How To: 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.

Before submitting out-of-network claims:

• Verify that TherapyNotes EDI is enabled for your practice
  • Click the User Icon > Settings > Practice Billing
  • Verify that both the Enable Billing Features checkbox and the Enable TherapyNotes EDI checkbox are selected
• Set the payer's Billing Method to EDI, or read How To: Set Billing Method for more information
  • Click Payers
  • Click the 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 EDI (send claims electronically). This will update the Method for all pending claims for the payer
• Under Clearinghouse EDI Enrollment Status, enroll to submit electronic (EDI) claims for this payer
• Click the Save Changes button

To submit an out-of-network claim electronically:

• Follow the instructions on How To: Submit Electronic (EDI) Claims
• 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
• 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
• 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