Creating batch claims is an efficient way to get your billing done. It's incredibly easy to assemble all of your unbilled appointments and with a click of a button, you can create and submit claims.
This guide will go through:
- How to create batch claims
- Missing information when a batch claim is not created
- How do I remove appointments from the Unbilled Appointments list
Note: The Unbilled Appointments tab will list all clients whose billing type for an appointment is set to Insurance and is not included on a claim.
How to create batch claims
- From the Calendar homepage, go to Billing > Insurance.
- On the Unbilled Appointments page, you’ll see a list of all billable insurance appointments that have not been included on a CMS 1500 (HCFA) form. You can read more about how to check for unbilled appointments here: Appointment Status Report: Checking the billing and documentation status for appointments.
- Under the Appointments column, you will find the number of unbilled insurance appointments a client has.
- Click on the arrow symbol to view the appointment date, CPT code, and billed amount. This is also where you can determine which appointments you would like to include on the batch of claims.
Note: You can include up to six appointments on one claim.
Note: If your account is missing the Tax ID or an address, you cannot create claims from this page until these fields are complete.
Now, you will see all of the unbilled appointments with the Insurance billing type for the selected client and can choose which appointments are included on the batch claim by using the box to the left of the appointment details. Unchecking the box means that the appointment will not be included on the batch claim.
Note: Appointments with the Self-Pay billing type are not included on this page. If you need to create claims for Self-Pay appointments, you can generate them from the client's Billing page. See Creating and printing a CMS 1500 (HCFA) claim form to learn how.
- Click Create Claims or Create & Submit Claims to create a batch of claims for all the client's listed on this page.
- Clicking on Create Claims will create claims for all appointments on this page, but will not submit the claims. When a claim is created, the appointment(s) will be removed from the Unbilled Appointments list. All created claims will be found under the Claims tab on the Insurance page and within the Client’s Billing page.
- Clicking Create & Submit Claims will create and submit claims to the insurance payers for all appointments under the Unbilled Appointments tab.
- From the Claims tab, you will see the newly created claims listed at the top of your claims list in the Prepared status.
- Review, edit, and file these batch claims just as you would any other claim. You can read more about filing claims here: Filing primary claims in SimplePractice.
Note: If one client has more than 6 unbilled appointments (the maximum amount allowed on a CMS 1500 claim form), SimplePractice will generate multiple CMS claim forms to accommodate all of the billable appointments. If a client has unbilled appointments from multiple years, SimplePractice will generate multiple CMS claim forms for each year since insurance payers will only process claims from the same year.
Missing information when a batch claim is not created
Sometimes claims won't be generated for an individual client when you click Create Claims. When this happens, it means that SimplePractice does not have all the required client information to auto-populate a claim form for that client. If you see an orange exclamation point next to the client’s name, this indicates that there’s missing information that the insurance payer requires on a CMS 1500 (HCFA) form.
To see what information is missing and to be taken to the Client Info page to add the required information, follow these steps:
- Click on the orange exclamation point next to the client's name to see what information is missing.
- Clicking Add Missing Info will take you to the Client Info page to update this information for the client.
Note: You can read more about the minimum field requirements to create a claim in this guide: The minimum information required to create a claim.
How do I remove appointments from the Unbilled Appointments list
If you’ve filed claims outside of SimplePractice, these appointments will still appear on the Unbilled Appointments list because they are set to Insurance pay. You can remove the appointments from this list by creating a claim. You don’t need to submit the created claim since you already have.
To remove insurance pay appointments from the Unbilled Appointments list:
- Go to the client’s Billing page.
- Select the date range to isolate the appointments you'd like to remove from the Unbilled Appointments list, and click Apply.
- Click New, select Claim/CMS1500. You do not need to submit the claim here because you’ve already submitted the claim to the payer outside of SimplePractice.
Once the claim has been created, you can click Save to move the claim to the Prepared status. If you have received an Explanation of Benefits from the payer for the claim's you've submitted outside of SimplePractice, you can manually add the insurance payment for the dates of service and the Prepared status will update to Paid. This guide will go through the process of manually adding an insurance payment in SimplePractice.
Now that the appointments have been included on a claim, you should no longer see these on the Unbilled Appointments list. This is because the software now recognizes that these appointments have been put on a CMS 1500 claim form for billing.