Insurance FAQs
Billing insurance can feel overwhelming at first, especially if you're new to the process—but you're not alone. Our goal is to help you understand the system and feel confident managing your claims.
Below is a list of the most frequently asked questions we receive from users learning to navigate insurance billing in Sessions Health.
- Is everything correct so I can submit a claim?
- How do I submit a claim?
- I don’t know what any of these terms mean.
- It’s saying there’s no eligible services.
- My enrollment was denied.
- What’s the status of my enrollment?
- It’s saying I’m not enrolled to submit a claim.
- What is the status of my claim?
- My claim was rejected.
- My claim was denied.
- How do I resubmit my claim?
- The insurance payer never got my claim.
- The insurance payer denied my claim but says it’s not in their system.
- I’m not receiving ERAs/Remittance.
- Where is my payment from insurance?
- Where is my payment from Stripe?
- How do I submit a secondary claim?
- Is this the correct Payer ID?
- It won’t let me save a remittance.
- Is there an additional cost?
- Can I add one big payment instead of going claim by claim?
- The remittance is wrong.
- My claim is processed but the status still shows as [insert status here].
- What do I do if my client has a copay/coinsurance/deductible?
- How can I see what’s actually on the claim form?
- Do I need my own Claim.MD account?
- Where do I put the EAP authorization or prior authorization number?
- How will I know if claims are rejected or denied?
- What does my rejection or denial reason mean?
- Why is there a red X by eligibility?
- My coverage report failed.
- My coverage report doesn’t tell me the client’s coverage.
- I need help with Medicare.
- How do I add a modifier?
- What do I put for insurance type?
- I don’t see where I can add an attachment to the claim.
- Can I create a superbill for my client's sessions in my previous EHR?
Is everything correct so I can submit a claim?
There are many moving parts in claim submission, and it’s completely normal to have questions. Since we don't have access to your insurance contracts or credentialing details (like whether you are credentialed under your NPI 1 or NPI 2), we can’t verify everything for you—but we can guide you in checking key areas within Sessions Health. Here's what to review:
Rendering Provider - Ensure your profile contains your NPI 1.
Insurance Settings - Confirm that your insurance settings include the information registered with the insurance payer—this may be your NPI 1 or NPI 2.
Payers - Double-check that you've added the correct payer ID to your payer list. If you're unsure, you can search Claim.MD’s payer list for guidance.
Enrollments - If there isn’t a green checkmark next to Claims for a payer, your enrollment may be incomplete. You’ll need to submit and confirm enrollment before sending claims.
Still need help? Check out our Getting Started with Insurance Guide and Electronic Claims Setup article for a more thorough walkthrough.
How do I submit 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.
Learn more about creating and submitting claims here and here.
I don’t know what any of these terms mean.
If you're new to insurance billing, it’s completely normal to feel overwhelmed by unfamiliar terminology. To help, we’ve created a searchable Electronic Claims Terms list to explain key phrases, codes, and acronyms.
It’s saying there’s no eligible services.
Claims can only be created for insurance-eligible sessions. Here are the most common reasons you might see this message:
- Unbilled or Zero-Dollar Rate
A session with an unbilled service or a $0 rate will not generate a claim. To verify:
- Navigate to [Client Name] > Summary.
- Click the circle representing the date of service.
- Under Billable Services in the right-hand column, ensure a CPT code is present and the rate is greater than $0.
- To correct this, click "..." next to Billable Services and select Edit, then update the rate and save.
- Non-CPT Service Code
If the service code is not marked as a CPT code, it won't qualify for insurance billing. To check:
- Go to Billing Settings > Services.
- Click "..." in the right hand column for the service code and select Edit.
- Ensure that the service Type is set appropriately (e.g., "CPT" for CPT services).
Still having trouble? Email us at support@sessionshealth.com and we’re happy to help.
My enrollment was denied.
Enrollment denials can happen for a variety of reasons. Most denials include a message from the payer explaining why. To resolve, first, review the denial message and address the reason—this may involve updating your Sessions Health settings or contacting the insurance payer directly. After resolving the issue, navigate to your Payers list and click the red Denied button next to Remittance to resubmit the enrollment.
What’s the status of my enrollment?
Many insurance payers do not send Sessions Health updates on the status of enrollments. They either send confirmation to directly to the practice or the confirmation of approval is sent via ERAs being returned after claims are submitted. You can contact the insurance payer's EDI department to inquire on the status of your enrollment.
It’s saying I’m not enrolled to submit a claim.
If you are unable to submit a claim and see the message, "You are not currently enrolled to submit electronic claims to this payer using the current Billing Provider NPI" it typically means one of the following:
- There is no payer ID listed for the insurance payer in the payers list. To check on this, navigate to Billing Settings > Insurance > Payers and check to make sure there is a payer ID listed for the insurance payer. If the insurance payer's name is listed more than once, and there are policies for each name, you will want to include the payer ID for all of them.
