How To: Submit Claims Outside of TherapyNotes

Follow

Occasionally, you may choose to submit certain claims outside of TherapyNotes. For instance, you may need to submit a claim to a payer directly through their online portal, or you may have employed a billing service that does not submit claims through TherapyNotes. In these cases, TherapyNotes allows you to mark the claim as submitted externally after you've submitted the claim to the payer through other means, helping you to keep your records in TherapyNotes accurate.

The bubble next to Mark External Items throughout TherapyNotes (such as on the main Billing page and on your To-Do list) will display the number of line items that are ready to be marked as submitted externally. TherapyNotes determines that an item is ready to be submitted externally when a clinician completes and signs a billable note for a client who is set up to bill their insurance. However, please note that TherapyNotes does not generate a claim when a billing item is marked as submitted externally. You must generate the claim through other means.

Role Required: Practice Biller

Before marking a claim as submitted externally:

  • Click Patients > Patient Name > Patient Billing tab
  • Under Search Billing Transactions, click the date(s) of service you want to mark as external
  • Verify that the Method for the corresponding date(s) of service is set to External (Submit claims separately from TherapyNotes). For additional guidance, read How To: Set Billing Method

To mark a claim as submitted externally:

  • Do one of the following
    • Click To-Do > Mark External Items
    • Click Billing > Mark External Items
    • Click Patients > Patient Name > Patient Billing tab > Mark External Items
    • Click Payers > Payer Name > Payer Billing tab > Mark External Items

mark_external.png

(A) Method: Select Pending External Submission from this dropdown. Pending EDI Submission and Pending Paper Submission should only be selected if the billing line item's method is either EDI or Paper and you do not need to use TherapyNotes to generate or submit the claim.

(B) Mark Submitted: After you have submitted the line item manually via a method outside of TherapyNotes, click the Mark Submitted button next to the corresponding date of service. Clicking Mark Submitted does not send the claim - this button only changes the status of the line item from Pending External to Submitted External within TherapyNotes.

Once you receive reimbursement from the payer, be sure to enter the insurance payment in the TherapyNotes. To learn more, read How To: Enter Insurance Payments.

Have more questions? Submit a request

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.