Electronic Billing: Is it Time to Ditch Paper Claims?

By Barbara Griswold, LMFT
(August 23, 2014)

The pressure is on from insurance plans to get providers to do all transactions online, including checking eligibility, benefits, authorizations, and claim status, and filing claims. It may not be long before they refuse to accept paper claims and only accept those filed via the Internet (aka electronic billing).

While many of us detest change, if you are like me, once you start filing online, you will wish you had done so years earlier. That’s because electronic billing has many advantages for therapists:

1. Faster payment. Because electronic claims are instantaneously received by the insurance plan, and are often given priority processing status. This speeds payment, sometimes by weeks.
2. Less delay and denials due to errors. Built-in alerts notify you of missing/invalid information before filing.
3. Filing confirmation. You have proof of filing in case the plan ever questions that you filed, or filed on time.
4. More security. Electronic claims are encrypted, so the file is secure and HIPAA-compliant.
5. Cost savings. Saves the cost of claim forms, envelopes, and postage.
6. No more claim denials because of illegible handwriting.
7. It’s simple. If you can fill out a CMS-1500 form by hand, you can do it online.

You have several options for how to file electronically:

1. Submit at the plan website. If a plan’s website has the ability to accept claims, no special software is required. You log in, give a few pieces of client information, then follow the instructions to file claims. It’s free, easy, and quick since the plan has the member’s information and yours – you just add the session dates, diagnosis, and charges. Once submitted, claims are filed directly with the plan, and you get proof of filing. This is a good option if you only have a few insurance clients or only work with a few plans.
2. Purchase billing software, and submit claims through a “claims clearinghouse.” After you enter all information into billing software on your computer, the software creates an electronic file, which is then uploaded to your chosen clearinghouse (Office Ally, NaviNet, Availity, MD-Online, etc.). A clearinghouse is like a “go-between” between your computer and the insurance plan. The clearinghouse checks the uploaded file for errors, and then acts as an online post office, securely transmitting the claims electronically to the appropriate plan. Once submitted, you get proof of filing. While some clearinghouses charge monthly fees, most users of Office Ally (www.OfficeAlly.com) pay nothing (to read my article on Office Ally, click here). This option is good if you have many insurance clients or multiple insurance companies. There are many billing software programs (some inexpensive) – just be sure to get one that creates electronic billing files, and that is compatible with your clearinghouse. Contact the clearinghouse to make sure the insurance plans you bill are on their payer list.
3. Submit through a claims clearinghouse without a billing program. Some clearinghouses do not require separate computer billing software. Office Ally (www.OfficeAlly.com), for example, also has a free online billing program you can use called Practice Mate, which allows you to maintain a patient database as well as to create Superbills and electronically submit claims. This may be a good option if you have many insurance clients or multiple insurance companies. Contact the clearinghouse to make sure the insurance plans you bill are on their payer list.
4. Submit through a billing service. After you send initial client data to the billing service, you might regularly send a list of clients seen with session dates and procedure codes, and the service will transmit the claims to the appropriate insurance company. For an additional fee, most billing services will even follow-up on unpaid claims, track authorizations, and verify insurance coverage for you. Financial arrangements vary: They may offer flat-fee pricing, per-claim fees, or a percentage of your reimbursements. (We will be talking more about this option next month. Stay tuned!)

A few final notes:

• Remember, once you (or someone on your behalf) file(s) electronically, you are a HIPAA Covered Entity and must follow HIPAA regulations.
• Always print a copy of claims you submit online (or the confirmation page), as proof of claim filing.
• Follow up if you are not paid in a timely fashion – electronic claims occasionally do get lost.

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Barbara Griswold, LMFT, is the author of Navigating the Insurance Maze: The Therapist’s Complete Guide to Working with Insurance – And Whether You Should. To purchase the book or other resources for therapists, click here. Contact Barbara at barbgris@aol.com to get answers to your insurance questions.

Copyright 2008-, Barbara Griswold, LMFT. No part may be reproduced without written permission of the author.