1O9| 5-Digit Payer ID| 2/80| | Use a payer ID listed on the Office Ally Payer list.
Patient Information (Situational)
Loop 2010CA— NM1, N3, N4, DMG

The purpose of this segment is to supply the name of the patient – if different than the subscriber (dependent)
Position| Description| Min/Max| Value| Comments
NM101| Entity Identifier Code| 2/3| QC|
NM102| Entity Type Qualifier| 1/1| 1|
NM103| Patient Last Name| 1/60| |
NM104| Patient First Name| 1/35| |
N301| Patient Street Address| 1/55| |
N401| Patient City| 2/30| |
N402| Patient State| 2/2| |
N403| Patient Zip| 3/15| |
DMG01| Date Time Period Format Qualifier| 2/3| D8|
DMG02| Patient Date of Birth| 1/35| | YYYYMMDD format
DMG03| Patient Gender| 1/1| F, M, or U| F = Female
M = Male
U = Unknown
Attending Provider Information
Loop 2310A— NM1

The purpose of this segment is to supply the name and NPI of the provider who is responsible for the patient’s medical care.
Position| Description| | Min/Max| Value| Comments
NM101| Entity Identifier Code| | 2/3| 71|
NM102| Entity Type Qualifier| | 1/1| 1| 1= Person
NM103| Attending Last Name| | 1/60| |
NM104| Attending First Name| | 1/35| |
NM108| Identification Code Qualifier| | 1/2| XX|
NM109| Identification Code| | 2/80| | 10-digit NPI number
Operating Provider Information (Situational)
Loop 23108 — NM1

The purpose of this segment is to supply the name and NPI of the provider who is responsible for performing the patient’s surgery.
Position| Description| Min/Max| Value| Comments
NM101| Entity Identifier Code| 2/3| 72|
NM102| Entity Type Qualifier| 1/1| 1| 1= Person
NM103| Attending Last Name| 1/60| |
NM104| Attending First Name| 1/35| |
NM108| Identification Code Qualifier| 1/2| XX|
NM109| Identification Code| 2/80| | 10-digit NPI number

ACKNOWLEDGEMENTS AND REPORTS

Office Ally returns the following responses and report types. As noted, the 999 and 277CA responses are only produced for claim files submitted via SFTP. Refer to Appendix A for a list of file naming conventions associated with each response.
9.1 999 Implementation Acknowledgement
The EDI X12 999 Implementation Acknowledgement document is used in healthcare to provide confirmation that a file was received. A 999 acknowledgement is returned to the submitter only for claim files submitted via SFTP.
9.2 277CA Claim Acknowledgement File Summary
The purpose of the EDI X12 277CA File Summary is to report whether or not a claim has been rejected or accepted by Office Ally. Only accepted claims will be sent to the payer for processing. This is an X12 formatted file which is equivalent to the text formatted File Summary Report.
9.3 277CA Claim Acknowledgement EDI Status
The purpose of the EDI X12 277CA EDI Status report is to convey whetier or not a claim has been accepted or rejected by the payer. This is an X12 formatted file which is equivalent to the text formatted EDI Status Report
9.4 File Summary Report
The File Summary Report is a text (.txt) formatted file which indicates whether claims were accepted or rejected by Office Ally. Accepted claims will be sent to the payer for processing. Refer to Appendix B for file layout specifications.
9.5 EDI Status Report
The EDI Status Report is a text (.txt) formatted file which is used to convey the status of a claim after it was sent to the pager for processing. Claim responses received from a pager will be passed on to you in the form of an EDI Status Report. Refer to Appendix C for file layout specifications.
In addition to these text reports, you may request to also receive a Custom CSV EDI Status Report. The Custom CSV EDI Status Report contains the claims included in the EDI Status Report text file, along with any additional claim data elements of your choosing.
For additional details and/or to request this option, please contact Customer Support.
9.6 835 Electronic Remittance Advice
Office Ally will return EDI X12 835 files, as well as a text formatted version of the remit file. Refer to Appendix D for file layout specifications.