- The insurance payer requires an enrollment before you are able to submit claims to them. To check on this, navigate to Billing Settings > Insurance > Payers and check to see if there is a green check mark next to Claims in the insurance payer's row.
- The client's insurance information is not linked to the payer ID. To check on this, navigate to [Client Name] > Billing tab > Settings and scroll down to Insurance. Click the three dots on the left hand side and select Edit. In the Payer* box, confirm that the payer is listed. If it is blank, select the correct payer and then scroll down to save.
What is the status of my claim?
To track a claim's progress, be sure you're enrolled to receive electronic remittance advice (ERAs)—this allows you to receive updates from payers after submission.
You can check the status of any claim in Insurance > Submitted Claims. Each claim will show a status like "Queued for Submission," "Submitted," "Rejected," "Processed," etc.
Additionally, you can check on the status of each claim individually by opening up the claim and clicking on the Status tab. This might include additional information about the payer acknowledging or accepting the claim.
My claim was rejected.
A rejection means the claim couldn’t be processed due to an error. Rejections can come from the clearinghouse or the payer.
Common reasons include:
- Missing or incorrect information (e.g., diagnosis codes, NPI, member ID)
- Incorrect payer ID
You can review the rejection message by going to the claim and checking under the Status tab. The message may show directly in that list or you may need to click View Details to see the message.
To resolve a rejected claim, you need to make the correction directly to the claim. This can be done under the Details tab in the appropriate area. Once it has been corrected on the claim, you can scroll to the top of the page and click Submit.
You will also want to make sure you correct anything in the client's account for future claims if necessary.
My claim was denied.
Denials happen when a claim is processed but not paid. Common reasons include:
- Services not covered under the client’s plan
- Invalid or missing authorization
- Client’s insurance benefits exhausted
The denial message can be found under the claim's Status tab or if you are enrolled in ERAs, navigate to Insurance > Payments and click View for the ERA to see the message sent by the insurance payer. You may need to reach out to the insurance payer for further details about why a claim was denied.
Once you know the reason for the denial, you can correct the claim. Resubmission information can be added under the Details tab > Other > Resubmission Information. Be sure to use the payer claim number. Then scroll to the top of the claim details page and click Submit.
How do I resubmit my claim?
If your claim is marked as Needs Review, Denied, or Rejected, it’s already open for edits.
- Open the claim and go to the Details tab to make the necessary corrections.
- Once corrected, under Other > Resubmission Information, click Edit.
- Choose the appropriate Resubmission Code and enter the Original Reference Number (payer claim number), found at the top of the claim.
If the claim is marked Processed, you’ll need to reopen it:
- Click "..." in the upper-right corner of the claim page and select Reopen for Edits.
- Confirm yes, you'd like to replace the claim.
- Add the payer claim number (found at the top of the claim details page). *If the payer didn't include a claim number on the response to the clearinghouse, you will need to contact the insurance payer.
You can read more about resubmitting a claim here.
The insurance payer never got my claim.
While there have been a handful of exceptions to this, most of the time there are one of two reasons why an insurance payer might state they never received the claim.
- If a claim came back as rejected for invalid patient, subscriber, or provider details, it most likely was not "logged" into the insurance payer's system. That means, when they go to look up the claim, they won't find it attached to the client or the provider. If there is a payer claim number at the top of the claim, you will need to provide that to the insurance payer to have them look up the claim instead of looking it up by the client or provider details.
- It's possible the claim was sent to a different insurance payer than the insurance payer you called. We use Claim.MD as our clearinghouse and they have a payer list you can search to ensure you are sending your claims to the correct insurance payer.
If neither of these situations apply to you, reach out to us at support@sessionshealth.com with the following information.
- Confirmation that you called the insurance payer and asked for them to look up the claim via the payer claim number and the insurance payer said it was not in their system
- The phone number you called
- The date you called
- The call reference number
We can then have our clearinghouse investigate the missing claim.
The insurance payer denied my claim but says it's not in their system.
If the payer denied the claim but cannot locate it in their system, have them search using the payer claim number. This number can be found in:
- The claim’s details page in Sessions Health
- The Explanation of Benefits (EOB)
- The ERA (if you're enrolled to receive remittances)
I'm not receiving ERAs/Remittance.
Many insurance payers do not send us confirmation that they have approved remittance enrollment. First, confirm with the insurance payer that your enrollment for ERAs is active. If the payer confirms you are set up, please reach out to us at support@sessionshealth.com with the following information for a missing ERA:
- Full payment amount
- Payment date
- Payment number
- A copy of the EOB (optional)
We’ll then coordinate with the clearinghouse to investigate the missing ERA.
