TheraPlatform allows you to create and submit claims manually (i.e. the user clicks buttons) and automatically (the system automatically creates/submits them according to your preferred setting)
You can submit claims in batches with a couple of clicks of a button or you can turn auto submit claim function on and our system will automatically submit claims for you with claim validation. Any claims that have missing information would need to be addressed by you first before you or our system submits them. The blow article reviews what information is needed for claims and how to create and how to submit claims.
TheraPlatform (Plan Pro and Pro Plus) allows to submit claims electronically and it has integrated with the largest clearing house in US. Our claim function also offers validation so before one can submit claims we validate if the created claims are clean. If not, one will be promoted to correct or provide missing information before submitting the claim. For example, if CPT code is missing, you will be asked to enter one before submitting claim. This helps with claim rejection due to common human errors.
TIP: Please watch our built-into the platform video tutorials under the orange button "Watch video tutorials".
This article reviews:
- What needs to be set up before creating and submitting claims
- How to submit claims manually vs automatically
- How to batch claims manually
- Workflows for creating and submitting claims manually
Note: Please familiarize yourself with basic information that you need to have on claims.
You can also watch our built-into the platform video tutorials under the orange tab "Watch video tutorials".
Important: When submitting an insurance claim, only 6 items are permitted per claim. If you have more than 6 items on one invoice, you will need to remove some. You also need to have an invoice created before submitting claims as claims are created from invoice.
Please note that there is a fee for submitting claims. Every time the claim is submitted on TheraPlatform, you will be charged. If the claim that you submitted returns as rejected or denied, you still will be charged as you submitted the claim. There are no refunds.
The fee for submitting claims is $0.25 and if you submit many of them you will get automatically a discount and price will drop to $0.20.
Manual vs Automatic Claim Creation and Submission
TheraPlatform offers manual and automatic claim submission. The manual option, means that the admin or the biller by hand (clicks buttons) creates and submits claims. The manual option also includes batching. This means that multiple claims can be both created and submitted for multiple clients at once, with a few clicks of buttons.
When submitting claims manually, you also have an option to filter claims by the payer (insurance) and submit multiple claims at once to this particular insurance.
Automatic claim creation and submitting
How to set up automatic claim creating and submitting
Step 1: Click on Settings< Billing< Settings< Edit
Step 2: At the pop up box, turn on Auto create invoices.
Step 3: Select the frequency of auto invoicing according to your needs (e.g. every day)
Step 4: Turn on, Auto create claims.
Step 5: Select the frequency of auto claim creation (e.g. every day)
Step 6: If you wish you can delay the claim creation so it does not automatically get created right after the invoice by turning on Auto Create Claim Delay (select hours after invoice created).
Step 7: Turn on Auto submit claims if you want the system to automatically submit claims after they get created.
Step 8: If you wish turn on Auto Submit delay and mark how many hours after claim is created. For example, if you want the system to automatically submitted claims 24 hours after claims get created, enter 24 next to hours.
Step 9: Toggle on any other options that you prefer (e.g. auto charge card, etc.) and click on Save changes.
Important: If you wish to automate claims for some but not all clients, you can first set up automation with the steps above and then disable these particular auto functions for particular clients under the client chart (open the chart <Billing< Edit billing).
When auto functions are turned on, our system will automatically create invoices, claims and submit them according to your set time. This way you will not have to create anything by hand.
Auto-Submission for Not Clean Claims After Correction
With auto-claim on, TheraPlatform still validates if the claims are clean. If claims are not clean, the system will not automatically submit them till information is corrected on the claim.
Once it is corrected, the system will automatically re-submit the claim as long as auto-submission is enabled in General Settings and not disabled for the client.
Important Note About Automatically Created Claims
When automatic claim creation and submission is enabled, TheraPlatform validates claims before submitting them.
If an automatically created claim is missing required information (for example, a CPT code, progress note, or other required data), the claim will be placed in the More Info Required status instead of being submitted.
Once the missing information is corrected and the claim moves back to Draft status, TheraPlatform will automatically resubmit the claim after the configured auto-submit delay.
In addition to automatically submitting claims, TheraPlatform can automatically resubmit claims that were previously placed in More Info Required status. Once the missing information is corrected, the system will automatically submit the claim based on your configured auto-submit delay—no manual action required.
Key Points to Know
Automatically created claims with missing information will not be submitted until they are corrected.
If you fix a claim and it returns to Draft status, the system will automatically submit it based on your auto-submit settings.
Claims that were previously in More Info Required status will now be automatically resubmitted once fixed.
You do not need to manually submit the claim unless you prefer to do so before the auto-submit delay occurs.
