Claim for Telehealth
Answered

Hello,

I am trying to submit a claim for the first time, but I noticed that the claim form does not have Telehealth or a code for telehealth on it. What should I do? How will the insurance know that this was a telehealth session?

19 comments

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    Gillian

    Hi Natasha, did you do your telehealth session using the integrated Telehealth by SimplePractice platform? If so, the Service Location code should be correctly coded on the claim as 02 for Telehealth. 

     

    Additionally, some payers require a modifier code to be entered when you see a client via Telehealth. We recommend reaching out to the payer directly to understand whether or not a modifier code is needed.

    Hi Natasha, did you do your telehealth session using the integrated Telehealth by SimplePractice platform? If so, the Service Location code should be correctly coded on the claim as 02 for Telehealth. 

     

    Additionally, some payers require a modifier code to be entered when you see a client via Telehealth. We recommend reaching out to the payer directly to understand whether or not a modifier code is needed.

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    Brenda Lee Gauthier

    What if you do not use Simple Practice platform.  How do you indicate telehealth on the claim form?

    What if you do not use Simple Practice platform.  How do you indicate telehealth on the claim form?

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    Gillian

    Hi Brenda, if you're not using SimplePractice's integrated Telehealth platform, you'll want to create another Office Location for Telehealth visits under My Account > Settings > Practice Details, with the Insurance Place of Service entered as 02-Telehealth. That way, the Telehealth Place of Service code will populate onto claims. As I mentioned in my previous comment, some insurance payers require a modifier code on the CPT code for Telehealth sessions, so we recommend asking the insurance payers you work with if a modifier code is required. 

    Hi Brenda, if you're not using SimplePractice's integrated Telehealth platform, you'll want to create another Office Location for Telehealth visits under My Account > Settings > Practice Details, with the Insurance Place of Service entered as 02-Telehealth. That way, the Telehealth Place of Service code will populate onto claims. As I mentioned in my previous comment, some insurance payers require a modifier code on the CPT code for Telehealth sessions, so we recommend asking the insurance payers you work with if a modifier code is required. 

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    Robin Bates-Pualuan

    After I've set up a second office with the Insurance Place of Service entered as 02-Telehealth, where do I indicate on the client's session record that was the office used? A client switched a session to telehealth at the last minute; do I have to delete and re-enter the appointment with the 02 office location?

    After I've set up a second office with the Insurance Place of Service entered as 02-Telehealth, where do I indicate on the client's session record that was the office used? A client switched a session to telehealth at the last minute; do I have to delete and re-enter the appointment with the 02 office location?

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    Gillian

    Hi Robin, there's no need to delete the appointment - you can simply click on the appointment on your Calendar, and change the Office Location in the drop-down menu on the calendar flyout. 

    Hi Robin, there's no need to delete the appointment - you can simply click on the appointment on your Calendar, and change the Office Location in the drop-down menu on the calendar flyout. 

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    Robin Bates-Pualuan

    Thanks Gillian! My calendar flyout doesn't seem to have an Office Location section?

    Thanks Gillian! My calendar flyout doesn't seem to have an Office Location section?

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    Gillian

    Hi Robin, under My Account > Settings > Practice Details, does the office have a name? If no name has been entered, or if you don't have any Office Locations, your calendar flyout will not have an Office Location section - you can add a name to show this section on your calendar flyout. 

    Hi Robin, under My Account > Settings > Practice Details, does the office have a name? If no name has been entered, or if you don't have any Office Locations, your calendar flyout will not have an Office Location section - you can add a name to show this section on your calendar flyout. 

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    Nadimeh Badaan

    Is there a way to input a modifier for a specific insurance plan that will repopulate for every claim for that patient? 

     

    Is there a way to input a modifier for a specific insurance plan that will repopulate for every claim for that patient? 

     

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    Gillian

    Hi Nadimeh, currently, to add a modifier to a claim form you'll want to create the claim and then edit it manually.

    Hi Nadimeh, currently, to add a modifier to a claim form you'll want to create the claim and then edit it manually.

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    Shari Keller

    How do I set the reminder text/message to be specific for telehealth or specific to in office?

    How do I set the reminder text/message to be specific for telehealth or specific to in office?

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    Gillian

    Hi Shari, happy to help. You can edit your Client Reminders under My Account > Settings > Client Reminders. Telehealth appointment reminders can be edited separately from in-office appointment reminders.

    Hi Shari, happy to help. You can edit your Client Reminders under My Account > Settings > Client Reminders. Telehealth appointment reminders can be edited separately from in-office appointment reminders.

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    Bonnie Mark

    I have checked box 32 for location to be included in claims, but it's not showing up. I see the drop-down menu on the claim but why isn't it auto-populating?

    I have checked box 32 for location to be included in claims, but it's not showing up. I see the drop-down menu on the claim but why isn't it auto-populating?

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    Gillian

    Hi Bonnie, because this is specific to your account and the claim, a member of the Success team will reach out to you privately to assist.

    Hi Bonnie, because this is specific to your account and the claim, a member of the Success team will reach out to you privately to assist.

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    Jennifer Forbes

    It would be very helpful to be able to automatically populate the modifIer code for telehealth sessions based on insurance.  i.e. BC/BS requires GT or Cigna requires 95.  I am able to do that with my other EHR software...

    It would be very helpful to be able to automatically populate the modifIer code for telehealth sessions based on insurance.  i.e. BC/BS requires GT or Cigna requires 95.  I am able to do that with my other EHR software...

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    Gillian

    Hi Jennifer, we are actively working on this feature for SimplePractice and look forward to releasing it soon. You can subscribe to updates here: https://simplepractice.uservoice.com/forums/918553/suggestions/36554008

    Hi Jennifer, we are actively working on this feature for SimplePractice and look forward to releasing it soon. You can subscribe to updates here: https://simplepractice.uservoice.com/forums/918553/suggestions/36554008

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    Faith Gisondi

    Hi, I am having a problem with my telehealth appointments not showing up in my calendar. I never had this problem previously.

    Hi, I am having a problem with my telehealth appointments not showing up in my calendar. I never had this problem previously.

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    Gillian

    Hi Faith, I'd be happy to help. Please check the drop-down menu on the upper right-hand corner of your Calendar to ensure All Office Locations are shown on your Calendar and not just in-person appointments. 

    Hi Faith, I'd be happy to help. Please check the drop-down menu on the upper right-hand corner of your Calendar to ensure All Office Locations are shown on your Calendar and not just in-person appointments. 

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    Jennifer W. Whitlock

    I have my PA address for my telehealth claims. However, I have a couseling license in two states. How do I make sure my clients are charged for the state where they're located?

    I have my PA address for my telehealth claims. However, I have a couseling license in two states. How do I make sure my clients are charged for the state where they're located?

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    Ayelette R

    Hi Jennifer,

    It is always recommended to consult with the payers directly regarding their own specific rules and regulations as this can vary from payer to payer but claim filing usually is based on where you, the provider, are providing your services, not where your clients are located.

    The following organizations provide resources to help you learn more about your state’s specific policies and regulations:

    In order to find out more your specific state’s Telehealth rules, here are a few additional resources:

    Edited by Ayelette R

    Hi Jennifer,

    It is always recommended to consult with the payers directly regarding their own specific rules and regulations as this can vary from payer to payer but claim filing usually is based on where you, the provider, are providing your services, not where your clients are located.

    The following organizations provide resources to help you learn more about your state’s specific policies and regulations:

    In order to find out more your specific state’s Telehealth rules, here are a few additional resources: