Summary: To submit claims electronically, you need to have Insurance Features enabled on your account, review your Insurance settings, add Payer IDs to your payers, and begin Enrollments. You may also need to customize some settings for different payers or practitioners. You may need to wait a few weeks for your enrollments to be completed.
Once your account is setup for electronic claims, you may begin submitting them to payers where you are enrolled through our clearinghouse.
You may initiate an electronic claim a couple of ways.
The most common way is to navigate to Clients> [Client Name] > Billing > Documents. Click New... and select Claim.
Create a new claim
Select services
Note: Eligible services are services from previous sessions that have not already been submitted as electronic claims that also include insurance-reimbursable CPT codes. You may submit claims as an in-network or an out-of-network provider.
You may also create an electronic claim from a relevant bill by clicking on the Create Insurance Claim button.
Note: If you find yourself changing information here often, you may need to setup a customization for a payer and/or provider.
Verify the claim data
You may edit the billable services including modifiers, any co-pay / co-insurance amount, the location, and the diagnosis.
Make changes to billable services
You may edit insurance information including changing the insurance policy, payer information, and policy information.
Insurance tab
You may edit patient information from the Patient tab.
Patient tab
From the Providers tab you may change Insurance settings for the organization and/or the rendering provider.
Providers tab
Other
From the Other tab you may change the Accept Assignment value and add additional fields. Most payers require you to accept assignment as it relates to contract rates. It should be checked by default.
Additional Claims Fields
If needed, you may include additional claims fields on a case-by-case basis.
At the top of the claim you will see a submit button. If you are ready to submit your claim, press Submit.
Submit the claim
Not Enrolled - If not enrolled for this payer, you will see the Not Enrolled status. You will need to go through the enrollment process for this payer before submitting claims.
If you submit a claim outside of Sessions Health, you can still create the claim and mark the claim as submitted externally. To do this, you'll want to first Initiate a claim. When the claim is created, you can click "..." within the claim and select Mark as Submitted Externally.
After you've created a claim by following steps 1-3 above, you can click on the Download button in the top left corner to download a version of the claim that can be printed and mailed or faxed.
Incident-to billing & adding a supervisor's information to a claim
When a supervisee bills using a supervisor's credential, it is called incident-to billing. You may submit electronic claims through Sessions Health using incident-to billing. You may also add the supervisor as the referring provider using box 17 of the CMS 1500 claim form.
These are the approaches you may use:
Using the supervisee's name with the supervisor's NPI as the rendering provider
When creating a claim, you may enter an NPI for the rendering provider. Enter the supervisor's NPI to replace the supervisee's NPI. You do this from the Providers tab on the claim by clicking edit by the Rendering Provider.
Change the NPI to the supervisor's NPI
Using the supervisor's name and the supervisor's NPI as the rendering provider
If the supervisor has the supervisor role and is assigned as the supervisor for the supervisee, you may use a different approach.
You can assign the supervisor as the rendering provider on any of the supervisee's claims from the Provider tab on the claim by selecting them from the dropdown under Rendering Provider.
Selecting the supervisor as the rendering provider
Using Box 17
If a supervisor is established, you may also leave the supervisee as the Rendering provider and use the supervisor's information in box 17 on the claim. You do this on the Provider tab by making certain the box is checked to Include supervisor in Box 17?
Set box 17 on the 1500 claim to include the supervisor's information
Note: Before submitting secondary claims, you must add a secondary insurance policy in the Insurance section of the client's Billing > Settings tab. You must also wait until a primary claim through Sessions Health has been approved or denied/rejected from the primary payer.
The process for submitting secondary claims is the same as submitting to primary insurance with some caveats. See our Manage insurance information article for directions on adding insurance.
To initiate a secondary insurance claim, click the Add Secondary button at the top of an eligible claim.
Add secondary insurance button
Next, select the secondary insurance policy and click the Create Claim button.
You'll then see a message telling you to adjust the patient responsibility amount. This means that you need to add an adjustment reason code so the secondary payer understands why the primary payer didn't pay the amount being submitted. You must add any contractual obligation adjustments within the patient responsibility and write-off adjustment sections.
To add a reason code, to to the claims Details > Adjustments tab and click the Add button in the Patient Responsibility section.
In the pop-up, add a Reason Code.
Note: If the primary claim is approved, the patient responsibility adjustment is almost always set with a reason code of 1 - Deductible Amount, 2 - Coinsurance Amount, or 3 - Co-payment Amount. If the primary claim is denied for being out-of-network, you'll oftentimes want to set the reason code to 242 - Services not provided by network/primary care providers.
Once the reason codes are added, click Save. You'll then be able to click Submit at the top of the claim.
Note: If the primary claim is approved, but the secondary payer requires changes to modifiers, you can adjust these prior to submitting the secondary claim. If you go to the claim details page and scroll to the bottom, you can click on the bill associated with the claim. From there, you can click on the three dots in the same row as the date of service and select Edit Services. This will then allow you to make changes to modifiers.
You may add a prior authorization to a claim prior to submitting it. When creating a claim, navigate to the Details > Other tab.
In the Additional Claims Information panel, click Edit. Next, check the Include additional claims field box. Scroll down to the Prior Authorization Number field, enter your authorization number, and click Save.
Your prior authorization code will then be included when you submit the claim.
Note: When you add a prior authorization number to a claim, each consecutive claim will include that number until you remove it.