Workflows for creating and submitting claims manually
TheraPlatform offers multiple workflows (ways) one can create and submit claims. Here is the list of workflows and below you'll find steps for each one:
- From To Do (allows for batching for multiple clients) + you can batch claims per each insurance
- From the client's chart (allows batching but only for one client)
- From the calendar (no batching)
Directions on how to create and submit claims manually from To Do (This is the quickest workflow as you can batch all claims for all clients)
Step 1: Click on To Do.
Step 2: If you haven’t created invoices yet- click on To Do- Under Billing tab- Uninvoiced Sessions and Invoice for sessions first.
Step 3: Invoices that have insurance on them and are still open will then move to To Do-Insurance Unprocessed Claims- Click on Unprocessed Claims.
Step 4: A list of invoices that need claims will pull- Click on either Add All Claims to create all claims or if you prefer to create a few claims (not all), select the invoices you want to create claims off by clicking on the little box next to the invoice blue box and then click on the blue box Add Selected Claims
Step 5: The system will inform you that claims are being created. Once claims are created, you will see a message that claims were created and how many were created.
If any of the claims have missing information (e.g. missing progress note, CPT code, etc.), our system will detect it and you will see a message that claims need to be fixed. You can either click on fix link on the message to fix the claims or you can fix them later by clicking on to To Do- Insurance- More Info Required.
If you click on either option: fix link or More Info required, you will see a list of claims that need your attention and to fix them, click on the red button next to the claim. Once you fix the claim, e.g. add missing CPT code, you can click on submit button the claim that you just fixed or you can do that later, by clicking on To Do Draft Claims.
Note: If you have many claims, it may take a few minutes to create claims and you will be notified to return later. You can always come back to To Do and check if you were claims created or/and if your claims are not clean, you will find then under To-do-Insurance-More Info Required claims. Claims that were created will be found under Draft (see step below)
Step 6: Once the claims were created and no information is missing, they will appear under To Do- Draft. Click on Draft and a list of claims that were created will pull.
To submit these claims either click on Add All Claims or select particular claims you wish to submit by clicking on the box next to the claim and then on the blue box Submit selected claims.
Directions on how to create and submit claims manually from client's chart
Step 1: Click on clients.
Step 2: Click on view next to the client you wish to submit a claim for to open the chart or start typing the name of the client in the upper right navigation under search bar "search clients". Select the name and this will open the chart.
Step 3: Click on billing.
Step 4: Click on invoices (if the meeting has not been Invoiced, please click on uninvoiced first and invoice the meeting). You can click on "Invoice all "or on "Invoice selected". Invoice all will create one invoice with multiple services that were completed (you can have up to 6 on one claim ). "Invoice selected" option will create one invoice with the services that you select. For example, if you have 3 uninvoiced sessions and you want to have 2 of them on one invoice. Click on select button next to the 2 that you wish to have on one invoice. If you want to have one invoice for one session, then only click on select button next to that session and then click on button Invoice selected.
Step 5: Once you create invoice/s, click on the Invoice tab.
Step 6: Under first filter box, select Without claims and under second filter box, select Open Insurance.
Step 7: This will pull a list of invoices that have insurance on them and are ready for claim creation.
Step 8: Click on the blue button Create all to create all claims. The system will start creating claims. If you have many of them, you may see a message to return later. If not, the system will create them right away and you will see a message that the claims were created with a link to see them.
You can click on this link or you can come back to the claims you created later on.
To return later on, you would open the chart-click on Billing- Claims- change the first search bar to Draft and from there, you can then submit claims.
Click on Submit all to submit all claims or Click on the little box next to claims that you wish to submit and then on the blue button Submit selected.
Step 9: If your claims were not clean during claim creating, you will see a message and a link to where you can fix them. You can click on that link to fix them right away or you can return later.
To fix them later, you would go to the chart- billing- claims- change the first search bart to More info required claims. This will pull up a list of claims that need your attention. To fix a claim, click on the red button and follow instructions.
Claims that were fixed, will then be moved to Draft. Change the status to Draft under the first search filter and from there you can submit all or selected claims.
Directions on how to create and submit claims manually from the calendar
Step 1: Click on the scheduled appointment that needs a claim on the calendar.
Step 2: At the pop up box, click on Add Invoice.
Step 3: An invoice will pop, click on Add Claim green button.
Step 4: If the claim is clean, you will be able to click on Submit claim button on the claim. If not, the system will inform you what information is missing and you will be able to fix it. Once fixed, click on Submit button on the claim.
Related Articles:
How to submit a claim with the supervisor's NPI
How to Add an Insurance Company
How to Add Insurance to Client Account
How to Delete Items on an Invoice
Comments
0 comments
Article is closed for comments.