Required Information for Claims

Please verify with the payers (health insurance) re: their required information that needs to be reported on claims. Each payer may have different rules. For example, one payer may require a modifier another may not, etc. 

It is your responsibility to know what the requirements are from each insurance.

Below is basic information needed for claims on TheraPlatform and any additional information, please verify with the payer.

TIP: Please watch our built-in video tutorials for visuals. They are available to you once you log in to TheraPlatform under orange button "Watch video tutorials".

This article reviews what basic information is needed for claims and how to enter this information on TheraPlatform. 

Here is basic information needed on claims

A. Provider Information

• Provider name
• NPI (organization, individual or both)
• Tax ID or Social Security Number
• Billing provider address
• Service rates with CPT codes ( bill insurance your full appointment fee on claims, even if that amount exceeds your contracted rate. The insurance will still pay you your contracted rate and will write-off the remaining balance.)

B. Health Insurance Information

• Name of the health insurance and any additional information that the health insurance needs
• Client's information on the health insurance: payer ID, member ID

C. Client Information

• First name
• Last name
• Date of birth (DOB)
• Gender 
  • This is required by insurance payers for billing
• Address
• Phone number
• Insurance information, including:
  • The payer ID
  • Member ID
  • Main subscriber information (if the client is not the main subscriber, for example the client has health insurance under the spouse) 

D. Client's Co-Pay

E. Client Diagnostic Code/s

Here is how to enter basic information for claims on TheraPlatform

A. Provider Information

• Provider name
• NPI (organization, individual or both)
• Tax ID or Social Security Number
• Billing provider address
• Service rates with CPT codes ( bill insurance your full appointment fee on claims, even if that amount exceeds your contracted rate. The insurance will still pay you your contracted rate and will write-off the remaining balance.)

How to enter the provider's information on TheraPlatform

1. Under Settings < Organization < General: Enter the following information:

• Mark in blue " Is Tax Id SSN?", if you file taxes with your social security number and enter your social security number under Tax Id number field
• Uncheck the blue box "Is Tax Id SSN? " (should not be marked in blue), if you file taxes with tax id and enter your tax id number under Tax Id number field
• If you marked, "Is Tax Id SSN?" in blue and entered your social security number, enter your individual NPI number under NPI and enter your first and last name
• If you un-checked "Is Tax Id SSN?"  and you entered your tax ID number, enter the name of your organization and enter your organization NPI.
• Select the currency you take and your time zone and click on Save changes.

2. If you're a superuser on TheraPlatform (you're the main subscriber and admin) and you added your organization NPI under Settings < Organization < General but you also need to enter your individual NPI, click on My Account < Details< Enter your individual NPI under the NPI field and click on Save changes.

3. If you have therapists in your practice and you need to enter your therapist's NPI follow these steps:

• Click on Therapists (if you added them before,  their names will show and you can click on the green edit button to enter info on your therapist) or click on add therapist button to add your therapist/s.
• At the pop up box: select the provider type; enter your therapist's full name; email, time zone; if your therapist's tax id is social security number- mark in blue "Is Tax Id SSN?" and enter your therapist's social security number under tax id field. If your therapist needs tax id (not social security), un-check Is Tax Id SSN?" (should not be in blue) and enter your therapist's tax ID number. Enter your therapist's credentials, license and individual NPI and click on Save changes.
• If you need to submit claims with the supervisor's NPI, please refer to this article. You can also review our built-in the platform video tutorial under the orange button "watch video tutorials"

4. Under Settings < Organization<  Office Locations: Enter:

• Your billing provider office
• Note: You can add as many office locations as needed. Please make sure that at least one of the addresses is marked as the billing address.
• At times you may need to submit claims with the facility NPI, if this is the case for you, enter the facility NPI at the pop-up box when entering the address. Please note that this will vary and if you're not sure if you need to enter the facility NPI, contact your biller or insurance.

5. Under Settings  < Billing < Services: Enter your services with CPT codes

• Click on Add Service and provide : the name of the service, e.g., Therapy; rate; CPT code under Code, enter Modifier (only if the payer/health insurance requires); enter line note (only if required by the payer) and save changes. 
• Sometimes services are timed and sometimes they are not timed (this depends on insurance). To learn more about how timed services work on TheraPlatform, review this article.
• Services that you add should have full amount (not contracted rate). Always bill insurance your full appointment fee on claims, even if that amount exceeds your contracted rate. The insurance will still pay you your contracted rate and will write-off the remaining balance.
• Do NOT enter co-pays under Settings < Billing< Services. Co-pays must be entered under the client's chart. See below for directors.

