Support Center

Manage Insurance Claims and Posting

Last Updated: Jun 12, 2015 12:56PM EST

Posting is one of the most complicated parts of TherapyAppointment.com, primarily because there are so many situations to consider. As a result, the posting screen can be a bit daunting. The usual procedure is as follows: when a patient comes in for an appointment, and notes are charted, an entry will appear on this screen automatically showing the CPT code, patient payment, etc. DON'T ATTEMPT TO ENTER ROUTINE APPOINTMENT CHARGES MANUALLY ON THIS SCREEN: the software does this for you automatically as you chart progress notes.

There are three types of claims: paper claims (to be printed locally and mailed), simple claim lists (to be printed for reference as you enter claims on insurance company web sites or on paper forms), and electronic claims (which are sent automatically at the click of a button, making life very easy). The type of claim that is produced is determined by the information you have entered about the insurance company--see below.

After you have printed and/or submitted the claims, and pressed the button indicating that the paper ones printed correctly, the computer will note that they have been mailed and allow 45 days for an EOB (Explanation of Benefits) to be mailed back to you (hopefully with a check included!).

IN THE GREAT MAJORITY OF CASES, YOU WILL NOT CLICK ON THE "POSTING" BUTTON UNTIL YOU HAVE RECEIVED THIS EOB! Everything else should be automatic.

Once you receive the EOB, you must enter the information into the system. *please note that our system has the abilitly to 'auto-post' for you. Please read our article under the posting section of thse help pages. Display the patient, click on "Posting", and find the date of service reflected in the EOB. Enter the amount the insurance company paid, the amount "adjusted" (i.e. any discount to your rates because of membership in a PPO), and any amount credited toward the patient's annual deductible. Press the "post" button for that row to enter the information.

With any luck, this results in a zero in the "Session Balance" column, and the row color changes to a nice serene blue. If the insurance paid less than expected, however, it will turn red, and a note will pop up to make you aware that there is a problem.

Claims that are not paid in 45 days (or another duration selected by you in "Preferences") will also turn red automatically. This color is meant to alert you to the problem claims that may need further attention, such as asking the patient for the balance, resubmitting a lost claim, or calling the insurance company to determine why the full amount was not paid.

If you want to RESUBMIT a claim, you can press the "P" or "B" buttons for that claim (depending on whether you want to Print it immediately on paper, or just include it with the next Batch of claims). The system will prompt you to resubmit old (45 days plus) claims automatically; these will be labeled as such when you are prompted to submit claims.

If a patient has secondary insurance, and the primary insurance is not Medicare, you can print out a secondary claim. In these circumstances, after you have entered the amount paid by the primary insurance carrier, a new "S" button will appear. Clicking on that button will print a secondary claim on paper. Why paper? Because, most often, you will have to include documentation about the primary claim payment with the secondary claim. (It is noteworthy that many mental health professions do not file secondary claims for patients because of the workload involved in producing such claims.) We also have a video about filing secondary claims.

If you are submitting claims electronically through Office Ally, there is a setting you should change in your Office Ally account. They have a "helpful" feature that blocks resubmission of claims until 90 days have elapsed after the original claim was submitted. My opinion: don't let the "trail go cold" for 90 days before resubmitting: 45 days is a more reasonable time period. Fortunately, you can turn this "helpful" feature off. Log in to your Office Ally account, and at the bottom left of the screen click on "Admin Section" and then "Duplicate Filter Settings." Turn them off permanently, and you can resubmit to your heart's content.

If you want to make notes about a claim status (e.g. you spoke with the insurance company about an overdue claim and they said that the check is on its way), press the button in the "notes" column. You'll notice that you can also choose to "postpone red action alerts" for a specified period, say to give time for the promised check to arrive. In this case, the claim will turn red again after the specified time period, alerting you to a continuing problem.

You may also choose to "postpone red action alerts" permanently. If you have just given up, and want to write off a loss, do this and note the write-off at the bottom of the Posting page. That will make the books balance nicely. Document this with notes so that you will remember later why you made that decision.

There are a few other buttons of interest on the Posting screen. The "alter" button lets you select which insurance was in effect at the time of the session. You'll deal with this if a patient forgets to tell you of a change in coverage and you need to resubmit claims to a different carrier. Clicking the button that displays the date will give details about that line item, and will permit refunding an invalid charge to a credit card.

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