How To: Submit Electronic (EDI) Claims
TherapyNotes EDI (electronic data interchange) allows you to submit both in-network and out-of-network claims electronically through our clearinghouse, Change Healthcare, who is partnered with over 2,000 payers nationwide. By submitting your claims electronically through TherapyNotes, you can track claims from initial submission through posting the payments, all in one place. There's no need to log in to a third-party system and no need to worry about data entry errors.
To enable electronic (EDI) claims:
Note: Practice Billers, Practice Administrators, and Clinical Administrators can complete this step.
- Click the User Icon > Settings > Practice Billing
- Select the Enable Billing Features checkbox
- Select the Enable TherapyNotes EDI checkbox
For more information about setting up your account for billing in TherapyNotes, read Quick Start: Billing.
To locate claims that are ready to be submitted electronically:
Follow one of the methods below. Claims are ready to be submitted when a clinician completed and signed a billable note for a client who is set up to bill their insurance. The bubble next to Submit EDI Claims throughout TherapyNotes (such as on the main Billing page and on your To-Do list) will display the number of claims that are ready to be submitted electronically.
- To view claims that are ready to be submitted, click To-Do > Submit EDI claims OR click Billing > Submit EDI Claims
- To view claims that are ready to be submitted for a specific client, click Patients > Patient Name > Patient Billing tab > Submit EDI Claims
- To view claims that are ready to be submitted for a specific payer, click Payers > Payer Name > Payer Billing tab > Submit EDI Claims
On the Submit EDI Claims page, use the Status, Payer, Clinician, Patient, and Appointments filters to find the specific claims you are ready to bill.
The Submit EDI Claims page defaults to show you pending claims for appointments within the last 30 days. If there are pending items older than 30 days, a message will display to let you know how many other appointments are ready to bill. TherapyNotes will also show how many appointments require a note to be completed and signed before the corresponding claims can be submitted.
To submit claims on the Submit EDI Claims page:
- Select the appointments you wish to create electronic claims for. Each box which surrounds a group of appointments represents a single claim. This is know as "batching"
(A) Select All Items Ready for Initial Submission: Click this link to select each appointment that has not been previously submitted
(B) Select All: Click this link to select all dates of service for a client and submit multiple dates of service in a single claim
(C) Checkboxes: Select the checkbox next to each appointment you're ready to submit claims for if you only wish to submit claims for specific appointments
- Click the Review Claim Details link and verify that all information on your claim is accurate
- Choose whether to include only the primary diagnosis code or up to four diagnosis codes from the dropdown at the bottom of the page
- Click the Submit Claims button
Warnings on the Submit EDI Claims page
Occasionally, you may see red or yellow warnings on the Submit EDI Claims page.
A red warning indicates there is an error with the information on the claim that needs to be fixed before the claim can be submitted. To correct these errors, click on the hyperlinked appointment information to edit the corresponding data, or, when applicable, click on the hyperlinked text in the warning to be taken to the appropriate page in TherapyNotes to make your corrections.
A yellow warning appears to indicate potential discrepancies in claim information or other non-crucial concerns. For instance, this may appear when you are billing as a supervisor but one claim is billing as the rendering clinician, or when a client has hospitalization dates inputted. You can still submit a claim with the yellow error if the information is correct.
- Once a claim has been created, track its status with EDI Claim History
- If a claim is rejected, read How To: Resubmit EDI Claims
- If a claim is paid, see how much you were paid with Electronic Remittance Advice