How To: Submit Claims Externally from TherapyNotes

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Sometimes TherapyNotes users submit certain claims externally from TherapyNotes. This includes submitting claims to a payer directly through their online portal or hiring a billing service that does not submit claims through the TherapyNotes account. This article walks through how to do the initial set up for such claims and how to handle the claims thereafter. 


Initial Set Up

Submitting all claims externally from TherapyNotes

If you want to submit all in-network or out-of-network claims separately from TherapyNotes:

  • Click the User Icon > Settings > "Practice Billing"
  • Under "Preferred Billing Methods" select from either the in-network or out-of-network dropdown to "External (Submit claims separately from TherapyNotes)". 

  • Click the green "Save Billing Settings" button.

 

Initial Set Up

Submitting only certain claims externally from TherapyNotes

If you only want to submit the claims for a certain payer, or only certain claims, separately from TherapyNotes:

  • Click PAYERS > Click payer  > "Payer Information" tab
  • Change the "Billing Method" dropdown to "External (Submit claims separately from TherapyNotes)". 

  • Click the green "Save Changes" button. 

To learn how to add a payer, see this article


Workflow

Finding, viewing, and marking these items as submitted

The workflow for marking appointments as having already been submitted to insurance is as follows: 

  1. Schedule appointments.

  2. Complete and sign their corresponding notes.

  3. Choose one of the following ways to get to the "Mark Externally Submitted Items" page: 

Option 1: Click TO-DO"Mark externally submitted items" 

Option 2: Click BILLING > "Mark External Items" 

Option 3: Click PATIENTS > Click patient > "Patient Billing" tab > "Mark External Items"

Option 4: Click PAYERS > Click payer > "Payer Billing" tab > "Mark External Items"

 



 Method: Select "Pending External Submission" from the dropdown. 

  • "Pending EDI Submission" and "Pending Paper Submission" appear as options. Only select one of these options if the billing line item's method is either EDI or Paper, and you do not need to use TherapyNotes to send the claim electronically or generate the paper CMS-1500 form. 

 Payer: Either leave "Any Payer" or select an option from the dropdown. 

 Clinician: Either leave "Any Clinician" or select an option from the dropdown. 

 Appointments: Select an option from the dropdown or enter a date range. 

 After you have submitted the line item manually through a method outside of TherapyNotes, click the green "Mark Submitted" button.

  • Note: The "Mark Submitted" button does not send the claim anywhere. The button only changes the status from "Pending External" to "Submitted External" within TherapyNotes.
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Comments

  • Avatar
    Marya McNorton

    Is there a way to change the billing method for one clinician? - i.e., if one clinician is not using Therapy Notes for billing, can we set it up so that all their clients' sessions will be set to "external"? Thanks.

  • Avatar
    Laura

    Elaine,

    The method of "External" can only be set up per payer, or for all in- or out-of-network payers. Otherwise, the method can be toggled per billing line item under PATIENTS > Click name > "Patient Billing" tab > Click on date of service > "Method" dropdown.

  • Avatar
    Cherrell Thomas

    is there a way to show the date the claim was marked as "billed externally"?

  • Avatar
    Laura

    Cherrell,

    To find the date an item was marked as externally submitted, go to PATIENTS > Click patient > "Patient Billing" tab > Click on date of service. In the billing dialog, click the "Billing Activity History" link on the bottom left. This displays all activity for the billing line item, including the date the item's status was set to "Submitted External".

  • Avatar
    Judi Bucholtz

    Confused that patients did not populate. On individual details their insurance indicates that it is externally submitted .

  • Avatar
    Rachael

    Judi,

    One of our Support representatives will contact you directly regarding your question. Thank you.