How to: Out-of-Network Electronic Claims


The general workflow for submitting electronic (EDI) claims for out-of-network payers is as follows: 

  1. Under the "Patient Billing" tab click on the date of service.
  2. Make sure the "Method" dropdown reads "Insurance - Out of Network - EDI".
  3. Leave "Coverage" box blank.
  4. Submit the claim by clicking BILLING > "Submit EDI Claims".
  5. Receive the insurance payment, either as a paper check or as an electronic funds transfer. Note: Insurance payments are not arranged through TherapyNotes.
  6. Enter the insurance payment. Click BILLING > "Enter Insurance Payment".
  7. When in the "Enter Insurance Payment" screen: Click the date of service > Type the insurance payment amount in the "Coverage" box > "Save Changes".
  8. Fill out the "Enter Insurance Payment" screen, including the "Payment Amount", "Payment Allocation", and any Adjustments. Click the green "Save Payment" button.
  9. Now the patient amount is the difference between the rate and what insurance covered. To verify the amount go to the patient's chart under the "Patient Billing" tab.


Note: If your practice wants the patient to pay in full up front and then have insurance pay the patient, go to the "Billing Settings" tab in the patient's chart and change the "Payments Sent To:" dropdown menu to "Override and Always Assign to Patient"

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