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Client insurance coverage

Two things make a client "an insurance client": their payment responsibility is set to Insurance, and their coverage details are on file. Both live on the client's Payment & Insurance tab.

In this guide, we'll cover:

Adding coverage​

  1. Open the client's profile → Edit → Payment & Insurance tab

The Payment & Insurance tab: payment responsibility, payment methods, insurance info, and document automation

  1. Under Payment Responsibility, select Insurance
  2. In the Insurance info card, open the insurance drawer and enter:
    • The coverage Type — Primary, Secondary, or Other
    • The Primary policy holder — the client, their spouse, a parent, or other (for dependents, the policyholder's details matter to the payer). Clients who fill in the demographics form enter the policyholder themselves
    • The Payer — search your own payers or the full US directory by name or payer ID. Payers that operate in your practice's state are listed first, and regional payers show their state (for example "Regence BlueShield of Idaho · ID, UT"), so it's easier to pick the right local plan
    • Member ID (required), plus Plan ID and Group ID from the insurance card — type it the way the card prints it; spaces and dashes are removed before anything is sent to the payer
    • The Copay/Coinsurance estimate and optional Deductible — these drive the client's responsibility split
    • Claim details when relevant: Filing indicator ("Insurance type for CMS-1500 claims") and who superbill payments should go to
    • Optionally, effective dates and a photo of the insurance card
  3. Save

Additional claim fields​

Two CMS-1500 fields are set per client, not per plan, in the Insurance claim / CMS fields card further down the same Billing tab. They stay hidden until you check Show additional claim fields, since most clients never need them:

  • Accept assignment? (Box 27). Leave it at Yes for in-network billing. Choose No for courtesy or out-of-network billing: the claim names the client as payee, the client pays your full fee, and an incoming ERA never changes their balance — see Courtesy and out-of-network claims.
  • Referring provider (Box 17) when the payer requires one — for example a TRICARE referral from the client's primary care manager. Pick DN - Referring provider (or DQ - Supervising provider when a payer wants a supervisor named for this client), then enter the provider's name and 10-digit NPI. Every claim for the client from then on carries them in boxes 17 and 17b, electronically and on the printed form. A claim created earlier can pick them up through Edit & Resubmit on the claim.

Both apply to claims created from the moment you save; a claim already sent keeps what it was filed with. Unchecking the box returns the client to a standard claim (Yes, no referring provider) when you save.

The same tab also holds their payment methods (card on file, AutoPay), document automation (automatic monthly statements or superbills for this client), and their default appointment billing (service code, rate, and modifiers that pre-fill when scheduling — the fee that ends up on claims).

Client-responsibility estimates

Once coverage is on file, set the client's copay/coinsurance estimate so each session splits correctly between insurance and client responsibility — see Balances & Deductibles.

Collecting insurance details at intake​

You don't have to type the card in yourself: the demographics intake form can collect insurance details and card photos from the client through the portal, and applies them to the profile automatically — but only when the client has no coverage on file yet, so a client's form can never overwrite details you've already verified.

Verifying coverage​

The client's Payment & Insurance tab has a Check Eligibility button: one click asks the payer directly whether the coverage on file is active, and the response lands on the client's Billing tab. It's available once your practice has at least one payer enrollment, works for payers that support real-time eligibility (most do), and each check is billed at the usage rate shown on your Subscription page.

The check asks the payer about outpatient mental health benefits first. When the payer supplies them, the Billing tab shows the therapy copay or coinsurance, any visit limit, and a prior-authorization flag, labeled Mental health benefits. Many payers answer that question with only "covered" and no figures; the check then runs the general plan inquiry as well (that pair counts as two checks) and the tab shows the plan-level deductible and out-of-pocket totals and remaining amounts, in-network and individual first, with a note that the payer returned no therapy-specific cost sharing. Anything the payer said in free text — "call the number on the card", a separate behavioral-health administrator, the standard not-a-guarantee-of-payment disclaimer — is shown under the figures. For payers without real-time support, verify benefits with the payer directly and record the copay/coinsurance estimate on the client.