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Filing claims

Once a client has coverage on file and their session is complete, the appointment becomes a claim waiting to happen. Filing lives in the Insurance hub → Unbilled Appointments tab.

In this guide, we'll cover:

What makes an appointment "Unbilled"​

The Unbilled Appointments tab lists every completed appointment for an insurance-billed client that doesn't have a claim yet (self-pay clients never appear here). Each row carries the appointment's service code, fee, and diagnosis — pulled from the appointment's billing details and the client's diagnosis.

Each client's Status column says Ready to file or Missing info, from the same checks Create claims runs (member ID, date of birth, sex, address, the payer's electronic-claims setup, the clinician's NPI and your Tax ID). Hover Missing info to see what's missing, and click Update info to open the client. The Status filter narrows the list to one or the other. While the check is still running a row says Checking….

Creating claims​

Select the appointments to file, then choose:

  • Create claims — builds prepared claims you can review before submitting
  • Create and submit claims — builds and submits in one step (batch filing)

Filter by date, payer, clinician, or note status first if you like. Select sessions for as many clients as you like. The button counts the claims it will create. Select all leaves out sessions nobody has marked attended, and offers to include them, so a no-show doesn't get filed by accident. Sessions still running can't be selected until they end.

Before anything is created you'll see a review listing each client, plan, clinician and amount. A client with missing information is left out with the reason and a link to fix it, and the others go ahead. Afterward you stay on Unbilled and see what happened to each claim. A claim that couldn't be sent stays Prepared with the reason.

A single CMS-1500 claim holds up to 6 service lines from a single calendar year, for one plan and one clinician. Larger or mixed selections split automatically into separate claims. To file one claim per session, untick Multiple appointments per claim. One run files up to 25 claims, oldest first, and any others stay selected for the next run.

The Place of Service (Box 24B) comes from each session's location — Office (11), Telehealth in the client's home (10), or Telehealth elsewhere (02), as set on the location under Settings → Practice details. There is nothing to pick at claim time. A session with no location, or whose location has no place-of-service code, blocks the claim with a message naming the session; set its location on the calendar and try again. This is the same model SimplePractice and Sessions Health use, so a batch that mixes office and video sessions bills each line correctly.

A claim needs the client's sex (Male or Female, as on their insurance policy), and the policyholder's too when someone else holds the policy. Payers accept only those two values. If it's missing, the claim isn't created and you're told where to add it: the client's profile, or the policyholder in the client's insurance details. Sex can differ from gender identity, which has its own field.

Two row hints keep batches clean: a "Confirm attendance" badge means a session isn't marked Show/No-Show yet, and an "(est.)" amount means the session has no charge item — the CPT and fee shown are defaults, not what you set. Sort those out before filing.

What goes on the claim​

  • Services: CPT code, fee, and modifiers, from the appointment's billing details (defaults come from the client's Default Appointment Billing)
  • Diagnoses: the client's active diagnosis codes (up to 12), pointed at the service lines — fine-tune with Edit diagnosis pointers (Box 24E) on the prepared claim (see Diagnoses)
  • Prior authorization: an active prior-auth number on the client's coverage lands in Box 23 automatically. Add it on the client's Payment & Insurance tab under Prior Authorizations → Add (number, valid dates, approved sessions); on a claim that's already prepared, type it in Box 23 and Save
  • Providers: rendering provider (the clinician's NPI/taxonomy) and billing provider (your practice or individual identifiers, subject to any claim rule)
  • Coverage details: member ID, subscriber, and the filing indicator (the insurance-type code payers require, set when entering the client's coverage)

Reviewing a claim before submitting​

Prepared claims appear in the Claims tab with status Prepared. Open one and it opens on its Claim form, the claim drawn as a CMS-1500; you can also add claim notes for your own records. Submit when you're satisfied — or use external filing to print the CMS-1500 and file it outside the platform instead.

After submission​

The claim's status updates as the clearinghouse and payer process it — see Claim Statuses. If something's wrong (a scrub error or a payer rejection), it shows up in Needs Attention on the hub — see Fixing Claims.