When you submit a claim, you have two options: Print & Mail or Electronic (EDI). The system has the ability to format the CMS-1500 using the information that is entered throughout the application. Before you can create a claim, the client must have an insurance card that is mapped. For more information, please see: Insurance Card Mapping.
Note: The system will format the CMS-1500 for you, but you are responsible for printing and mailing the claim.
Create a Paper Claim
- Navigate to Billing > Bill Insurance.
- Use Select Client to display a client's billable services. You can use the filters to narrow your results. If a client or session is not listed, please see: Missing Session.
- On the invoicing screen, use the checkboxes to select which lines you wish to create a claim for.
- Click Create Invoice.
- In Additional Settings, you have the option to check One Date of Service per claim. Some insurances require this.
- On the Create Invoice window, select the Adobe PDF icon on the insurance card you wish to bill.
- The claim will be created once the claim has passed the error check. You will then be given 4 options for printing.
What version should I print?
Quick Open/Flattened versus PDF Form/Large File
The flattened files are much quicker to open (as they are smaller files). Typically, this is the file type you should use, however they are not editable.
PDF Form means that the file is editable. It is a larger file, therefore, it may take longer to open. However, the form file will allow you to change information within it. If there is information you need to include that you were unable to enter in the system, you can use this form to make those changes. Important: Changes that you make are not saved into the system. If you have to resubmit the claim, you have to manually make those edits again.
Red Line versus No Line
The Red Line option will create a PDF with the red background. For this, all you need is a printer with red ink. However, some payers do not allow you to submit claims that are not on official CMS-1500 forms.
The No Line option will create a PDF with no background. This allows you to print the information onto an official CMS-1500 form.
The payer's address isn't listed at the top of the claim form.
For more information, please see: Add Payer Address to Print & Mail Claim Form.
I want the payment to go to a P.O. Box.
For more information on P.O. Boxes, please see: Use P.O. Box for Insurance Payments.
Why were the charges split onto multiple claim forms?
The CMS-1500 form has 6 available spots for service lines. However, when you create a claim for multiple sessions, the system may not fill up all 6 service lines and instead, create multiple claims. Here is a list of the reasons why the system will use multiple claim forms:
- Different Rendering Providers
- Different Authorizations
- Different Diagnosis Case
- Different Facility Address
The claim doesn't line up when I print. What do I do?
If your claim does not line up on your CMS-1500, please see: Claim Does Not Line Up When Printing
Do I need to save a paper copy of the CMS-1500?
Whether or not you want to save a paper copy of the CMS-1500 for your records is up to your preferences and clinic policies. The application will store a digital copy of the CMS-1500 under Filing > CMS-1500. Paper claims will have a gray status bar to the left of the claim.
Do I receive status updates on paper claims within the system?
Only claims that you submit electronically will have electronic status updates delivered to you. There is no way for the system to know if you mailed the claim or if the payer received it.
I created a paper claim but would now like to submit it electronically. Can I do this?
If the insurance company that you submitted to has the option to submit electronically, but a paper claim was created instead, then you can change it to an electronic submission.
- Navigate to Filing > CMS-1500.
- Locate the claim and click on the icon.
- In the drop-down list, select Submit Electronically.