TherapyNotes works with the clearinghouse Change Healthcare (formerly Emdeon) to submit claims and to receive ERAs. To learn about Emdeon's name change to Change Healthcare click here. An ERA, or Electronic Remittance Advice, is an electronic EOB (explanation of benefits). We call our electronic claim submission and ERA service TherapyNotes EDI (Electronic Data Interchange).
Role of the Clearinghouse
TherapyNotes users typically do not have to interact with the clearinghouse . If you have an issue with a rejected claim please contact the TherapyNotes support team, and the team member will contact the clearinghouse if needed.
When you submit an electronic claim through TherapyNotes, it first goes to the clearinghouse. The clearinghouse checks the claim for missing information or errors, then translates the claim to the appropriate format for the specific insurance company. If the clearinghouse detects any errors, they will reject the claim. To learn more about rejected claims, see this article.
It takes about 24 hours for the claims to go from TherapyNotes to the clearinghouse, and about 24-48 hours to go from the clearinghouse to the insurance company. Some insurance companies require paperwork in order to submit claims electronically through the clearinghouse. To learn how to enroll for EDI claims, see this article. Many insurance companies also send feedback regarding the claim status through the clearinghouse into TherapyNotes. This includes notification that the claim was received, accepted into the adjudication system, and any rejection feedback.
The amount of time it takes the payer to process and pay out the claim varies depending on the payer. If it's been more than 1 month since you submitted claim and it hasn't been paid out yet, follow up with the payer directly. The payer will send a paper check to the address under "Practice Information" or, if it is entered into your account, "Alternate Billing Address" under "Practice Billing Settings". If you want to set up electronic funds transfer (EFT) contact the payer directly.
Some insurance companies send Electronic Remittance Advice (ERA) through the clearinghouse into TherapyNotes. To learn how to enroll to receive ERAs through TherapyNotes, see this article.
While Change Healthcare has relationships with over 1,900 insurance companies, not every single insurance is supported. This means that it is not possible to submit claims electronically to every single payer through TherapyNotes. If a payer is not supported by the clearinghouse there are a few options about how to handle the claims. To learn how to handle claims to payers not supported by the clearinghouse, see this article.
There is no cost to enroll to submit electronic claims or receive ERAs. The costs for EDI claims are $0.14 per electronic claim. Once TherapyNotes releases auto-posting ERAs, they will be $0.14 per claim.