Submit Out-of-Network Claims Electronically

Even if you're out-of-network with a payer, you can still submit claims for the payer electronically through TherapyNotes. Submitting out-of-network claims electronically helps you maintain a paperless practice and saves your client from the stress of waiting to be reimbursed by the payer directly. 

The process to submit an out-of-network claim electronically is nearly identical to submitting any claim electronically through TherapyNotes, allowing you to maintain a consistent, stress-free workflow.

For more details on the benefits of submitting out-of-network claims electronically, check out How Out-of-Network Electronic Claims Keep You and Your Clients Happy on our blog.

Role Required: Practice Biller

Before submitting out-of-network claims:

1) Verify that Electronic Claims are enabled for your practice.

  • Click the User Icon > Settings > Practice Billing
  • Verify that both the Enable Billing Features checkbox and the Enable Electronic Claims and ERA checkbox are selected.

2) Set the payer's Billing Method to Electronic Claims, or read Set Billing Method for more information.

  • Click Payers > Payer Name of the payer you are out-of-network with.
  • Click anywhere on the Payer Information box to edit.
  • From the Billing Method dropdown, select Electronic Claims. This will update the Method for all pending claims for the payer.
  • Under Clearinghouse Services, enroll to submit electronic (EDI) claims for this payer.
  • Click the Save Changes button.

Submit an Out-of-Network Claim Electronically

1) Follow the instructions on how to Submit Electronic (EDI) Claims.

2) After you receive the insurance payment (either as a paper check or through electronic funds transfer), enter the insurance payment.

  • Click Billing > Enter Insurance Payment
  • For Payment Type, select Out-of-Network Insurance Payment.
  • From the Payer dropdown, select the appropriate payer.
  • Click the date(s) or service that the payment covers.
  • A dialog with additional details about the date of service appears with the Billing tab selected by default. Enter the insurance payment amount in the Coverage field.
  • Click the Save Changes button.

3) Back on the Enter Insurance Payment screen, enter information about the payment and allocate the payment to the correct date(s) of service using the Allocation column. 

4) Click the Save Payment button.

The amount owed by the client is now the difference between the Service Rate and the Coverage amount. To verify the amount owed by the client, click Patients > Patient Billing tab and check the Pt Amt column for the corresponding date of service.

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