How To: Submit Electronic (EDI) Claims

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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.

Role Required: Practice Biller

To enable electronic (EDI) claims:

Note: Both Practice Billers and Practice 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

Quick Tip: TherapyNotes will automatically group appointments on a single claim if you meet the payer's criteria for batching. Batched claims may save you money. However, if any date of service in the batch is rejected, the entire claim will be rejected.
  • 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 
Quick Tip: If your claim indicates that the client has secondary insurance, TherapyNotes includes this information on the primary claim. We ask the primary payer to forward the claim to the secondary payer when they have finished processing it. For more information, read Secondary Insurance.

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.

Next steps

Have more questions? Submit a request

Comments

  • Avatar
    Ashlie Straka

    Hello, can you submit a and EDI claim without competing a note?

  • Avatar
    Jordan

    The note needs to be completed before submitting a claim as certain items from the note get pulled into the EDI claim.

  • Avatar
    amy baker

    how long does an EDI claim typically take to process? And are the checks sent directly to my home address?

  • Avatar
    amy baker

    I have only submitted one claim through Therapy notes to see how it works. I don't want to do others until I know I will get paid & the claim actually goes through. The last update is showing a week ago. how do I see what has happened as of today's date? thanks.

  • Avatar
    Laura

    Amy,

    It takes 24 hours to go from TherapyNotes to the clearinghouse, then 48 hours for the clearinghouse to review the claim and send it to the payer. Each payer has its own timeline regarding how long it takes to process claims. To view the status of an EDI claim submitted through TherapyNotes click BILLING > EDI Claim History > select the patient > select the date range > Search Claims

    The "Status" column reads either Pending, Sent, Submitted, or Rejected. Click on the status to view the claim history. This is where to locate feedback from the clearinghouse and payer.

  • Avatar
    Jennifer Mezey
    why when I submit a pending edi it prompts me to resubmit claims I sent
  • Avatar
    Laura
    Jennifer, If the "Insurance Status" column reads "Resubmit EDI" in green, that means that the claim was rejected and is available to be resubmit. Check your EDI claim history for rejection feedback from the clearinghouse or payer, make the necessary changes, then you can resubmit the claims. If you have questions about specific billing line items please reach out to the support team at 215-658-4550 or support@therapynotes.com.
  • Avatar
    Donya Wallace
    How do I submit claims to the secondary insurance using EDI after the primary insurance has made a partial payment?
  • Avatar
    Laura
    Donya, At this time TherapyNotes does not support sending electronic claims (EDI) to secondary insurance directly but we are working on that feature. When you submit a claim electronically from TherapyNotes to a primary insurer, and the date(s) of service have a secondary insurer attached, we always put instructions in the electronic claim (5010) to please forward the information to the secondary electronically. Sometimes the insurers comply with our request, sometimes they do not. If the primary has not forwarded the information to the secondary you have two options. Option 1: Call the primary's EDI department and ask them to please forward the information to the secondary electronically, as per the instructions in the 5010 file. Option 2: Generate a CMS-1500 for secondary in TherapyNotes. Mail that, along with a copy of the explanation of benefits from the primary insurer, to the secondary's paper claims address.
  • Avatar
    Bill Gonzalez

    I have a rejection - Payer ID: 43324, Status: Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and has not been entered into the adjudication system. (Code: 2256), Message: BILLING PROVIDER SECONDARY IDENTIFIER: INVALID; MUST BE IN A VALID FORMAT FOR PAYER. What does this mean and where do I find a key to the rejection codes?

  • Avatar
    Jordan

    Cheryl,

    I will have an agent reach out to you regarding this. Thank you.

  • Avatar
    Julie Davies

    Question, I selected Pending Initial Submission and the green text says Pending Paper instead of Pending EDI. What am I doing wrong.

    Also when I click on the Submit EDI, I don't have an option to submit, just view.

  • Avatar
    Laura

    Julie,

    The billing method for your dates of service are set to "Paper" instead of "EDI". There are two ways to change this.

    Option 1: Change the Billing Method in the payer's profile. PAYERS > Click payer > "Information" tab > Change "Billing Method" to "EDI (Send claims electronically)" > Save Changes. Go back to the "Patient Billing" tab, and verify that the billing method updated in each line item. The "Insurance Status" column should read "Pending EDI".

    Option 2: Change the Billing Method per line item. PATIENTS > Click patient > "Patient Billing" tab > Click on date of service > Change "Method" to "Insurance - In/Out of Network - EDI" > "Save Changes". Do this for each date of service. Now the "Insurance Status" column will read "Pending EDI".

    If you need help please do not hesitate to email us at support@therapynotes.com or call 215-658-4550.

  • Avatar
    Saudia Turney

    Where does payment get sent?

  • Avatar
    Laura

    Saudia,

    Insurance will continue to pay you how they paid you before. If you want to set up electronic funds transfer (EFT) please contact the payer directly. If insurance pays paper checks, they will mail it to the address saved under User Icon > Settings > "Practice Information" > "Business Information". If you have an alternate billing address on file, they will send it there instead. The alternate billing address is located under User Icon > Settings > "Practice Billing" > "Alternate Billing Address".

  • Avatar
    Karen Schultz

    how do I add a modifier on to a claim for submission

  • Avatar
    Laura

    Karen,

    Modifiers are manually entered in each billing line item.

    To apply a modifier:
    Click PATIENTS > Click patient > "Patient Billing" tab > Click date of service
    Enter the 2 character modifier code into one of the “Modifiers” boxes to the right.
    Click the green "Save Changes" button.

  • Avatar
    Barbara Bates

    I have an old file that still shows a "pending EDI claim" from 11-10-15. The patient has passed away, and I don't want to submit the EDI claim. How do I remove the claim from TherapyNotes?

  • Avatar
    Sean Behan

    Hi Barbara,

    I'm sorry to hear about the situation. You could click on the date of service, then set the Method dropdown to "Direct" and check the box to write off the patient balance and click the green "Save Changes" button.

    Please let us know if you have any other questions. Thank you.

  • Avatar
    Peggy Haymes

    I have number of claims on my "to submit" list that i need to delete for various reasons. Is there anyway to delete claims from that que?

  • Avatar
    Jordan

    Peggy,
    There is not a way to delete a claim to be submitted. However there are a few options you have. You can change the status by going to billing> "mark external items"> change method to pending edi submission> click mark submitted for the dates you do not want to be in the edi queue. You can also click on the date of service and change the method to direct or the status submitted and closed. If you have any questions please contact support at 215-658-4550 or via email at support@therapynotes.com.