TheraPlatform enables you to create billing rules that allow billers and administrators to create custom billing service rules tailored to your organization’s specific needs. With this feature, you can now define rules based on meeting duration, cancellation types, payer specific service - location - units - rate and modifier configurations.
Whether it's applying different services for varying session lengths or assigning modifiers for specific insurers, this added flexibility supports more accurate and efficient billing workflows. These rules can be easily set up within your billing settings, helping to minimize claim errors and manual corrections, which ultimately improves billing accuracy.
Important Note: Any service billing rules you configure will apply automatically to all clients who meet the conditions you set (e.g., payer, location, cancellation type, duration).
Here are the billing (service) rules you can customize:
⏱️ Service Billing Rule: Meeting Duration: Automatically assign the correct service based on session length, payer, and location.
Example:If Duration = 15 minutes, Payer = Blue Shield of California, and Location = Telehealth → assign the “Therapy” service automatically during scheduling.
🚫 Service Billing Rule: Cancellation Type: Easily automate fees for cancellations like no-shows or client-initiated cancellations.
Example:If Cancellation Type = No Show → automatically apply a no-show fee using a non-service.
💲 Service Billing Rule: Units, Rates & Modifiers: Define specific billing logic based on insurer, service, location, and more.
Example:If Payer = Aetna, Service = Therapy, and Location = In Office → apply Modifier 95, 2 units, and a rate of $90 automatically.
Important: We also strongly recommend becoming familiar with each insurer’s specific billing requirements before creating rules to make sure your billing setup aligns with payer requirements to avoid rejected claims.
Note: Before configuring payer-specific rules, ensure that your practice is correctly enrolled with each insurer to avoid claim denials. To learn more about enrollment, please visit: Adding an Insurer and Enrolling for ERA.
How to Create a Service Rule Based on Meeting Duration
Step 1: Click on Settings > Billing > Service Rule > Add service rule
Step 2: In the drop-down, select the rule and select the Meeting Duration Option. At the pop-up box, under the Insurer field, select the insurer (you need to add your insurer, e.g., Blue Shield of California) under Settings > Billing > Insurers > Add insurer first to see your insurers in this drop-down menu.
Step 3: Under the Service Location field, select the location for this specific service
Step 4: Under the Duration field, select the duration for this specific service
Step 5: Under the Service field, select your service (you need to add your services under Settings > Billing > Service > Add service first to see a list of your services in this drop-down menu)
An example of how to use this function: You want all clients with Blue Shield of California who have a scheduled Telehealth appointment at home to be automatically assigned the "therapy" service when you, your therapists, or schedulers schedule for this client.
If Duration = 15 minutes, Payer = Blue Shield of California, and Location = Telehealth, → automatically assign the “Therapy” service when scheduling.
How to Create a Cancellation Service Based on Cancellation Type
Step 1: Click on Settings > Billing > Service Rule > Add service rule
Step 2: In the drop-down, select the rule and select the Cancellation Type Option
Step 3: Select the Cancellation Type: No Show, Therapist Cancelled, Client Canceled, or Rescheduled
Step 4: Select the Cancellation Service that you would like to apply when either of these cancellation types is selected
Example: If no show → automatically apply X fee
Important: In order to select a Cancellation Service, you’ll need to ensure that you’ve first created a Non-Service in your service list. Please follow the steps below on how to add a cancellation Service
Step 1: Settings > Billing > Services > Add Service
Step 2: Next, in the pop-up box, mark the service as non-service, enter your fee, and save the changes.
Example: If Cancellation Type = No Show → automatically apply your no-show fee using a designated non-service.
How to Create a Service Rule Based on Units, Rates & Modifiers
Step 1: Click on Settings > Billing > Service Rule > Add service rule
Step 2: In the drop-down, select the rule and then choose the Insurer Service Pricing and Modifier Option. At the pop-up box, under the Insurer field, select the insurer.
Step 3: Under the Service field, select your service
Step 4: Under the Service Location field, select the location
Step 5: Under the Units field, select Units for this specific service
Step 6: Under the Rate field, enter the rate for this specific service
Step 7: Under the Modifier field, enter the modifier for this specific service
Example: If Payer = Aetna, Service = Therapy, and Location = In Office → automatically apply Modifier 95, 2 units, and a rate of $90. (This will apply to all clients who meet the criteria)
How to Apply Automatic CPT Codes Based on Insurers, Meeting Type, Service, and Service Location
Step 1: Click on Settings > Billing > Service Rule > Add service rule
Step 2: In the drop-down, select the rule and then choose the Insurer Meeting Type Services Option. At the pop-up box, under the Insurer field, select the insurer.
Step 3: Under Meeting Type, select the Meeting Type
Step 4: Under the Service field, select your service
Step 5: Under the Service Location field, select the Service Location
Step 6: Then select the services that you would like to apply based on the rules above.
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