Should I set up an account with Office Ally?
OptiMantra is directly integrated with Office Ally through a corporate account, which means all our clients submit claims through this shared setup. Because of this integration, you don’t need a separate Office Ally username or password, and you won’t need to access the Office Ally portal. All the information required for claims processing is available directly within your OptiMantra EHR.
What do I complete the Clearinghouse Setup if I want use Office Ally?
You don’t need to enter anything in the Clearinghouse Setup if you're using Office Ally. These fields should remain blank unless you've specifically requested a sub-account. In that case, the OptiMantra team will enter the required information on your behalf.
How do I check the status of my claims?
The Claims Listing Page, go to: Shortcuts > Administrative > Insurance Claims (HCFA) from the Checkout Page, click Checkout (in main headers between Patients & Inventory), and click All Claims (HCFA) button.
When will I know that a claim has been processed?
If the claim goes through the clearinghouse, its status will update to "Submitted to Payer." Once it passes the insurance company's scrubber, the status changes to "Payer is Processing." At that point, the payer typically responds within 30 days. Claims stay on the Claims Listing Page until you reconcile and mark them as Done—either directly on that page or when applying a payment.
How do I send secondary insurance claims?
To be able to submit a secondary claim, you need:
The primary insurance must have already processed the initial claim. You’ll need the Explanation of Benefits (EOB) from the primary payer—either in electronic or paper form—before proceeding.
Secondary insurance is set up on the patient’s profile. Either select SELF as the insured or enter the following details:
Insured's Name
Insurance ID
Date of Birth
Address
Insurance Company (Payer)
Payer ID
Once you have these details, you can create a secondary claim from the posting page of the initial primary claim. Additional information for submitting secondary claims: Submit secondary claim: Knowledge Base
How do I set up the insurance in your system so I can send claims?
OptiMantra offers a streamlined billing process through its integration with Office Ally. Once you've customized your settings and completed any required enrollments, claims will automatically be sent through the clearinghouse—no additional setup is needed. Here’s a link to our setup guide: Get started with insurance billing: Knowledge Base. We recommend using it as a checklist to ensure everything is properly configured.
How does payment posting work (ERA, EOB, EFT, etc.) and where are detailed reports?
Currently, OptiMantra is working on an auto-posting ERA feature - for now, as long as you’ve completed your ERA enrollments, the ERAs will flow into your EHR and can be found under EOB Checks in the Claims Listing Page for posting. More information on ERA/EOB/EFT here: Enroll with payers for EDI/ERA/EFT and other Insurance FAQs: Knowledge Base
Common reports used by billers include HCFA, EOB, Aging, and Daily Deposit reports. You can find these reports under Analytics by searching the List of Reports.
What is the difference between the clearinghouse options / is one better than the other?
We support three clearinghouses: Office Ally (recommended), Change Healthcare, and Jopari. Office Ally is fully integrated with OptiMantra, meaning you can manage the entire claims process directly within your EHR. Change Healthcare is only used by clients who were integrated with them prior to their 2024 shutdown. We no longer support new integrations with CHC. Additionally, we offer Jopari as a clearinghouse option, but it's only used for motor vehicle accident and workers' compensation claims. If you'd like to integrate with Jopari, please submit a support ticket, and our team will assist you.
How do I run eligibility checks?
To check your patient's eligibility, you need to have the patient's insurance info listed on their patient profile on the Insurance tab. Note: The information on the Insurance tab must also be listed in your contact list, under the type ‘Insurance (payer)'.
The eligibility tool uses the NPI from the default billing provider set in your Provider Settings Profile. To retrieve accurate eligibility data, ensure you know which NPI was used during your credentialing and that it's correctly entered into the system.
From the patient’s profile, click on the Eligibility Check section (see the screenshot below).
In the Payer Type section, choose whether the insurance is primary or secondary, choose the provider, and select the type of coverage. If the payer isn't already listed, add it. Then, click the blue Check Eligibility button to run the check.
Note: You can ignore the Payer Portal Login and Portal Pass fields for now; these are used for special circumstances and will be explained if applicable.
When an eligibility check is successful, a copy of the results is automatically saved in the patient’s Documents tab. This can be helpful when preparing for visits and billing. If you're unable to complete an eligibility check or encounter any issues, please submit a support ticket for assistance.
Please visit our Glossary to learn more about insurance-related terms.