Skip to main content

External filing (CMS-1500)

Sometimes you don't want to submit a claim electronically through the platform — a payer that requires its own portal, paper-only payers, out-of-network billing quirks, or simply a workflow you already have. External filing keeps those claims tracked here even though they're submitted elsewhere.

In this guide, we'll cover:

How it works​

External filing is a per-claim choice — there's no practice-wide switch, so you can file most claims electronically and handle the exceptions externally.

The one-click way: on the Unbilled Appointments tab, a session's row menu offers Download CMS-1500 (file externally) — it creates the claim already marked filed-externally, hands you the PDF, and clears the row: "Upload it to your clearinghouse; the session has left the Unbilled list."

The review-first way:

  1. Create the claim as usual (it starts as Prepared)
  2. Open the claim. It opens on its Claim form, the claim drawn on the standard paper form, with Print and Download PDF buttons
  3. File it your way (payer portal, mail, fax service)
  4. Open the arrow next to Submit to Payer and choose Mark as Filed Externally — it moves to the Filed externally status so your Unbilled list stays clean and the claim remains on the client's record

Filed-externally claims stay out of your Needs Attention count — the platform knows it can't hear back about them automatically.

Already rejected? If the payer rejected a claim you sent from here and you're filing it another way, don't start over. See Filing a rejected claim somewhere else below.

Filing a rejected claim somewhere else​

When a payer rejects a claim and you file it another way instead (on paper, or through the payer's portal or another clearinghouse while an enrollment is pending):

  1. Open the rejected claim, open the arrow next to Create Corrected Claim, and choose Mark as Filed Externally…
  2. Confirm. The rejected claim is archived, and you land on a copy already marked Filed externally. Download PDF on its Claim form gives you the paper form if you still need it

If the claim also needs fixing before you file it elsewhere, click Create Corrected Claim instead, make the fixes, confirm, and then choose Mark as Filed Externally from the arrow next to Submit to Payer on the copy.

When the payer pays, record the payment under Insurance → Payments against the copy, not the archived claim. Archived claims don't take payments or write-offs.

Tracking externally filed claims​

The platform can't receive electronic status updates for a claim it didn't submit, so externally filed claims are updated manually: when the payer responds (EOB, portal status), record what they paid via Add insurance payment.

Out-of-Network billing​

If you're out-of-network, you have two options:

  • Client-files: give the client a superbill and let them seek reimbursement — simplest for you; the client pays your full fee up front
  • You file: submit the claim yourself (electronically or externally) with the appropriate out-of-network setup; payment may go to the client depending on assignment of benefits. With Accept assignment? set to No on the client's Billing tab (under Show additional claim fields), the client pays your full fee and an incoming ERA never changes their balance — see Courtesy and out-of-network claims