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 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: 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.

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. We recommend contacting your payer to confirm the correct payer ID. Most payers have this information on their provider portal 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. Here are the streamlined steps for providers to locate and use the correct Payer ID:

Verify Payer ID:
- Check the member's ID card for the payer ID to determine the correct payer.
- If the payer ID isn't listed on the card:
  - Call the payer directly to request the payer ID.
  - Alternatively, search online by typing the payer name followed by "payer ID" (e.g., "Cigna payer ID") in the search bar.
Navigate to "Payer Search."
- Enter the payer ID or name in the search bar. You may click on the More Info 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.

Begin Enrollments

Once your Payer IDs have been added, you may begin the process of enrolling in any transaction types that are required for a specific payer. This process varies from payer to payer. To initiate the process, go to Billing Settings > Insurance > Payers. You will see your existing payers and the status of the transaction types supported. You will have the ability to add new enrollments for any payers where you have added a Payer ID.

After clicking Enroll, you will see a popup. Select Go to Paperwork.

Note: If the page isn't loading, you can reset the link by clicking the button from the enrollment in Sessions Health.

Follow the instructions given to complete your enrollment.

Each payer is different and so you may need to take additional steps to complete the setup process. Please email support@sessionshealth.com if you have any questions about the enrollment process.

Self-serve enrollment approvals

If you receive a notification from a payer that an enrollment has been approved, you can mark this enrollment as approved in Sessions Health by going to your Payers list.

If the enrollments is in a pending state, clicking the arrow will bring up a button to mark the enrollment as approved.

Note: Only mark an enrollment as approved if you have received confirmation from the payer that your enrollment has been approved. If you mark an enrollment as approved without having received communication from the payer, any claims submitted may be rejected.

The instruction popup will also have a button to mark the enrollment as approved.

What about EFT?

In general, since transactions are an arrangement between the payer and the provider, Sessions Health does not provide enrollment forms for EFT*. To arrange or change EFT, please visit the provider portals for your payers (or call the payers) and fill out any EFT forms provided by them. Setting up or changing EFT should have no impact on existing remittance or claims enrollments as long as no changes to claims or remittance enrollments are made on the EFT forms.

*On rare occasions, some payers provide an optional EFT form on remittance enrollments forms provided by the clearinghouse via Sessions Health.

Once you're setup for electronic claims, you can take the next step, submitting to electronic claims.