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.
Finding, viewing, and marking these items as submitted
The workflow for marking appointments as having already been submitted to insurance is as follows:
Complete and sign their corresponding notes.
- 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.