This article discusses the most common issues encountered when submitting claims, billing patients, and posting payments.   

Unable to Submit Claim: Insurance Invoicing Area 

Insurance Not Mapped

One of the most common reasons a claim can’t be submitted is if the patient’s insurance is not mapped. Let’s review how to confirm. 

1. In the Insurance Invoicing Area, the insurance linked to the client should appear in the Primary Insurance/Secondary Insurance columns.
2. If the field next to a patient's name for primary or secondary insurance is blank, this means the insurance has not been mapped using the Insurance Mapping Tool. 
3. Another way to identify if the insurance is not yet mapped, is if the insurance card is in the client's Therabill chart, but the insurance name on the card is missing.
4. If you click the blue pencil to edit the card, there will also be a blank field where the Insurance Company should be listed in the Policy Info section.
5. The field in the Insurance Mapping Tool for the client’s insurance will also be blank. Any client linked to this insurance is not yet mapped.
6. Once you complete the mapping in the Insurance Mapping Tool, you will then be able to submit the claim(s) from the insurance invoicing area for all clients with that insurance.

Date of Service Marked as Self Pay 

If the DOS was marked as Initially Bill to: Client/Patient, you will not be able to see that DOS in the insurance invoicing area.

The Session History box of the Editing Session screen will also display if the session was marked as Initially Bill to Client. 

If Self Pay is selected in the patient’s chart at the time of submission, it is telling the system that the patient is responsible for payment instead of an insurance company.

You will have to manually send each DOS back to the insurance invoicing area before you can submit it from the insurance invoicing area. 

Unable to Bill to Client: DOS Missing 

If the DOS was marked as Initially Bill to: Insurance, you will not see the DOS listed when trying to create a client statement in the Client Balance Statement screen. The DOS will be in the Insurance Invoicing Area.

The Session History box of the Editing Session screen will also display if the session was marked as Initially Bill to Insurance.

Since the DOS is in the insurance invoicing area, you will need to click the Session Tools icon and mark the DOS as Self Pay.

The DOS will then be available on the Client Balance Statement. 

Statement Settings 

At times the client statement settings may be changed to hide or show specific sessions when creating the statement for a patient. If a DOS is missing, double check that all DOS are showing and not hidden when creating the statement by matching your settings to the picture below:

Unable to Post Payment: ERA 

When an ERA is received, the system will automatically select a next step action depending on the information contained within the ERA for the service line. If an action for a service line is missed, you will not be able to post that ERA until ALL actions are selected. This is most common with larger ERA’s.