A client’s profile displays their own balance and their insurance balance. While these amounts are tracked separately, insurance payments impact both, as they include the client’s responsibility for insurance appointments. Reviewing a client’s insurance billing history can help determine how much they owe and if their insurance balance is accurate. 

In this guide, we’ll cover:

• Understanding a client’s insurance balance
• Reviewing an insurance appointment’s billing history
• Locating an insurance balance or credit
• Updating an insurance appointment’s billing details

Understanding a client’s insurance balance

Clients can have their billing type set to Self-Pay or Insurance. For an Insurance balance to be shown, their billing type needs to be set to Insurance. 

A red Insurance balance amount indicates the client has an outstanding insurance balance. 

A red insurance balance followed by CR indicates that a client has an insurance credit. 

This happens when an insurance payment exceeds an appointment’s insurance responsibility.

To view the insurance balances or credits for all insurance appointments, navigate to Analytics > Reports > Unpaid insurance appointments. This report will display all insurance balances and credits in the Ins. Balance column.

Reviewing an insurance appointment’s billing history

Note: The appointment billing history is rolling out in groups and will be available to all customers at a later date. 

If you’re enrolled to receive Payment Reports, a client’s balance may change after the claim is processed. This can happen if the payer lists a client responsibility that's different from what’s listed in their profile. 

Reviewing an appointment’s billing history is helpful when determining what’s causing a client’s balance, as it displays a summary of all changes that have taken place. To view an appointment’s billing history: 

• Navigate to the client’s Billing page
• Locate the appointment
• Click Manage > View Details

• Scroll down to the appointment’s History and review the Billing tab

The first line shows the date the appointment was created and its original fee, with the client’s and insurance payer’s responsibilities listed in the Client balance and Insurance balance columns. 

Billing events that take place for the appointment will be listed chronologically and in descending order. Events that will be tracked in the appointment’s billing history include: 

• Changes to the appointment total 
• Changes to the client’s balance and/or insurance balance
• Invoices being deleted or created
• Refunds and disputes
  • These amounts will be highlighted in red
• Payments from the client or insurance payer, including manually added insurance payments and Payment Reports (ERAs)
  • These amounts will be highlighted in green
• Primary and secondary claims being deleted or created

Note: Deleting an appointment will permanently remove its billing history.

As client and insurance payments are added, the respective balance for each will be lowered. In the example below, the appointment was created on March 3rd, 2025, with a client balance of $25 and an insurance balance of $75. A $60 insurance payment was added with a $15 write-off, lowering the Insurance balance to $0. A client payment of $25 was then added for their copay, lowering the Client balance to $0.  

Note: The More info column includes links to each associated payment and/or billing document, such as a claim or invoice. Claim statuses won’t show in the appointment’s billing history. Click on a claim’s link in the More info column to see its status.

As insurance payments are added, the Details column will highlight if the client’s responsibility has been increased, decreased, or remains unchanged. Click View in the More info column to review the associated insurance payment. 

Note: The appointment billing history is a new feature and only tracks billing activity for appointments that take place beginning March 1st, 2025. 

Locating an insurance balance or credit

You can use the Appointment Status Report to determine what’s contributing to a client’s insurance balance or credit.

Note: If your client has an insurance credit that doesn’t appear in the report, it may stem from canceled appointments.

Investigating with the Appointment Status Report

To investigate an insurance balance or credit using a client’s Appointment Status Report:

• Navigate to the client’s profile
• Click Appointment Status Report in the Client billing summary

• Click More and toggle on Include Insurance

• Review the Unpaid column under the Insurance Responsibility section for appointment(s) with an insurance balance or credit (CR)

Note: If you’re not seeing any appointments with an Unpaid amount, you can adjust the date range to begin from the client’s first date of service.

Once you’ve found an appointment with an Unpaid amount, see Updating an insurance appointment’s billing details for next steps.

Investigating canceled appointments

If a client’s Appointment Status Report doesn’t show any appointments with insurance credits, the credit may stem from appointment(s) that’ve been Canceled or Clinician canceled. 

Insurance payments can’t be added to canceled appointments. If an insurance payment was added for an appointment before it was canceled, it’ll reflect as an insurance credit.

To identify canceled appointments contributing to an insurance credit:

• Navigate to the client’s Overview page
• Click All Items and select Appointments
• Take note of appointment dates with a Canceled or Clinician canceled status

• Click the Billing tab
• Update the Billable items filter to Transactions by insurance

• Adjust the date range to start before the client’s first appointment
• Click View for an insurance payment dated around the client’s canceled appointment(s)

• Look for the canceled appointment’s date(s) among the dates of service listed
  • If the insurance payment doesn’t include the appointment(s), look through other insurance payments until you find the appointment(s)

If the appointment status should be Show, you can update the appointment’s status through your calendar. This will allow the insurance payment to apply to the appointment, and remove the insurance credit.

If the appointment is actually a Canceled or Clinician canceled appointment, reach out to the payer for next steps to rectify this, such as submitting a corrected claim. If its insurance payment was manually added, edit the insurance payment and remove the Insurance Paid and Write-Off amounts for the appointment.

Updating an insurance appointment’s billing details

If an insurance appointment’s billing details are reflected incorrectly, you can update them using three common workflows: 

• Making an appointment level billing change
  • Use this workflow to update an appointment’s billing type, the client responsibility, or the total fee
• Editing an insurance payment
  • You can edit insurance payments if the client’s responsibility has changed, if the initial amount was incorrect, or if you need to update the insurance write-off
• Adding an insurance payment
  • Insurance balances are mostly caused by missing insurance payments or write-offs. You can manually add insurance payments, including write-offs, or enroll to receive Electronic Payment Reports (ERAs)

Changes resulting from one of these workflows will be logged in the respective insurance appointment’s billing history.