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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.

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)
    • The Payer — search your own payers or the full US directory by name or payer ID
    • Member ID (required), plus Plan ID and Group ID from the insurance card
    • 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"), Accept assignment? (Box 27), and who superbill payments should go to
    • Optionally, effective dates and a photo of the insurance card
  3. 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​

Eligibility checks against payers are being rolled out payer-by-payer; where enabled, a verification action appears alongside the client's coverage once the payer is enrolled. Until then, verify benefits with the payer directly and record the copay/coinsurance estimate on the client.