TherapyNotes cannot send $0.14 electronic claims to payers not supported by the clearinghouse. You can tell a payer is not supported in two ways:
1) When searching Payers Supported by Clearinghouse (from the Payers tab) the search result will read No payers matched your search.
2) When adding a payer profile and typing in the Ins. Provider Name field, the Payer ID will not be listed next to the payer name in the dropdown and the Payer ID field will not autofill.
Submit Claims Not Supported by the clearinghouse
You have three options to submit claims to payers not supported by the clearinghouse.
Option 1: CMS-1500 – Free
Add the payer profile. Set the Billing Method dropdown box to Paper (Print CMS-1500 forms or superbills). Leave the Payer ID field blank. Insert the paper claim mailing address of the payer. Click the Save New Payer button. Your office must generate, print, and mail all CMS-1500 forms.
Option 2: Electronic CMS-1500 – $1
Add the payer profile. For Billing Method select Electronic Claims from the dropdown. Leave the Payer ID field blank. Insert the payer’s paper claim mailing address. Click the Save New Payer button.
Click Submit Electronic Claims to send the claim to the clearinghouse. The clearinghouse reviews the claim for errors, then prints and mails the claim to the paper claim address saved in the payer profile. These claims cost $1. Multiple dates of service per patient can be batched together in a single $1 Electronic CMS-1500 claim.
Option 3: Submit Separately from TherapyNotes – Free
Add the payer profile. For Billing Method select External (Submit claims separately from TherapyNotes). Leave the Payer ID field blank. Click the Save New Payer button. Submit the claims in a system outside of TherapyNotes, such as through the payer’s online portal.
Mark Externally Submitted Items
After submitting the claim separately from TherapyNotes choose one of the following:
- Click Billing > Mark External Items
- Click Patients > Patient name > Billing tab > Mark External Items
- Click Payers > Payer name > Billing tab > Mark External Items
- Click To-Do > Mark External Items
Locate the claim in question. If the line item's method is set to External, then search under Pending External Submission. If the line item's method is set to paper or electronic, change the Method dropdown selection to Pending Paper Submission or Pending Electronic Submission. Then click the button to mark the item as submitted.
To learn more about submitting claims separately from TherapyNotes, see this article. This includes marking the claims as submitted as well as entering the insurance payment into TherapyNotes.