Automatically Create CMS 1500 Claims
Healthie simplifies CMS 1500 claim creation to support efficient, scalable billing workflows.
Providers and organizations can generate CMS 1500 forms directly within Healthie, with the option to submit them to an RCM partner or clearinghouse. To streamline claim generation, CPT codes can be linked to specific appointment types. Once a session is marked as completed, a CMS 1500 form can be automatically created — helping reduce manual work and improve billing efficiency.
In this article, we walk through how to enable automated claims creation for your account.
Enable Automated Claims within Settings
Within the Automated Insurance Billing section of your Insurance Settings, you have the ability to enable the Automatically Create CMS 1500s setting. When toggled on, a CMS 1500 will be automatically created each night for any appointments that meet the following criteria:
- Insurance billing is enabled for that appointment type.
- Automated billing is selected for the scheduled appointment.
- Appointment status is set to "no status" or "occurred" at the end of the day.
To enable insurance billing for specific appointment types, head to Settings>Appointment Types>Edit where you will see a new Insurance Pricing toggle. Once applied, the setting will be automatically enabled for that appointment type for any future appointments created.
Note: This setting is not available for Group Session appointment types.
When you go to schedule a new appointment on the calendar, you will notice a new setting that will allow you to enable or disable this setting at the individual appointment level.
If an appointment status is marked as Occurred or the appointment end time has passed, a CMS 1500 will automatically be created.
However, if the appointment status is marked with a Canceled, No-show, Late Cancellation, or Re-scheduled status, the Healthie system will not generate a CMS 1500.
Note: The batch job to create all CMS 1500s runs at 12AM UTC for all applicable appointments that day.
Reviewing Auto-Created Claims
As CMS 1500 claims will be batch created overnight, you can review all newly created claims the subsequent day within Billing > CMS 1500s.
We recommend reviewing auto-generated claims for accuracy before submitting to insurance, particularly if this is the first time you're submitting a claim on behalf of the client. On subsequent claims, Healthie will auto-fill information from the previous claim for even faster and consistent billing.
Healthie offers a direct connection with Claim.MD and Office Ally clearinghouses for claim submissions, additionally providing claim status updates and remittance details within Healthie. Our integration with ClaimMD also supports eligibility checks in addition to claims management.
Alternatively, Healthie supports integrations with leading RCM solutions — learn more here.
