Billing insurance under supervision

If provisionally licensed under your supervisor, you can still offer appointments that are covered by your client’s insurance. 

Important: We recommend reaching out to the insurance payers that you plan on billing to determine your eligibility for billing this type of appointments and the requirements you must meet.

In this guide, we’ll cover:

• Understanding incident-to-billing requirements
• Billing box 24j with the appropriate name and credentials
• Billing supervised appointments for Optum and United Healthcare

Note: To add a clinician as a supervisor or supervisee before billing insurance, see Designating a clinician as a supervisor or supervisee.

Understanding incident-to-billing requirements

If you'll be billing appointments to insurance while you're under your supervisor, you may be participating in incident-to-billing. While incident-to-billing requirements vary by payer and state, supervisees are typically allowed to hold appointments without the supervisor in the room as long as the supervisor is facilitating by being present on location during the appointment, and reviewing notes after the appointment.

Note: For more information on reviewing documentation as a supervisor, see Reviewing and signing documentation under supervision.

It's important that claims submitted for these appointments are formatted correctly. Box 24j, which lists the rendering provider and their NPI, can be adjusted to fit your requirements. Certain regulatory bodies require that this box lists the supervisee’s name with the supervisor’s credentials, while others require that it lists the supervisor’s name and credentials.

Note: It’s your responsibility to make sure that you’re submitting claims in the correct format and that the payer’s requirements are being met. If you’re not sure how incident-to-billing should be handled based on payer and state requirements, please reach out to the payer directly.

Once you’ve confirmed that you’ve met these requirements and know the format your claims will require, you can update the settings in your SimplePractice account so that the appropriate information will auto-populate.

Billing box 24j with the appropriate name and credentials

If you're the supervisee, you can make sure box 24j populates with the correct name and credentials in your settings:

1. Navigate to Settings > Profile > Clinical info
2. Next to Clinician details, click Edit
3. Enter the supervisor's taxonomy code

4. To bill with the supervisee's name and the supervisor's credentials, enter the supervisor’s NPI

5. To bill with the supervisor's name and credentials, leave the NPI number empty and only enter the supervisor’s taxonomy code

6. Make sure that Pre-Licensed was chosen for your Licensure type and your supervisor is reflected in the dropdown

7. Click Save

Once you’ve saved these settings, claims created moving forward will populate box 24j with the chosen name and your supervisor’s credentials.

If you’re the Account Owner or a practice manager, you can update another clinician's information by navigating to Settings > Team > Team members and clicking on their name. For more information, see Adding and managing team members.

Note: These steps can't be followed if e-Prescribe is added to your account, as the NPI field becomes locked and you won't be able to edit it to be able to bill under a supervisor's information. In this scenario, we recommend creating and downloading claims for submission outside of SimplePractice so that you can enter your supervisor’s information on the downloaded claims.

Billing supervised appointments for Optum and United Healthcare

As of October 1st, 2024, Optum and United Healthcare have updated requirements for supervised appointments under commercial health plans in California, Colorado, Iowa, and Massachusetts. These appointments now require the supervisor’s name and NPI in box 17 of claims, and the U5 modifier in box 24d.

To review the documentation for these new requirements, see Outpatient Services Rendered Under Supervision - Commercial and the Reimbursement for Supervisory Services Reference Guide. For questions about the requirements, we recommend contacting Optum or United Healthcare directly.

Note: These payers have additional requirements for the supervising information included in box 24j of claims. For guidance on these, see Billing box 24j with the appropriate name and credentials.

Including the supervisor’s name and NPI in box 17

To automatically populate the supervisor’s name and NPI in box 17 for a client’s claims:

1. Navigate to the client's Overview > Edit > Billing and Insurance
2. Make sure that Show additional claim fields is checked
   • For more information, see Enabling additional claim fields
3. Select DQ - Supervising Provider Claim Level from the Referring provider dropdown menu

4. Enter the supervisor’s name and NPI
   • The Outside Lab?, Lab Charges, and Client account number fields aren’t required
5. Click Save Client

Once this is saved, claims created for the client moving forward will automatically include the supervisor’s information in boxes 17 and 17b.

To include the supervisor’s information in previously created claims that haven’t been submitted, we recommend deleting and recreating them, or editing them manually. 

Note: If you've already submitted a claim without this information, see Resolving claim rejections and Submitting a corrected claim.

Adding the U5 modifier to appointments and claims

Supervised appointments with Optum and United Healthcare under commercial health plans in specific states require the U5 modifier for each service in box 24d.

To make sure this modifier can be added, first make sure that modifiers are turned on in your account. To do this, see Enabling modifiers in your account.

If the client has default services set in their Overview > Edit > Billing and Insurance, you can have the U5 modifier automatically added to new appointments. To do this, add U5 in the modifier field under Client Default Services.

Note: Make sure to click Save Client after adding this.

For more information on client default services, see Creating and using service codes and products.

After this is saved, claims created for future appointments will populate the U5 modifier. To add the modifier to appointments you’ve already created, see Adding modifiers to individual appointments.

If you’d like to add the modifier to claims you’ve already created but haven’t submitted, you can edit the claims manually, or delete and recreate them after adding the modifier to each appointment. 

Note: If you've already submitted a claim without the modifier, see Resolving claim rejections and Submitting a corrected claim.