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.
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:
- Create the claim as usual (it starts as Draft)
- Open the claim and go to its CMS-1500 tab — the claim rendered on the standard paper form, with Print and Download PDF buttons
- File it your way (payer portal, mail, fax service)
- Mark the claim 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.
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), update the claim and record the payment 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