B. Health Insurance Information

• Name of the health insurance and any additional information that the health insurance needs
• Client's information on the health insurance: payer ID, member ID, etc.

How to enter all the health insurance (payers) that you contract with on TheraPlatform

1. Under Settings < Billing<  Insurers:

• Click on Add Insurer
• At the pop-up, start typing the name of the insurance under "Select payer" field.
• Select the payer from the drop-down menu. If you cannot see the name of the insurance you try to add, contact us.
• If the health insurance you try to add, requires additional enrollment to submit claims, you will see "yes" message and a link to the insurance's website to enroll.
• If the health insurance you try to add offers ERA, you will see a message "yes" and you can enroll to receive ERA from this insurance, by marking the switch Enroll for EOB/ERA in blue. Make sure to also draw your signature at the signature box so you can enroll.
• Under "Submitter ID" field, enter your issued by insurance submitter ID. Please note that not every single payer (health insurance) requires that and provides that. If not sure, contact your health insurance. You can leave it blank and then edit this information later too. 
• If you plan on submitting claims with the supervisor's NPI, Leave " Use supervisor NPI as rendering provider" unchecked till you learn from the insurance what the requirements are. So don't mark this till you know. Some payers require that you mark the above option in blue and some payer do not. Please review our built-in the platform, video tutorial under the orange tab "watch video tutorials" and review this article on how to submit claims with the supervisor's NPI.
• If the health insurance (payer) requires that you add additional IDs on the claim, click on the blue button Add additional IDs. Select the qualifier and ID. To add another qualifier, click on Add additional ID again.
• If the health insurance does not require any additional IDs, don't click on Add additional ID and then click on Save changes. If you're not sure if you need additional IDs for this insurance, contact the insurance.

Note: To add anther payer/s (insurance), follow the above steps again. 

C. Client Information

• First name
• Last name
• Date of birth (DOB)
• Gender 
  • This is required by insurance payers for billing
• Address
• Phone number
• Insurance information, including:
  • The payer ID
  • Member ID
  • Main subscriber information (if the client is not the main subscriber, for example the client has health insurance under the spouse) 

How to enter the client's information on TheraPlatform

Demographic information

You can enter demographic information such as full name, DOB, gender, address, phone number manually by yourself under the client's chart or you can request this information from your client to save yourself time.

When you request demographic information from the client, the client can log in to the client portal and enter this information manually or you can also request the driver's license and our system will extract demographic information from the driver's license into the form and all this data will be saved for you under your client's chart. (additional small fee applies for data extraction) 

• To learn how to request demographic information from clients, review this article
• To learn how to enter demographic information yourself, review this article

Client's insurance information

Please make sure to add all payers (health insurance), you contract with under the Settings<Billing< Insurers following the directions provided above in this article.

Once you have all payers (e.g. Insurers) added under Settings, you can either enter/assign health insurance of your client under the client's chart yourself or you can request health insurance information from your client.

The client can enter health insurance information himself/herself manually via client portal. Or you can request an insurance card and  our system will extract some information from the insurance card into the form and all this data will be saved for you under your client's chart. (additional small fee applies for data extraction) 

• To learn how to assign health insurance yourself under the client's chart, review this article
• To learn how to request insurance information and insurance card from clients, review this article

Main Subscriber's Insurance (if your client is not the main subscriber on the insurance)

If your client is not the main subscriber of the insurance (e.g., the spouse provides health insurance), you need to enter the main subscriber's info under the chart. In other words, you need to enter contact information under the client's chart.

You can do it yourself under the chart or you can request this information from your client so your client can enter this info himself/herself via the client portal. All data entered by the client, will be automatically saved under the chart.

• To learn how to enter the main subscriber's information under the chart yourself, review this article
• To learn how to request contact information (the main subscriber information of insurance), review this article (2nd section)

D. Client's Co-Pay

If your client has a co-pay, enter the co-pay under the client's chart under< Clients Details< Insurance.

• To learn how to add a copay, review this article

E. Client Diagnostic Code/s

Diagnostic codes are entered under Assessment and treatment plan. Once you enter the diagnostic code/s under the assessment, they will automatically carry over to your therapy notes (for example, SOAP, etc.)

If you don't provide assessments in your private practice and you don't wish to write up assessment and treatment plan, you still need to click on Add Assessment and treatment plan under the chart just to enter the diagnostic code under Diagnostic Code field. Tip: You can build your own assessment template. 

• To learn how to document assessment and treatment plan and enter diagnostic code/s, review this article