Office Ally EHR: Price Surcharge & Non-Par Payer Update

Learn about Office Ally's EHR software and the latest surcharges in their pricing. Read about Office Ally's billing process and fees.

Office Ally is a full-service, cloud-based clearinghouse employed by health and wellness professionals who accept insurance for their services.  Office Ally software allows providers to create, submit, and track insurance claims, as well as run reports, check eligibility, and verify codes.  Office Ally is well-known for being one of the lower-cost clearinghouses on the market.  They do not incur any set-up fees, general monthly fees, or per-claim fees for electronic claims submission to Participating Payers.  Other clearinghouses can range anywhere from $39 to $95 a month for practitioners.  

There are two types of payers providers can submit to through Office Ally software.  Participating Payers (Par) pay a fee to Office Ally for pre-processing claims submitted to the payer; this is how Office Ally is able to generate their income.  Non-Participating Payers (Non-Par), on the other hand, do not pay this fee; therefore, the fee is incurred upon the provider instead.  The payer itself chooses which category they fall into, based on whether they want to pay the fee and benefit from Office Ally’s pre-processing services. 

Office Ally Price Surcharge & Non-Par Payer Update

Office Ally has recently made a few updates to their monthly fees for claims to Non-Par payers, as well as their list of Non-Par Payers.  Previously, if more than 50% of a provider’s claim volume was made to Non-Par Payers, providers were required to pay a monthly Office Ally fee of $19.95 per rendering NPI/TIN.  As of February 1st, 2019, this monthly fee was raised to $35 per month.  

Additionally, the list of Non-Par Payers is expanding rapidly, as insurance payers choose to not pay for Office Ally’s services.  The table below shows the latest round of payers that have switched as of July 1st, 2019.  You can find an updated list of Par Payers here

There are a few reasons why these switches and the surcharge are occurring.  Office Ally has seen a significant decrease in insurance companies that are willing to pay for their services.  This is due to the fact that the Affordable Care Act requires that between 80-85% of premium dollars are spent on medical care.  Therefore, insurance payers are becoming warier of the money spent on processing claims, Office Ally fees are consistently not making the cut.  

Originally, insurance companies were looking to encourage providers to submit claims electronically and were willing to concur with clearinghouse fees to bolster electronic submission.  However, electronic submission is usually employed by providers any which way, so insurance companies are less willing to pay for the incentive.  

In addition, most insurance payers currently offer their own portals for electronic claim submission. For providers who are in-network with several insurance payers, it can be inconvenient to utilize multiple portals for claim submissions, a large factor when choosing to utilize a single clearinghouse. However, from a payer perspective, a free way to submit claims is available to their in-network providers, and the provider’s choice to use an alternative clearinghouse as such is an independent decision. 

Office Ally EHR & Healthie

Healthie's sync with Office Ally EHR enables you to electronically submit CMS 1500 claims from Healthie to Office Ally. This eliminates the need to manually export claims from Healthie and upload them to Office Ally. Moreover, claim statuses will automatically update within your Healthie account as information is received from Office Ally, for a seamless and automated tracking process. 

It’s important as a provider who accepts insurance to run through the list of your insurance payers and identify any that have switched over to the Non-Par Payer list.  You may have payers that have switched, but unless 50% of your claims are Non-Par payers, you are still exempt from the monthly fee.   However, these updates very well may have pushed your Non-Par Payer claims submission rate over 50%, and you will need to begin paying the $35 a month.  Be sure to evaluate your income and overall budget to ensure you can accommodate this cost.  

You can see your clients insurance plans straight from the Billing > CMS-1500 tab on Healthie. You can easily verify any payers that have switched to the Non-Par Payer category and prepared yourself appropriately.     

Read more on syncing your Office Ally account with Healthie here.  Get started with Healthie, the all-in-one practice management solution for wellness professionals.

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