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.
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.
Creating Claims
Select the appointments to file, then choose:
- Create claims — builds draft claims you can review before submitting
- Create and submit claims — builds and submits in one step (batch filing)
A batch covers one client and one payer at a time — selections spanning multiple clients or payers are rejected with a validation message, so file client by client. A single CMS-1500 claim holds up to 6 service lines from a single calendar year; larger or year-spanning selections split automatically: "the [n] selected sessions will be filed as [k] separate claims (oldest first)." Before creating, confirm the Place of Service (Box 24B) — Telehealth (not patient home), Telehealth (patient home), or Office.
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 draft (see Diagnoses)
- Prior authorization: an active prior-auth number on the client's coverage lands in Box 23 automatically
- Providers: rendering provider (the clinician's NPI/taxonomy) and billing provider (your practice or individual identifiers, subject to any payer-specific billing profile)
- 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
Draft claims appear in the Claims tab with status Draft. Open one to review its details, see the generated CMS-1500 view, and 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.