Getting Started with Insurance
Navigating insurance billing doesn’t have to be overwhelming! Whether you're new to the process or just need a refresher, this guide will walk you through everything you need to know about setting up and managing insurance claims in Sessions Health. From getting your payers in place to submitting claims and troubleshooting any hiccups along the way, we’ve got you covered. Follow these steps to streamline your workflow and ensure your claims get processed smoothly, so you can focus on what really matters—caring for your clients.
This guide covers:
- Account Set Up
- Insurance Settings
- Insurance Payers
- Client Set Up
- Creating and Submitting a Claim
- ERAs
- Resubmissions and Cancelations
Account Set Up
Profile
Before submitting an insurance claim, it’s important to ensure your profile is correctly set up with your NPI and taxonomy code. To verify this information (which was gathered during account setup), click on your initials in the top right corner of your account and select Profile. On the Profile page, double-check that your NPI 1 and the corresponding taxonomy code registered with your NPI 1 are correctly entered.
Not sure what your taxonomy code is? You can check the NPPES Registry.
Service Locations
The place of service (POS) and details about your service facility locations are pulled from your Service Locations. To set up or review these settings, navigate to Account Settings > Account and scroll down to Service Locations. Here, you can click +Add to create new service locations, or use the three dots on the right to edit existing locations.
Note: If you have a telehealth location (POS 02 or 10) and choose to include a service facility location on your claim forms, you must enter a physical address for your telehealth location. Otherwise, your claim will be denied.
You can read more about Service Locations here.
Service Codes
Service codes, also known as CPT codes, are used to bill clients and submit claims to insurance payers. To access your service code settings, go to Billing Settings > Services. You can either manually add your own service codes or bulk import the most common CPT codes used by mental health providers. Be sure to include rates for each of your service codes.
You can read more about CPT and Service Codes here.
Insurance Settings
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. It will show up in box 33 on the claim form.
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. This will be the NPI used in box 33 on the claim form.
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 phone number 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.
Insurance Payers
Add Insurance 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.
You can read more about insurance payers and payer IDs here.
Insurance Enrollments
Enrollments are required by insurance payers if you wish to receive ERAs (electronic remittance advice) in your Sessions Health account. Many government funded insurance payers and some BCBS payers also require enrollments before claims can be submitted.
To initiate the process, go to Billing Settings > Insurance > Payers. Click on the blue Enroll button next to Claims (if applicable) or Remittance. Select Go to Paperwork. This will take you to a Claim.MD page with instructions unique to the insurance payer that you must complete in order to submit the enrollment.
You can read more about insurance enrollments here.
Client Set Up
Before creating and submitting claims, you will want to make sure your client is properly set up with their own insurance details.
Insurance Policy
You can directly enter in a client's insurance information or the client can enter it in themselves when onboarding. To make sure the necessary information is in the client's chart, navigate to the client account > Billing > Settings > scroll down to Insurance. If there is nothing under the Insurance heading, click Add Policy to add in the accurate information. If a policy is already entered in, you will want to be sure it is linked to an insurance payer in your payer list.
Co-Pays / Co-Insurance / Deductible
If you know your client has an amount they will owe (whether as a co-pay, co-insurance, or deductible), you can go to the client account > Billing > Settings and right near the top, enter in the amount the client will owe under the Co-Pay/Co-Insurance heading. Deductible amounts can be entered here as well.
You can read more about managing and collecting insurance information here.
Creating and Submitting a Claim
Once your account insurance settings, insurance payers, and the client's insurance settings have all been set up, you are ready to create and submit your first claim!
Any insurance-eligible services tied to sessions that have already occurred will show up under Insurance > Pending Submission. You can check the boxes for any claims you wish to submit. If there is a reason a claim can not yet be submitted, the checkbox will be blocked off. To edit any sessions before submitting, click Edit in the right hand column.
Claims can also be created from the client's individual account. Once on their chart, go to Billing > Documents. Click New... and select Claim.
You can read more about creating and submitting claims here and here.
ERAs
We can help you track the status of claims and payments. We can provide information about what the payer approved for reimbursement and help you add the payment details when available. If you submitted a remittance enrollment for an insurance payer, once it is approved, the ERAs will begin to come into your Sessions Health account.
If an ERA is received from the payer, we will automatically apply the payment information and mark the claim as paid. You may see the breakdown of this information on the Remittance tab for the claim. If a claim is denied, it will be marked as Needs Review.
Customers are notified of ERAs via the Daily Digest. They can also check their Payments list to view ERAs that have come into the account.
You can read more about remittances here.
Resubmissions and Cancelations
Most claims are processed smoothly. However rejections and denials do occur. Claims can be resubmitted or canceled (also known as voided) through Sessions Health.
Resubmitting Claims
A claim with a status of Needs Review, Rejected, or Denied will automatically be open for edits. In other circumstances, you may need to reopen the claim for edits first. To do this, click the '...' menu at the top right of the claim and select Reopen for Edits.
Note: If you reopen a claim this way, you will be asked to confirm you wish to resubmit to the insurance payer and to input the payer claim number. If you select 'yes' and put in the payer claim number, the resubmission code 7 and the original reference number (which are both needed for a resubmission) will automatically be included on the claim resubmission.
Before resubmission, edit the claim details to correct the problem stated by the error message or the insurance payer. This may involve editing the information in the claim's Details tab and updating other information in your account.
Once the claim has been updated, navigate to the Details tab > Other > Resubmission Information > Edit. If the resubmitted claim will be replacing a prior submitted claim, select 7 for the resubmission code. For the original reference number, put in the payer claim number and save. Then scroll to the top of the claim and select Submit.
Note: Sessions Health displays three claim numbers. Our own internal ID, the clearinghouse claim number, and the payer's claim number. In the case of resubmission information, only the payer claim number will be accepted by the insurance payer. Do not enter in the ID from Sessions Health or the clearinghouse claim number.
Cancelations
If you wish to cancel/void a previously submitted claim, click the '...' menu at the top right of the claim and select Void Claim.
You will prompted to confirm that you want to void the claim. After confirmation, you will be asked to include the Payer Claim Number of the original claim which you can find in the heading of the claim. If the payer didn't include a claim number on the response to the clearinghouse, you will need to contact the payer.
Note: If you need to resubmit or void a claim, you will want to wait until the insurance payer has processed the originally submitted claim before resubmitting/voiding. Otherwise, the resubmission may not get processed correctly.
You can read more about resubmissions and cancelations here.