Staying on top of insurance billing processes is a full-time job that requires continuous education and certifications. Many practices handle insurance billing on their own early in their practice’s lifecycle. 

As your practice grows, we know it’s important to spend more time on client care, and less time on managing insurance billing. That’s why SimplePractice has partnered with Gentem to provide you with a managed billing service for in-network insurance billing. In this guide, we’ll cover answers to some frequently asked questions, including:

• What is Gentem?
• Who is eligible for Gentem?
• What changes will I see in my account?
• How does Gentem manage my insurance claims?
• FAQs

What is Gentem?

Gentem is a best-in-class managed billing solution that's fully integrated with SimplePractice. Gentem takes care of your in-network insurance billing to not only give you time back, but also to make sure that you get insurance claims paid faster and more successfully. Plus you won't have to deal with rejections, denials, or appeals - Gentem will handle all of those completely on your behalf. They can offer this because they have a robust and knowledgeable team of billing specialists, revenue cycle experts, and engineers dedicated to making insurance billing easier for customers, and we're incredibly proud to partner with them.

Who is eligible for Gentem?

If you’re eligible for this new service, you’ll receive an email from SimplePractice with information on how to start the process of working with Gentem.

If you’d like to learn more about Gentem, navigate to: 

• Settings > Billing and Services
• Select the Managed billing tab
• Click Schedule call

Note: Practices are eligible if they process at least $100,000 in claims annually. Additionally, managed billing is only available for practices on the Plus plan.  

What changes will I see in my account?

As you begin onboarding with Gentem, you’ll have the option to mark insurance clients as in-network or out-of-network. 

Note: Gentem only manages in-network claims and will only submit claims for clients marked as In-network insurance.  

While onboarding with Gentem, all insurance clients will be pre-selected as In-network insurance for their billing type. Before your go-live date, you’ll want to go through your client list and make sure any Out-of-network clients are properly denoted.

Tip: Filtering your Clients list by insurance payer can help when searching for any out-of-network clients. 

When creating new clients, you’ll be able to select their correct billing type. 

How does Gentem manage my insurance claims?

After reaching your go-live date, Gentem will manage the full process of creating, submitting, and managing claims. Please note that Gentem will only submit claims if a session’s progress note is locked and signed.

Once the claim is created, it’ll be handled by Gentem, and you won’t be able to make any edits to it. 

Gentem will manage the claim throughout the adjudication process, and will handle any rejections, denials, or resubmissions. 

If a clinician in your practice is under supervision, Gentem will only create a claim once the progress note has been locked and signed by the supervisee and the supervisor. For more information, see Adding a Supervisor to review and sign notes.

You can use the notes filter in the Unbilled appointments page to sort appointments based on their notes status, including any that are unlocked or don’t yet have a note. 

Additionally, Gentem will only manage claims for appointments where the date of service took place after your go-live date. You’ll still be able to create, submit, and manage claims for dates of service that took place prior to your go-live date. 

FAQs

• What type of insurance filing does Gentem support?
• What's included with managed billing?
• What isn’t included with managed billing?
• How much does it cost?

What type of insurance filing does Gentem support?

Gentem only supports the management of in-network insurance claim filing. For out-of-network insurance claims, clinicians will need to continue to submit these independently.

What's included with managed billing?

Managed billing is a fully integrated service that includes: 

• ERA/EDI/EFT enrollments 
• Coding review and custom claim edits
• Electronic primary and secondary claim submission for in-network government and commercial payers
• Claim status management
• Rejection and denial management
• Payer accounts receivable (A/R) follow-up
• Insurance payment posting 
• Transparent and actionable reports
• Business review with your dedicated account manager
• A dedicated team of certified billers and coders

What isn’t included with managed billing?

Services that aren’t offered with managed billing include:

• Credentialing/paneling
• Payer negotiations
• A/R follow-ups for claims filed before your start of service date
• Prior authorizations
• Patient billing, invoicing, collecting copays, or A/R follow-up
• Partial billing models (such as only working with denials and rejections)

How much does it cost?

Managed billing through Gentem costs either:

• 6% of the reimbursed amount from each paid claim + $0.30 per claim filed or
• $750 per month

Your cost will be whichever amount is higher each month.  

Note: SimplePractice won’t charge an additional per claim fee for claims billed through Gentem. 

Managed billing fees aren’t added to your SimplePractice subscription fee. You’ll be invoiced by Gentem separately.