Getting Started: Insurance Billing and CMS 1500 claims
Healthie's CMS 1500 platform makes it easy for you to create CMS 1500 claims and submit them (electronically or physically) to an insurance company for reimbursement for services. You can use this feature if you are credentialed with an insurance company and considered to be in-network. In this instance, after a session with a client, you can prepare this standardized form, and then submit this for possible reimbursement. This is distinct from creating a Superbill, in which you receive payment for services from the client at the time of service.
Healthie's CMS 1500 feature contains safeguards as you fill out the form, to help ensure that you have completed all required fields. It is important to double-check that you have completed fields correctly prior to submission to an insurance company, in order to minimize the likelihood that a claim is denied. We recommend reviewing the NUCC official instruction manual and coordinating directly with your payer to understand best practices on Creating a Claim and Submitting this form for insurance reimbursement.
IN THIS ARTICLE:
Creating a new CMS 1500 form
There are two ways to access a CMS 1500 Form Template within your Healthie account:
- Navigate to Billing > CMS 1500 > New CMS 1500 > Select Client
- Within a Client Chart Note, Export to CMS 1500
This will generate the standard CMS 1500 form template that you will need to complete. If you have client information stored within Healthie, the form will pre-populate with information that is already on file, in order to save you time entering information.
Moreover, if you have previously created a CMS 1500 form for the client that you have selected, past information will pre-fill, so you will be able to leverage that information, and make modifications as necessary, to complete and submit your form.
Completing fields of the CMS 1500 form
You will be prompted to enter required fields of the CMS 1500 form prior to creation and submission of the Form. Once you have filled out an initial CMS-1500 form, basic information will populate into subsequent claims created in Healthie. Healthie's CMS 1500 form generator is broken into 6 sections. These sections include:
- Client Information (Name, E-mail address, Phone Number, DOB, Insurance information)
- Referral Information
- Billing information (Your Company Information, Tax Number, NPI number, etc, which often pulls from your Business Information)
- NPI Number: Your NPI number is a 10-digit numeric identifier given to all covered providers as an Administrative Simplification Standard under HIPAA.Your NPI number is not your Social Security Number. To get your unique NPI number, you must apply through CMS.
- Tax Number: Your Tax Number, or Employer Identification Number (EIN), is a unique nine-digit number that you use when filing taxes for your nutrition practice. When submitting a Superbill as part of an organization, be sure to include your organization's EIN, not your individual EIN, as the organization is who is submitting the claim and receiving payment.
- Service facility information
- Miscellaneous Information
- Diagnosis codes (This often pulls from the Client Profile)
- Billing items
Submitting the CMS 1500 form to an insurance company
There are three ways to submit your CMS 1500 form to an insurance company.
1. Download the file generated within Healthie as a PDF document. Text fields that you have entered will show up as filled in within the standard form template below. You will then be able to scan or mail this document in, following instructions that you have received from your insurance company.
2. Export the data as a .txt file to submit the information electronically to your Clearinghouse. You can then upload this into the Clearinghouse of your choice, as long as they submit .txt file formats.
3. Connect your Healthie Account with Office Ally for direct claim submission. Instructions can be found here.
While you can track claim status and reimbursement details within Healthie, actual reimbursement payments will be made by the insurance payer directly to you. This is typically done via:
- Paper check mailed to your business address
- Direct deposit into your bank account
- Tip: Contact your insurance payer to set up Electronic Funds Transfers
- Via payment card for payment processing
Payments cards are an increasingly popular way for insurance payers to issue funds. Through the card (which may be a physical card, or simple a written card number), you must process the card as a "payment" into a payment processor. While Healthie utilizes Stripe as a payment processor, our direct integration means that our members do not need an account/login with Stripe. To process your payment card, many of our members either create their own Stripe or Paypal account, and process the payment accordingly.
Once you've been issued reimbursement, we suggest that you review your claims and update any reimbursement details for reconciliation. Learn more here.
If you have any questions or suggestions on receiving reimbursement payments, please feel free to email us at email@example.com
This brief overview video walks through the core features of Healthie Insurance Billing, including how to create CMS 1500 claims and Superbills, how to submit claims, how to set up the Office Ally integration, and how to track the status of your claim within Healthie.
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