APPENDIX A – OFFICE ALLY RESPONSE FILE NAMING CONVENTIONS

Office Ally Reports and File Naming Conventions

File Summary — Professional| FS_HCFA_FILEID_IN_C.txt
File Summary — Institutional| FILEID_UBSUMMARY_YYYYMMDD.txt
EDI Status*| FILEID_EDI_STATUS_YYYYMMDD.txt
X12 999| FILEID_SubmittedFileName_999.999
X12 277CA – Professional (File Summary)| USERNAME_FILEID_HCFA_277ca_YYYYMMDD.txt
X12 277CA – Institutional (File Summary)| USERNAME_FILEID_UB_277ca_YYYYMMDD.txt
X12 277CA – Professional (EDI Status)| FILEID_EDI_STATUS_HCFA_YYYYMMDD.277
X12 277CA – Institutional (EDI Status)| FILEID_EDI_STATUS_UB_YYYYMMDD.277
X12 835 & ERA (TXT)| FILEID_ERA_STATUS_5010_YYYYMMDD.zip (contains 835 and TXT) FILEID_ERA_835_5010_YYYYMMDD.835 FILEID_ERA_STATUS_5010_YYYYMMDD.txt

*Refer to Appendices B thru D for File layout specifications
**999/277CA report activation must be requested and are only available for files submitted via SFTP

APPENDIX B – FILE SUMMARY – INSTITUTIONAL

Below are examples of the Institutional File Summary Report:
All Claims in the File Were Accepted by Office Ally

Some Claims in the File Were Accepted and Some were Rejected (errored) by Office Ally

Below are the file layout details for each of the sections that may be included in the File Summary.

FILE SUMMARY DETAIL

Field Name Start Pos Field Length
CLAIM#| 1| 6
STATUS| 10| 3
CLAIM ID| 17| 8
CONTROL NUM| 27| 14
MEDICAL REC| 42| 15
PATIENT ID| 57| 14
PATIENT (L, F)| 72| 20
TOTAL CHARGE| 95| 12
FROM DATE| 109| 10
BILL TAXID| 124| 10
NPI / PIN| 136| 11
PAYER| 148| 5
ERROR CODE| 156| 50
DUPLICATE INFO

Field Name Start Pos Field Length
Information| 1| 182
OA Claim ID| 35| 8
OA File Name| | 55
DateProcessed| –| –
CONTROL NUM| | –

Notes: 1. “-” indicates that the start position and length may vary due to length of OA file name 2. Error cods are comma delimited and correspond to the error summary in the header. 3. If the ACCNT# (CLM01) is >14 digits, the PHYS.ID, PAYER, and ERRORS start position will be adjusted.

APPENDIX C – EDI STATUS REPORT

This text formatted report is similar to the File Summary Report; however, the EDI Status Report contains status information sent to Office Ally from the payer. Any message OA receives from the payer will be passed on to you in the form of an EDI Status Report.
The EDI Status Report will appear and look similar to the example shown below.

Note: In the ED! Status Report, if multiple responses come back for the same claim (at the same time), you’ll see multiple rows containing status for a single claim.
Below are the file layout details for the EDI Status Report.

EDI Status Report Detail Records

Field Name| Start Pos| Field Length
File ID| 5| 9
Claim ID| 15| 10
Pat. Acct #| 27| 14
Patient| 42| 20
Amount| 62| 9
Practicel D| 74| 10
Tax ID| 85| 10
Payer| 96| 5
Payer Process Dt| 106| 10
Payer Ref ID| 123| 15
Status| 143| 8
Payer Response Message| 153| 255

APPENDIX D – ERA/835 STATUS REPORT
Office Ally provides a readable text (.TXT) version of the EDI X12 835 file, a sample of which is shown below:

Standard Companion Guide Transaction Information Refers to the Implementation Guides Based on X12
Version 005010X223A2
Revised 01/25/2023

Documents / Resources

| Office Ally OA Processing Application [pdf] User Guide
OA Processing Application, OA, Processing Application, Application
---|---

References

• Healthcare Software for Your Medical Practice | Office Ally
• Healthcare Software for Your Medical Practice | Office Ally
• Home | WPC
• Search Payer List by Name, ID, & Transaction Type | Office Ally
• Free Training for All of Our Products | Office Ally
• OfficeAllyUi
• Office Ally - Powered by Kayako Help Desk Software

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