How To: Submit Out-of-Network Claims Electronically

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Even if you're out-of-network with a payer, you can still submit claims for the payer electronically through TherapyNotes. Submitting out-of-network claims electronically helps you maintain a paperless practice and saves your client from the stress of waiting to be reimbursed by the payer directly. The process to submit an out-of-network claim electronically is nearly identical to submitting any claim electronically through TherapyNotes, allowing you to maintain a consistent, stress-free workflow.

For more details on the benefits of submitting out-of-network claims electronically, check out How Out-of-Network Electronic Claims Keep You and Your Clients Happy on our blog.

Role Required: Practice Biller

Before submitting out-of-network claims:

  • Verify that TherapyNotes EDI is enabled for your practice
    • Click the User Icon > Settings > Practice Billing
    • Verify that both the Enable Billing Features checkbox and the Enable TherapyNotes EDI checkbox are selected
  • Set the payer's Billing Method to EDI, or read How To: Set Billing Method for more information
    • Click Payers
    • Click the Payer Name of the payer you are out-of-network with
    • Click anywhere on the Payer Information box to edit

editpayerinfo-billingmethod.png

    • From the Billing Method dropdown, select EDI (send claims electronically). This will update the Method for all pending claims for the payer
    • Under Clearinghouse EDI Enrollment Statusenroll to submit electronic (EDI) claims for this payer
    • Click the Save Changes button

To submit an out-of-network claim electronically:

billingdialog-coverage.png

    • A dialog with additional details about the date of service appears with the Billing tab selected by default. Enter the insurance payment amount in the Coverage field
    • Click the Save Changes button
    • Back on the Enter Insurance Payment screen, enter information about the payment and allocate the payment to the correct date(s) of service using the Allocation column
    • Click the Save Payment button
  • The amount owed by the client is now the difference between the Service Rate and the Coverage amount. To verify the amount owed by the client, click Patients > Patient Billing tab and check the Pt Amt column for the corresponding date of service
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Comments

  • Avatar
    Heather Langan

    I'm am out of network as of January 1, 2018, so am wondering how to handle that in the system. My plan is to NOT file OON for my clients (too complicated and will confuse things with the insurance company - they always mess things up!). Do I now go in on each client and remove the insurance information, so by default the system will consider them paying out of pocket?

  • Avatar
    Rachael

    Heather,

    Submitting out-of-network claims electronically helps you maintain a paperless practice and saves your client from the stress of waiting to be reimbursed by the payer directly. If you do not wish to do this, you can remove the insurance information from the Billing Settings tab for each patients. You can utilize the Billing Comments box to keep record of the patient's insurance information for reference. If you have any questions, please contact our Success Team at 215-658-4550 or by email at Support@TherapyNotes.com. Thank you.