Where is my payment from insurance?
Payments from insurance payers are a direct transaction between the practice and the insurance payer. While we can receive information about the payments (ERAs), the payments go directly to the provider from the insurance payer. If you wish to set up EFTs (electronic fund transfers or direct deposit), contact the insurance payer directly.
Where is my payment from Stripe?
Stripe manages the payout timing of your payments collected through Sessions Health. The first payout Stripe will make into your account typically takes a bit longer (5-7 business days). After that, Stripe generally deposits your transactions within 2-4 days. Please note that payment times in Stripe are in the UTC time zone, so they won't always align with your payment dates recorded in Sessions Health.
You can visit your Stripe Dashboard to view more details.
How do I submit a secondary claim?
To submit a secondary claim, ensure two things are in place:
1) A secondary insurance payer is added to the client’s account.
2) A remittance from the primary payer has been entered, showing a remaining client responsibility.
The process for submitting secondary claims is the same as submitting to primary insurance with some caveats. To initiate a secondary insurance claim, click the Add Secondary button at the top of an eligible claim. If you’re enrolled to receive ERAs for the primary payer, the system will pre-fill the required data for the secondary claim. If you manually entered the remittance, be sure to enter the necessary reason codes before submitting the secondary claim.
You can read more about secondary claims here.
Is this the correct payer ID?
Payer IDs can vary by clearinghouse. Sessions Health uses Claim.MD as our clearinghouse, and their payer list is the best resource to confirm the correct payer ID.
Note: The payer ID in Claim.MD may differ from what you used in a previous EHR.
You can read more about payer IDs here.
It won't let me save a remittance.
In order for a remittance to be saved, there must be a number in all three fields (client owes, insurance paid, write-off). Leaving any of these blank will prevent the remittance from saving. Be sure to enter "$0" in any fields that don't apply.
Is there an additional cost?
Our customers are charged $0.25/claim submission. Eligibility and benefits reports are $0.15/report. Our customers do not need to sign up for their own Claim.MD account.
Can I add one big payment instead of going claim by claim?
Yes! If an insurance payer issued one payment covering multiple claims, you can enter it all at once. From the Insurance > Payments screen you may enter payment information that spans multiple claims. Click the +Add button in the upper-right corner to manually enter this type of insurance payment.
From the New Insurance Payment modal, select the Payer from the dropdown and the Service Date Start / End that the payment covers.
Choose which clients & services are included in the payment by clicking the checkbox next to the relevant options. Then, enter the Client Owes and Insurance Paid amount and click the calculator to render the Write-Off. If you are unable to save the manual payment, it's likely because an amount must be entered in every box, even if it is $0.
Finally, you may enter the Payment Date and Payment Number and click Save to save the payment information.
You can read more about adding remittances here.
The remittance is wrong.
If the remittance for a claim is wrong, you can manually edit it. To do so, go to the claim's Remittance tab. Under that tab, click the "..." on the right hand side and select Edit. In the new page that pulls up, update the remittance numbers to the accurate numbers, then scroll down and select Save.
My claim is processed but the status still shows as [insert status here].
If a claim was processed but the status doesn't show that it was processed, you can add or edit the remittance to update the claim's status.
If the remittance is not already there, open up the claim, go to the Remittance tab and select Add Remittance. Input the remittance information and then save. This will update the claim's status.
If the remittance is already in there, still go to the Remittance tab. This time, click the "..." on the right hand side and select Edit. In the page that pulls up, you don’t need to change anything—just scroll to the bottom and click Save. This will refresh the claim status to "Processed."
What do I do if my client has a copay/coinsurance/deductible?
If you know the amount your client will owe each time, you can enter that into the client's chart under the Billing tab > Settings > Copay/Coinsurance. Even if it is a deductible amount, you can enter that amount there. Every time the client has a session, that amount will pull up onto their bill for what they owe.
If you are unsure or don't know what your client owes, you can wait on the insurance payer to process the claim. Once processed, you can add in the remittance (or the ERA will come in). This will then update the bill reflect the amount the client owes.
How can I see what’s actually on the claim form?
Many of our customers want to see how the information looks on the CMS1500 claim form before submitting a claim. We're happy to be able to provide this option to our customers. To view the information on the claim form, when on the claim details page, select Download (with background) from the upper left hand corner. You can then view the claim's information as populated onto the CMS1500 claim form.
Do I need my own Claim.MD account?
No, Sessions Health customers do not need their own Claim.MD accounts. Sessions Health has an account and you will be under our account for submitting claims and receiving ERAs. If you currently have or are a part of a Claim.MD account, you will need to be removed from it.
Where do I put the EAP authorization or prior authorization number?
