Insurance: 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. Once these locations are added, you may select the appropriate location for each appointment. To make changes to any location click the three dot menu "..." to the far right.
Place of Service Codes
Each location may be assigned a Place of Service Code. Place of Service (POS) codes are a standardized set of codes used to identify the location where healthcare services were provided. These codes are used for billing and reimbursement purposes by insurance companies and other payers.
Using the correct POS code on a claim is important for accurate reimbursement and to avoid claim denials or delays. It is essential that healthcare providers understand the correct codes to use and the requirements of the insurance companies they work with.
What is the difference between place of service code 02 and place of service code 10?
Place of Service (POS) code 02 and POS code 10 are two different codes that represent different healthcare settings or locations for telehealth.
From CMS (https://www.cms.gov/files/document/mm12427-newmodifications-place-service-pos-codes-telehealth.pdf):
POS 02: Telehealth Provided Other than in Patient’s Home
POS 02 represents the location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology.
POS 10: Telehealth Provided in Patient’s Home
On the other hand, POS 10 refers to the location where health services and health related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.
Do all insurers follow this standard?
No they do not. Some insurance payers accept both POS 02 and POS 10 for telehealth sessions. Some only accept one or the other. You must contact your payer to understand their expectations regarding these telehealth codes.
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.
Service (CPT) 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 and to select "CPT" as type.
You can read more about CPT and Service Codes here.