Setup Electronic Claims
Summary: Electronic claims are a way of sending bills to insurance companies to get paid. Sessions Health connects to a clearinghouse for electronic claims. The clearinghouse verifies the claims for errors and makes sure things look good before getting sent to the insurance companies. The insurance companies have internal systems that process the claims and decide what to pay, what the client owes, etc. Sessions Health is the conduit for all of the information between you and these systems. However, the payment portion is always an arrangement between you and the insurance company. You will need to setup EFT or ACH information for each payer you are submitting claims to. Otherwise, almost all payers default to sending paper checks in the mail if you don't have EFT or ACH set up. Please check with your payer's provider portal to get details on what you need to do to add a bank account for electronic deposit. Otherwise, watch for a check in the mail from the insurance company for claims that have been processed and approved.
Configure Electronic Claims
Permissions: This feature requires administrator permissions. If you don't have permissions, please contact your account administrator regarding this feature.
To submit claims electronically through a clearinghouse, you will first need to have Insurance Features enabled on your account. You may find this under Billing Settings > Insurance. Check the box next to Insurance features enabled? to turn it on.
Next, review your Insurance settings. These are default settings that may be customized per payer and/or per practitioner.
EIN or SSN - Use either your business federal tax ID or your social security number, whichever is appropriate for your situation.
Who will be the Billing Provider in Box 33? - This refers to Box 33 on the 1500 CMS claim form. You may select either Individual or Organization. If you are a solo practitioner, you will likely want to select Individual. If you are setup as a business and use a federal tax ID, you will likely select Organization.
Billing Provider Name - This defaults to your Account Name. It may be overridden.
NPI - The NPI number to use for insurance claims. This may be a Type 1 if a solo practitioner, or a Type 2 if an organization.
Taxonomy Code - This should be the same taxonomy code associated with the NPI number used.
Which address will be used for the Billing Provider in Box 33? - You may enter a custom address or use the Primary account address of your Sessions Health account.
Phone Number - You may enter a custom phone number or use the Primary account address of your Sessions Health account.
Show Service Facility Location in Box 32? - This may be turned on or off. Some payers require it. However, for most electronic claims, this can be turned off.
Add Payer IDs to your payers
For each payer in your account that you would like to submit claims electronically, you must add their Payer ID. To do this, go to Billing Settings > Insurance > Payers. If you have not setup any payers, you will need to do this now. You must enter the Payer ID that the payer uses to accept electronic claims. You can search for payers on our clearinghouse partner's web site.
When you enter the Payer ID, you will see an autocomplete dropdown of options. Select the appropriate option for your payer.
Do you support [a particular payer] for submitting electronic claims?
To ensure accurate processing of claims, it's essential to verify the correct Payer ID. This can be one of the tricky parts of setup because payer IDs can vary between clearinghouses.
We use Claim.MD as our clearinghouse. They have a Payer List that you can search to find the Payer ID. To do this, first navigate to "Payer Search." Next, enter the payer ID or name in the search bar. You may click on the View Payer button to view more details about the payer. You'll want to make sure it shows "Yes" next to a Professional/1500 Claims in order for you to submit claims through Sessions Health.
After you have found the Payer ID in your search, you can cross-reference the Payer ID found on the member's card against the list of "also known as" payer IDs on Claim.MD’s details page for the payer. Because each clearinghouse is unique in what payer IDs they use, it is very possible the payer ID on the member's card will not match the payer ID in Claim.MD. The "also known as" list is a good way to cross-reference.
Add customizations
For every payer in your account, you may setup a customization. Not every payer will have the same information on record and so you may customize certain information specifically for each payer. If in a group practice, you may also have custom settings per practitioner.
To add a customization, click the + Add Customization button at the bottom of the Insurance Settings. You may then change any settings listed above for claims associated with payers and/or practitioners.
The modal that appears will allow you to associate the customization with combinations of all payers, specific payers, all practitioners, and/or specific practitioners. You may create as many customizations as you need to handle the needs of your practice.
Example 1: Perhaps one practitioner in your clinic uses a different Provider Name than the rest of the clinic for one specific payer. You may create a customization that is associated with that payer for just that practitioner.
Example 2: Perhaps you are contracted with one insurance payer under your NPI 2 for your organization and all other insurance payers under your NPI 1. You may create a customization that is associated with the one insurance payer that is unique that will include your NPI 2 and your organization name.
Example 3: For group practices that want to bill sessions through supervisors but aren't using the supervision features, you can create a customization for the rendering provider that will establish the supervisor as the rendering provider.