There are two ways to include an authorization number on claims:
Option 1: Add it to a Single Claim
- Open the claim and go to Details > Other > Additional Claims Information
- Click Edit and check the box next Include additional claims fields
- When the additional options populate, scroll down to Prior Authorization Number
- Enter in the authorization number and select Save
Option 2: Auto-Populate It for All Claims for the Client
- Go to [Client's Name] > Billing > Settings
- Scroll to the bottom to Additional Claims information
- Click Edit and check the box next to Include additional claims fields
- When the additional options populate, scroll down to Prior Authorization Number
- Enter in the authorization number and select Save
How will I know if claims are rejected or denied?
If you are enrolled in the Daily Digest, you will receive notification for any rejections or denials we receive. If you are enrolled in ERAs/electronic remittances, we should receive those rejections or denials.
Additionally, on your Home Screen, any claims that were rejected or denied, will show up as Insurance Claims Needing Review under the Needs Attention section.
What does my rejection or denial reason mean?
The messages included with claim rejections or denials come directly from the clearinghouse or the insurance payer. You can find these messages in a claim's Status tab by clicking Details. If you are unsure what a message means, you can reach out to support@sessionshealth.com. In many instances, we are unable to interpret the message and will direct you to the insurance payer for further clarification.
Why is there a red X by eligibility?
Don’t worry! A red X next to eligibility does not prevent you from submitting claims.
In Sessions Health, each payer has up to three possible functions:
- Submit claims
- Receive ERAs/remittance
- Run benefits and eligibility checks for your clients
A red X simply means that eligibility checks are not supported by that payer through our clearinghouse. You'll still be able to submit claims and receive remittances (if enrolled), but for eligibility and benefits, you'll need to use an external system or call the insurance payer directly.
My coverage report failed.
When a coverage report fails, you can hover over it to see a further explanation of why it failed. If it says to contact support, please email us at support@sessionshealth.com. If you are unsure what the message means, don't hesitate to reach out for further clarification.
Our coverage reports are run through our clearinghouse. One of the most common reasons a report might fail, is because the provider's profile might not yet exist in the clearinghouse’s system. This can happen if you haven’t selected Enroll for any insurance payers yet. To fix:
- Go to Billing Settings > Insurance > Payers
- Click any blue Enroll button and select Begin Enrollment
You don’t have to complete the full enrollment—just starting it is enough to register your profile with the clearinghouse.
Note: Customers are not charged for any failed coverage reports.
My coverage report doesn’t tell me the client’s coverage.
The information provided on the coverage reports is sent to our clearinghouse from the insurance payers. Some payers provide detailed benefit summaries, while others offer only limited information. If a report does not provide enough information to determine the client's benefits, you can try calling the insurance payer directly or using their provider portal to verify the client's benefits and eligibility.
I need help with Medicare.
Medicare can feel a bit more complex, but in Sessions Health, claims are submitted to Medicare just like they are for any other payer.
For setup guidance and specific considerations, visit our Medicare Setup article.
How do I add a modifier?
To add a modifier to a date of service:
- Go to the calendar view and click on the session you want to update.
- Next to Billable Services, click "…" and select Edit.
- In the pop-up window, click Add Modifier, then enter the desired modifier code.
- Click Save to apply the changes.
What do I put for insurance type?
When adding a payer to your Payers List, the insurance type will auto-populate based on the payer you select. If you're unsure what type to choose, you can leave the default selection as-is.
I don’t see where I can add an attachment to the claim.
Currently, Sessions Health does not support uploading attachments with electronic claims.
If a payer requires an attachment, download the claim from the top-left of the claim page using Download (with background), then submit the claim manually (e.g., by fax), including the required documentation.
Can I create a superbill for my client's sessions in my previous EHR?
Yes, you can—though it may take some manual setup.
If Sessions Were Backfilled During Import:
- Go to [Client Name] > Summary, and click on a circle with one of the dates of service.
- On the right hand side, under Billable Services, it will say Unbilled Service. Click the three dots next to Billable Services and select Edit.
- Add the correct service code and price, then click Save.
- Repeat for each session you'd like to include on the superbill.
If Sessions Were Not Imported:
- Go to Summary > +Add > New Appointment.
- Create appointments manually with the appropriate service code and rate.
- Repeat this for each session needed.
To Generate the Superbill:
- Navigate to Billing > Documents > New… > Bill and include all relevant dates of service.
- Click Add Payment, then choose one of these options:
- Client Credit/Discount (if you don’t want the payment included in income reports)
- Other (if you want the payment included in income reports)
*Note: Both options will mark the bill as paid without charging the client again.
- Go to Documents > New… > Superbill, select the sessions, and generate the document.
- To include a diagnosis:
- Click the three dots next to a date of service on the superbill and choose Edit.
- In the pop up window, the bottom section will be where you can add the diagnosis.
You can read more about superbills here.