Printer Friendly PDFSetting Up a Client for Insurance Billing (Paper Claim or Electronic Claim)
How to setup the billing information for a client who pays you a co-pay for the sessions, then you bill the insurance company for the remainder of your fee using a Paper Claim or an Electronic Claim.
Navigate to the Client Contact > Insurance Info > Current Insurance Policy tab.
Fill in the required insurance policy information for the client and select the type of claim to produce. Note that if you select "Electronic Claim," you must have an account set up with a clearing house, and have the account information entered in your User Settings > Claim Submit Info settings.
Navigate to the Client Setup > Billing Setup layout for the client.
(1) Enter the client co-pay amount in the Client Session Fee/Co-pay field, and (2) enter the full fee in the Insurance Session Charge field. (3) Enter the amount you expect to receive from the insurance company in the Insurance Share Expected field. (4) Select "Yes" for Bill Insurance to include this client when performing batch insurance billing. Be sure that you have entered a diagnosis under the Treatment Setup tab.
Navigate to the client's Account layout, then click on the Insurance Account toolbar button to view the client's Insurance Account.
The "Insurance Account" toolbar button lets you toggle between the client's account and the insurance account. It changes to "Client Account" when you are viewing the insurance account.
Review the insurance account and the dates for the transactions to be included in the insurance claim.
The full session charge will be entered in the Total Charge column, with the amount you expect to receive in the Insurance Share column. A checkmark will appear for transactions that have already been billed. None have been billed yet in this example. Review the dates for the transactions to be included in the insurance claim. We will prepare a Paper Claim for the August transactions in this example. Note that the Insurance Balance reflects the balance based on the Insurance Share amounts.
Navigate to the Reports section, and choose the Insurance tab.
(5) Be sure that "Paper Claim" or "Electronic Claim" is selected as the Insurance Bill Format. (6) Enter the statement date for the claim. (7) Choose the date interval that includes the desired transactions (August in this example). (8) Click on "Current Client" to prepare the insurance statement only for the selected client, or click on "All Clients" to perform batch billing for all clients marked for insurance billing.
Review the Insurance Claim
If you chose a Paper Claim, TheraQuick presents you with a sample of the insurance claim as it would look when printed (the buttons and page navigation information will not be printed). You can edit the entries for the Line 12 Signature and Date, and the Line 13 Signature on this layout. Click "Continue" to proceed with saving or printing the claim. You will be offered the choice of printing onto plain paper (TheraQuick will print the red form background in addition to the data), or onto a pre-printed red CMS-1500 form (TheraQuick will print only the data and not the form background). If you created an electronic claim, the Manage Electronic Claims window will open, and the claim will be added to the Pending Claims list. You can review it by clicking on the claim number.
Optional: Return to the client's insurance account to see the updated information.
The transactions that were included in the claim are now marked as "Insurance Billed" in the insurance account and the Statement Date you selected has been entered in the transaction record.